Tongue injury among patients with epilepsy undergoing video-encephalographic monitoring

Aim: We plan to investigate the effectiveness of mouthguards to prevent or minimise tongue injury among epilepsy patients who are undergoing VEEG or Stereotactic EEG (SEEG) monitoring. Study Design and Setting: A prospective, randomised controlled intervention study will be conducted from September 2020 to September 2023 in the EMU Neurology Ward at Royal Prince Alfred Hospital. At admission to the EMU, patients will be randomised into two groups. Group 1:Standard Care Group will not receive mouthguards. Group 2:Active Care Group w will receive a mouthguard for application to lower teeth. All the nurses who will be involved in performing VEEG monitoring will receive training about the study protocol before commencing the research. A training log for the nurses who will be performing the test will be maintained. Procedures: Pre-application assessment: Trained neurophysiology nurses will interview all patients who are eligible for the study and complete a demographic data form during the EMU admission process. Application of mouthguards: To maintain a standardised mouthguard placement and follow up care process, we will use the following product: 'Commercially available dental guard' mouthguard. The mouthguard works to keep upper and lower teeth apart by placing molar pads on both lower teeth. The pads cover at least half of the last molar and are secured by an adjustable strap over the lower teeth. Step 1 (Group2): The nurse will assist the patient in placing the mouthguard by adjusting a strap to fit the patient's teeth. Step 2: Group1: No mouthguard Group 2: After reducing AEDS, the nurse will apply the mouthguard to the patient's upper and lower teeth. The patient must wear a mouthguard during sleep and intermittently during daytime ( e.g. remove eating meals and talking until the cessation of their VEEG monitoring, or they have two generalised seizures. Day 2- 7 (Post mouthguards application): If the patient has a focal to bilateral tonic-clonic seizure or a generalised seizure, the nurse will assess the patient's tongue and take pictures. A nurse who is not involved in the VEEG monitoring will complete a tongue assessment based on the digital photograph in a blinded fashion. Photos will be un-notated. This blind nurse will not know the intervention allocation schedule, which will be maintained by the study nurses. Before discharge from the hospital: The nurse will ask the patient in group 2 to complete a self-report questionnaire to evaluate mouthguards' comfort during VEEG or SEEG monitoring.