SEARCH · PubMed Health

Results for “Telemetry”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,099 records · Page 61Linked to original sources

PubMed1986

Long-term performance of endocardial leads with steroid-eluting electrodes.

During a three-year period, 48 steroid-eluting leads (Medtronic 4003 and 4503) have been implanted in 39 patients. 23 were implanted in the atrium and 25 in the ventricle. 36 patients with 45 leads have been observed for more than 12 months. Stimulation thresholds have been followed using pulse generators with variable output (vario): 12 atrial and 11 ventricular leads, 4 atrial leads and 11 ventricular leads have been followed using pulse generators with variable pulse-width (auto-threshold), P-waves have been followed using telemetry or sensitivity programming (23 atrial leads). R-waves have been followed using telemetry in 11 ventricular leads. Mean stimulation thresholds after 2 years are 0.7 V +/- 0.2 in the atrium and 0.8 V +/- 0.3 in the ventricle. P-waves after 2 years are of magnitudes allowing a sensitivity setting of 2.5 mV in 12 cases and of 1.5 mV in 2 cases; R-waves have in all cases been high enough to permit lowest programmable sensitivity setting. During the observation time, two patients have died from nonpacing-related causes. The results obtained from this investigation document low stimulation thresholds and good sensing levels in both ventricle and atrium using the steroid-eluting electrode with no significant changes after 6 weeks postimplant.

Aged↗

PubMed1993

The response of implanted dual chamber pacemakers to 50 Hz extraneous electrical interference.

Twenty-two patients with dual chamber pacemakers with interchangeable lead configuration were exposed to 50 Hz electromagnetic interference. Current, at corporeal levels from 0-600 microA, was applied between electrodes on shoulders and feet using a bedside injection unit. Pacemaker behavior was monitored with telemetered event markers and intracardiac electrograms. In bipolar mode, noise reversion mode was induced in all except two Medtronic units at high (> 170 microA) levels of corporeal current. In the Intermedics, Siemens Pacesetter, and Telectronics models, onset of noise reversion mode was preceded by a window of inappropriate function, characterized by rate acceleration due to atrial malsensing, or pacemaker inhibition due to ventricular malsensing. In unipolar mode, pacemaker malfunction occurred at much lower current levels. Inappropriate behavior preceded the onset of protective noise reversion mode. During current injection, all pacemakers could be interrogated and reprogrammed, and intracardiac telemetry was reliably obtained except in two Medtronic units at high current levels. No pacemaker was reset by the electrical interference, and no cross-talk was seen. Use of bipolar mode confers a high degree of protection from extraneous electrical interference, but in unipolar mode pacemakers may be inhibited by small amounts of corporeal current, potentially encountered in every day life. The current injection unit allows safe, controllable, and quantifiable investigation of the effects of the electric field induced by a current on implanted pacemakers. Telemetry of annotated intracardiac signals during electromagnetic interference clarifies observations of pacemaker acceleration and inhibition.

Adult↗

PubMed1996

Use of automatic mode change between DDD and AAI to facilitate native atrioventricular conduction in patients with sick sinus syndrome or transient atrioventricular block.

The benefits of the automatic DDD (DDD/AMC) mode in the Chorus II pacemaker (Chorus 6234; Ela Medical Inc.), which automatically switches the modes between DDD and AAI to respect spontaneous AV conduction as much as possible in AAI while preserving safety pacing in DDD during paroxysmal AV block (AVB) only, remain unproven. This study examined the functions of the DDD/AMC mode in 12 patients with sick sinus syndrome (SSS; n = 10) or paroxysmal complete AVB (n = 2). A short-term (24 hours) comparative study between simple DDD mode and the DDD/AMC mode was performed in 8 of the 12 patients, and a medium-term (55.2 +/- 54.6 days) follow-up of the DDD/AMC mode was completed in all 12 patients. A comparative pair of 24-hour surface Holter ECGs was obtained in 6 of the 8 patients in the short-term study. Telemetry and built-in Holter histograms were collected in the outpatient clinic in all 12 patients. Although the percentage atrial pacing of the telemetry increased from 59.2 +/- 35.4 in DDD to 70.4 +/- 31.8 in DDD/AMC (P < 0.009; n = 8), the percentage ventricular pacing decreased from 64.6 +/- 37.7 in DDD to 36.2 +/- 43.1 in DDD/AMC (P < 0.027) in the short-term study. In particular, the reduction of percentage ventricular pacing to < 10% was observed in four patients with SSS not associated with > or = first-degree (1 degree) AVB on preoperative ECGs. Between the two modes a significant difference in arrhythmic events was not observed by the 24-hour surface Holter ECGS taken from the six patients in the short-term study. AAI-DDD switching associated with automatic modulation of AV delay and AV hysteresis occurred in all patients in the medium-term study. From the medium-term study, the total AV delay (AV delay plus AV hysteresis) exceeded 300 ms in 6 of the 12 patients in DDD/AMC, and usually became longest during nighttime. From the short- or medium-term study in the 12 patients, two patients preferred the DDD/AMC mode while one preferred the DDD mode. These results suggest that the DDD/AMC mode is useful, at least in SSS patients without > or = 1 degree AVB, by reducing the percentage ventricular pacing.

