Yield of conventional and automated seizure detection methods in the epilepsy monitoring unit

•Seizure alarm/detection methods varied by seizure type in our EMU.•Patient-push button alarm was low-yield for focal seizures with impaired awareness.•Automated seizure software detected 76.2% of seizures that had EEG correlate.•No difference in time to nursing bedside response by alarm type. To investigate the performance of seizure detection methods and nursing staff response in our epilepsy monitoring unit (EMU). We retrospectively reviewed 38 EMU patient admissions over a 1-year period capturing 133 epileptic and non-epileptic seizures with associated video-EEG data. We recorded detailed seizure event characteristics for further analysis. Rates of seizure detection, alarm usage, and time to nursing response varied by seizure type. Patients self-activated the push button (PB) alarm for 31.1% of all seizures, but only 8.9% of focal impaired awareness (FIAS) and focal to bilateral tonic-clonic seizures (FBTCS). In comparison, the Persyst automated seizure alarm reliably detected both electrographic seizures (76.2% of electrographic seizures) and FIAS/FBTCS (87.2% of FIAS/FBTCS), with a false positive alarm rate (FAR) of 0.14/hour, or every 7.3 h. 11.4% of all seizures went unrecognized by nursing staff, of which the majority (80.0%) were FIAS. The PB alarm was of higher yield for alerting nurses to focal aware seizures (FAS) and psychogenic non-epileptic seizures (PNES) versus FIAS and FBTCS (p