To provoke or not provoke: ethical considerations in the epilepsy monitoring unit.

Epilepsy is the second most common neurological disorder after migraines and headaches, with an economic burden of 15.5 billion dollars annually. Most patients with epilepsy can be controlled with antiepileptic drugs. Those who remain uncontrolled are considered refractory and are often admitted to an epilepsy monitoring unit for definitive diagnosis. Nonepileptic seizures are a common differential diagnosis in persons with refractory seizures. It is helpful for providers to witness the patients' seizures to make a definitive diagnosis for seizure classification. Frequently, unstandardized practice-provocation techniques are employed in an epilepsy monitoring unit setting. The purpose of these techniques is to elicit a seizure. A debate is occurring on whether the use of provocation techniques is ethical and necessary. This article will review the literature related to the current evidence and moral opinions swirling around this topic. It is important for the neuroscience nurse to be familiar with both sides of the seizure provocation debate as he or she will be on the front lines of shaping future policy and practice to come.