Adult↗

PubMed2005

Detection of atrial fibrillation by implanted devices with wireless data transmission capability.

Remote telemetry may facilitate the management of implantable devices. We tested the reliability of a new automatic, wireless home monitoring (HM) system that archives data every 24 hours. We retrospectively analyzed archival data from 276 consecutive pacing system implants to define temporal atrial fibrillation (AF) patterns and associated ventricular rate. An "AF day" was defined by a >20%/24 hour mode switch (MS) duration, irrespective of the MS number. Management decisions resulting from transmissions were noted. A pilot study confirmed that 89% of 22,356 transmissions were successful, of which >90% were received in <5 minutes. Data integrity was 100% preserved. Overall, AF developed in 29 patients (10.5%), representing a total of 645 AF days (mean = 22.2 +/- 29.6 AF, median = 9 days), over 12 +/- 2 months of monitoring. AF was infrequent ( /=1 day during which the AF burden was >50% of 24 hours. Ventricular rates during 645 AF days in 29 patients averaged 95.1 +/- 9.9 beats/min (median = 94 beats/min). Ventricular rates were >80 beats/min in 25 +/- 30 AF days (median = 11 days). HM enabled rapid anticoagulation decisions. In recipients of implantable devices, automatic wireless telemetry with HM was efficient and reliable. Its application may overcome some current challenges in AF management by early notification and precise measurement of both AF burden and ventricular rate during AF.

Atrial Fibrillation↗

PubMed2005

Safety of wireless capsule endoscopy in patients with implantable cardiac defibrillators.

OBJECTIVES: Wireless video capsule endoscopy (CE) is a new technology that allows visualization of the entire small intestinal mucosa. It is indicated for the evaluation of obscure gastrointestinal bleeding (OGIB) and other disorders of the small intestine. Studies to date suggest that CE is safe and associated with few adverse events. A concern, which has not been studied, is the potential effect of CE on implanted cardiac devices such as implantable cardiac defibrillators (ICD) and other electromedical devices. We previously found CE to be safe in patients with cardiac pacemakers. The primary aim of this study was to evaluate the safety of CE in patients with ICDs who were being evaluated for OGIB. In addition, a secondary aim of the study was to determine whether ICDs had any effect on the images captured by CE. METHODS: Patients referred for the evaluation of OGIB and who also had an ICD were enrolled into the study after informed consent. Five consecutive patients (four females and one male; mean age: 72 yr; range: 60-81 yr) with ICDs were studied. All patients had transvenous endocardial ICDs located in the chest. Prior to CE, patients had a baseline electrocardiogram (ECG) and ICD interrogation. Thereafter, CE was performed in a hospital setting with telemetry monitoring performed simultaneously. A post-procedure ICD interrogation was carried out to evaluate changes in programmed parameters. A cardiologist and ICD nurse specialist together reviewed both the telemetry monitor and the post-procedure ICD interrogation on each patient. When CE studies were reviewed, observations pertaining to technical difficulties and interference with video imaging were documented. RESULTS: No arrhythmia or other adverse cardiac events were noted during capsule transmission. No interference by the ICD on the CE video images was seen. CONCLUSIONS: CE was performed safely in these five patients with ICDs, and was not associated with any adverse cardiac events. ICDs also do not appear to interfere with video capsule imaging.

Aged↗

PubMed2005

Short-term effects of streptozotocin-induced diabetes on the electrocardiogram, physical activity and body temperature in rats.

A variety of contractility defects have been reported in the streptozotocin (STZ)-induced diabetic rat heart including alterations to the amplitude and time course of cardiac muscle contraction. Transmitter devices were surgically implanted in the peritoneal cavity of young adult male Wistar rats. Electrodes from the transmitter were arranged in Einthoven bipolar lead II configuration. Electrocardiogram (ECG), physical activity and body temperature data were continuously recorded with a telemetry system before and following the administration of STZ (60 mg kg-1). Heart rate (HR), physical activity and body temperature declined rapidly 3-5 days after administration of STZ. The effects became more conspicuous with time and reached a new steady state approximately 10 days after STZ treatment when HR was 255+/-8 beats min-1 in diabetic rats compared to 348+/-17 beats min-1 in age-matched controls. Heart rate variability (HRV) was also significantly reduced after STZ treatment (18+/-3 beats min-1) compared to controls (36+/-3 beats min-1). Reduced physical activity and/or body temperature may partly underlie the reduction in HR and HRV. Reductions in power spectral density at higher frequencies (2.5-3.5 Hz) suggest that parasympathetic drive to the heart may be altered during the early stages of STZ-induced diabetes. Short-term diabetes-induced changes in vital signs can be effectively tracked by continuous recording using a telemetry system.

Animals↗

PubMed2006

Do seizures in patients with refractory epilepsy vary between wakefulness and sleep?

AIM: To determine the effects of sleep and wakefulness on seizures in patients with refractory epilepsy recorded while undergoing video-electroencephalography (EEG) telemetry. METHODS: The video-EEG data of patients who had two or more seizures during video-EEG telemetry (n = 270) were reviewed. Fifty seven patients who had seizures both in wakefulness and sleep were identified. The video and ictal EEG data were reviewed, paying specific attention to type of seizures, duration, semiology, lateralisation and number of seizures. RESULTS: Three hundred and sixty two seizures were recorded; 237 seizures while awake and 125 while sleeping. Secondary generalisation occurred more often in sleep than in wakefulness (p < 0.01). Overall, there was no significant effect of sleep on the duration of seizures or ictal EEG change. Sleep and awake seizures differed in only eight patients. CONCLUSION: Secondary generalisation occurred more often in sleep than in wakefulness, perhaps due to the facilitated spread of seizures during sleep. For the most part, however, seizures recorded during sleep did not differ from those recorded during wakefulness.

Drug Resistance↗

PubMed2003

Stress-induced fever after postischemic rectal temperature measurements in the gerbil.

Postischemic temperature, which modulates brain injury, is commonly determined via a rectal temperature (Trec) probe. This procedure causes a stress-induced fever (SIF) in rodents that may aggravate injury or diminish the efficacy of a neuroprotectant. We continually measured core temperature (Tcore) via an implanted telemetry probe and made 16 Trec measurements over 4 days in sham and ischemic gerbils (5 min bilateral carotid artery occlusion). Controls did not have Trec sampled, but Tcore was measured. Rectal temperature measurements predicted Tcore in sham and ischemic gerbils. The Trec measurements caused a SIF (1 degrees C peak) in shams that did not habituate, whereas the SIF was initially absent and then increased over days in ischemic gerbils. Ischemic groups had similar CA1 injury (approximately 32% remaining), presumably because Trec measurements only resulted in a significant SIF starting on day 2 postischemia, when cell death is less sensitive to hyperthermia. Caution is warranted with Trec measurements, since the resultant SIF occurs to different extents in normal and ischemic rodents. Furthermore, the SIF could vary according to many other factors, such as the type and severity of insult, the time and frequency of measurement, and drug treatment. Accordingly, postischemic Trec measurements should be replaced with telemetry probes.

Animals↗

PubMed2005

AT1-receptor antagonism reverses the blood pressure elevation associated with diet-induced obesity.

Previous studies in our laboratory demonstrated that rats exhibiting obesity in response to a moderately high-fat (MHF) diet developed hypertension associated with activation of the local and systemic renin-angiotensin system. In this study, we examined the effect of the angiotensin type 1 (AT(1))-receptor antagonist, losartan, on blood pressure in obesity-prone (OP) and obesity-resistant (OR) rats fed a MHF diet. Using telemetry monitoring, we characterized the evolution of blood pressure elevations during the development of obesity. Male Sprague-Dawley rats were implanted with telemetry transducers for chronic monitoring of blood pressure, and baseline measurements were obtained. Rats were then switched to the MHF diet (32% kcal as fat) and were segregated into OP and OR groups at week 5. At week 9 on the MHF diet, OP rats exhibited significantly greater 24-h mean arterial blood pressure compared with OR rats (OP: 105 +/- 4 mmHg, OR: 96 +/- 2 mmHg; P < 0.05). Elevations in blood pressure in OP rats were manifest as an increase in systolic pressure. Administration of losartan to all rats at week 9 resulted in a reduction in blood pressure; however, losartan had the greatest effect in OP rats (percent decrease in mean arterial pressure by losartan; OP: 19 +/- 4, OR: 10 +/- 2%; P < 0.05). These results demonstrate that elevations in blood pressure occur subsequent to established obesity in rats fed a high-fat diet. Moreover, these results demonstrate the ability of losartan to reverse the blood pressure increase from diet-induced obesity, supporting a primary role for the renin-angiotensin system in obesity-associated hypertension.

Angiotensin II Type 1 Receptor Blockers↗

PubMed2005

Miniature neurologgers for flying pigeons: multichannel EEG and action and field potentials in combination with GPS recording.

To study the neurophysiology of large-scale spatial cognition, we analyzed the neuronal activity of navigating homing pigeons. This is not possible using conventional radio-telemetry suitable for short distances only. Therefore we developed a miniaturized data logger ("neurologger") that can be carried by a homing pigeon on its back, in conjunction with a micro-global position system (GPS) logger recording the spatial position of the bird. In its present state, the neurologger permits recording from up to eight single-ended or differential electrodes in a walking or flying pigeon. Inputs from eight independent channels are preamplified, band-pass filtered, and directed to an eight-channel, 10-bit analog-digital converter of the microcontroller storing data on a "Multimedia" or "Secure Digital" card. For electroencephalography (EEG), the logger permits simultaneous recordings of up to eight channels during maximally 47 h, depending on memory, while single unit activity from two channels can be stored over 9 h. The logger permits single unit separation from recorded multiunit signals. The neurologger with GPS represents a better alternative to telemetry that will eventually permit to record neuronal activity during cognitive and innate behavior of many species moving freely in their habitats but will also permit automated high-throughput screening of EEG in the laboratory.

Action Potentials↗

PubMed2006

Measuring the refractoriness of the electrically stimulated auditory nerve.

Intracochlear recordings in cochlear implant recipients provide access to the electrically evoked compound action potential (ECAP). ECAP thresholds are potential predictors of speech processor map's threshold and comfortable loudness levels. The auditory nerve's refractory properties can influence these levels due to high-rate stimulation with interpulse intervals within the relative refractory period. Recovery functions were investigated at 84 stimulation sites in 14 Nucleus CI24 recipients using neural response telemetry and a modified forward masking technique. This technique introduces a reference masker-probe interval (MPI). In our study, an appropriate value between 300 and 375 micro s was determined for this reference MPI, and the use of a reference MPI of 300 micro s is suggested for recovery and amplitude growth functions. A median absolute refractory period of about 390 micro s and a median time constant of about 425 micro s were obtained by fitting an exponential model to the data. Hence, the auditory nerve is usually in relative refractory state when standard neural response telemetry forward masking is selected because of its default MPI of 500 micro s. This can bias the measurement of ECAP thresholds. Additionally, the shape of standard forward masking recovery functions was explained by the influence of latency shift of the neural response.

Action Potentials↗

PubMed1989

Comparison of in vivo human dental plaque pH changes within artificial fissures and at interproximal sites.

Ion-sensitive field-effect transistor (ISFET) pH electrodes were used to monitor changes in plaque pH at the base of artificial occlusal surface fissures and at interproximal sites. Bovine enamel was used to construct fissures (1.5 x 0.1 x 1.0 mm) containing a small ISFET electrode. The fissures were fixed to carrier appliances and worn by 4 human volunteers. After plaque accumulation for 4 days changes in pH were monitored by wire telemetry following 1-min rinses with 10% solutions of either sorbitol or sucrose. Results were compared to data obtained from interproximal sites in the same subjects. Responses to sorbitol in the fissure and on the proximal surfaces were minimal and showed no significant difference in minimum pH (5.9 +/- 0.4 and 6.1 +/- 0.3, respectively) and area under pH 7.0. The response to sucrose at the two sites was very different revealing unique pH profiles which were statistically significantly different with regard to minimum pH (5.0 +/- 0.3, fissure and 4.3 +/- 0.2, proximal) and area under pH 5.7. Thus, the acidogenic potential of fermentable carbohydrate at two caries-prone sites in the human dentition is significantly different and conclusions based on interproximal telemetry measurements may not be applicable to occlusal surface fissures.

Acid-Base Equilibrium↗

PubMed1994

Psychiatric predictors of pseudoepileptic seizures in patients with refractory seizures.

This study compared psychiatric factors and diagnoses in patients with pseudoepileptic seizures and genuine seizures. A semistructured interview identified psychiatric diagnosis and the presence of psychiatric factors associated with conversion phenomena. Twenty-five subjects with medically refractory seizures were interviewed and followed prospectively until a definitive diagnosis of pseudoepileptic or genuine seizures was made by neurologists using video-EEG telemetry. Four factors help to identify patients with pseudoepileptic seizures: a psychiatric diagnosis of either somatization disorder or personality disorder, the presence of a childhood loss, or the presence of a model for seizure symptoms. These findings can aid clinicians in identifying patients who would benefit from referral to a video-EEG telemetry diagnostic unit.

Adult↗

PubMedDate not supplied

Feasibility of dual-chamber (DDD) pacing via a single-pass (VDD) pacing lead employing a floating atrial ring (dipole): case series, future considerations, and refinements.

The objective of this study was to assess the feasibility of DDD pacing from a standard single-pass VDD pacemaker system. Over the past 2 decades significant advances have been made in the development of single-pass VDD pacing systems. These have been shown in long-term prospective studies to effectively preserve atrioventricular (AV)synchrony in patients with AV block and normal sinus node function. What remains problematic is the development of a single-pass pacing system capable of DDD pacing. Such a lead configuration would be useful in those patients with peripheral venous anomalies and in younger patients with congenital anomalies, which may require lead revisions in the future. In addition, with the increased use of resynchronization (biventricular pacing) therapy, the availability of a reliable single-pass lead will minimize operative time, enhance patient safety, and minimize the amount of hardware within the heart. The feasibility of DDD pacing via a Medtronic Capsure VDD-2 (Model #5038) pacing lead was evaluated. Twenty patients who presented with AV block and normal sinus node function were recruited for this study. Atrial pacing thresholds and sensitivities were assessed intraoperatively in the supine position with various respiratory maneuvers. Five patients who agreed to participate in long-term follow-up received a dual-chamber generator and were evaluated periodically over a 12-month period. Mean atrial sensitivity was 2.35 +/- 0.83 mV at the time of implantation. Effective atrial stimulation was possible in all patients at the time of implantation (mean stimulation threshold 3.08 +/- 1.04 V at 0.5 ms [bipolar], 3.34 +/- 0.95 V at 0.5 ms [unipolar]). Five of the 20 patients received a Kappa KDR701 generator, and atrial electrical properties were followed up over a 1-year period. There was no significant change in atrial pacing threshold or incidence of phrenic nerve stimulation over the 1-year follow-up. A standard single-pass VDD pacing lead system was capable of DDD pacing intraoperatively and during long-term follow-up. Despite higher than usual thresholds via the atrial dipole, pacemaker telemetry revealed < 10% use of atrial pacing dipole over a 12-month period, which would minimally deplete the pacemaker's battery. In addition, the telemetry confirmed appropriate sensing and pacing of the atrial dipole throughout the study period. At this time such systems can serve as back-up DDD pacing systems with further refinements required to optimize atrial thresholds in all patients.

Aged↗

PubMed1991

Autonomic and behavioral effects of centrally administered corticotropin-releasing factor in rats.

Changes in heart rate, core temperature, and gross locomotor activity were recorded simultaneously by a wireless telemetry system for periods up to 60 min after intracerebroventricular (icv) administration of synthetic human CRF-(1-41) (CRF) or artificial cerebrospinal fluid in rats in their home cages. The telemetry system provides a highly sensitive method to monitor autonomic nervous system (ANS) activity without imposing restraint on the animal. CRF was administered at lower doses than hitherto used to study central effects on the ANS (0.03, 0.1, 0.3, and 1 microgram). Starting 10 min after icv injections, behavioral responses to CRF, i.e. grooming, locomotion, and digging, were determined by a time sampling method. Within 5 min after icv treatment, CRF, in a dose-related fashion, produced a significant increase in heart rate, core temperature, and behavioral activity. The absence of effect of 30 ng CRF, which already may be regarded as a supraphysiological amount, suggests that CRF does not modify ANS and behavioral activity under resting conditions. Tachycardiac responses in rats receiving 0.1 microgram CRF, icv, in the morning were more marked than those in rats given the same treatment in the late afternoon. In addition, the presumed intrinsic activity of the CRF receptor antagonist, alpha-helical CRF-(9-41) (alpha hCRF) at doses of 0.1, 1, 5, and 25 micrograms was evaluated. Intracerebroventricular injections of 0.1 and 1 microgram alpha hCRF failed to produce detectable effects. At the 5- and 25-micrograms doses, alpha hCRF dose-dependently induced tachycardia and behavioral activation, suggesting partial agonistic activity. Taken together, these results demonstrate that CRF does not play a role in the regulation of ANS and behavioral activity under resting conditions. The responses produced by icv injected supraphysiological amounts of CRF, however, may serve to model a stressful situation during which the massively released CRF induces similar effects on ANS and behavior, after reaching high local concentrations at brain sites involved in the mediation of these actions.

Animals↗

PubMed1981

Intensive monitoring in refractory epilepsy.

Forty patients with intractable seizures were studied in an epilepsy unit for an average of 8 weeks with video-electroencephalographic telemetry and continuous observation by trained personnel. Drugs were administered on the basis of antiepileptic drug measurements and seizure classification determined by clinical observation and telemetry. Seizure frequency was reduced in 24 patients (60%). Unrecognized seizure types were identified in 8 patients (20%), and diagnostic classification was changed in 19 patients (47.5). At least one antiepileptic drug was eliminated in 25 patients (60%), and the average drug reduction per patient--0.60--was highly significant (p less than 0.01). In patients with seizures refractory to conventional out-patient and hospital management, improvement in diagnostic accuracy and refinement in observation techniques result in significant reduction of seizure frequency, elimination of drugs, and limitation of toxicity.

Adolescent↗

PubMed1985

Direct comparison of 3- and 8-channel ambulatory cassette EEG with intensive inpatient monitoring.

During the intensive monitoring of 30 patients by means of cable telemetry EEG, simultaneous 3- and 8-channel ambulatory EEG recordings were also obtained. Blinded interpretations of the cassette tapes were compared with those of the cable telemetry records. Both 3- and 8-channel ambulatory EEG reviews correctly identified 93% of the records as either normal or epileptiform. Lateralization of abnormalities was equally good with either cassette system, but more detailed characterization was achieved with 8-channel ambulatory EEG. Although 100% of seizures were detected on both systems, there were more false-positive errors when only three data channels were available. Better ability to differentiate renal abnormalities from artifacts was the most significant advantage of 8-channel over 3- to 4-channel ambulatory EEG.

Ambulatory Care↗

PubMed2001

Seizures, lateral decubitus, aspiration, and shoulder dislocation: Time to change the guidelines?

The recommendation to position a patient having a seizure on a lateral decubitus is aimed at minimizing the risk of aspiration. The authors reviewed the database of the Epilepsy Foundation Clinic of South Florida for patients with epilepsy treated for pneumonia between May 1999 and May 2000 and patients admitted to two university telemetry units who had dislocation of the shoulder during an epileptic seizure. Over 2 months, 2 of 733 adults with intractable seizures had aspiration pneumonia after a generalized tonic clonic seizure (GTCS). Although no study has specifically addressed the problem of aspiration pneumonia in adults with GTCS, our findings suggest this problem is not common. From the two epilepsy centers, 5 of 806 patients dislocated a shoulder during a seizure. Video recordings showed that these patients were positioned in a lateral decubitus by staff while still having the convulsion. The dislocated shoulder in all cases was on the lower side. The risk of shoulder dislocation in a convulsing patient positioned in a lateral decubitus is less than 1%. Nevertheless, dislocations can result in disabling recurrences and are easily preventable. Because aspiration is more likely in the postictal rather than ictal phase of a GTCS, when oral secretions are not usually increased and there is cessation of respiratory movements, lateral decubitus should only be implemented after cessation of the convulsion, In inpatients (such as those on telemetry), secretions may be better managed by bedside aspiration of the oral cavity.

Epilepsy↗