The utility of long term video-EEG monitoring is well established and has diagnostic, prognostic, and therapeutic functions. Patients are admitted to the Epilepsy Monitoring Unit (EMU) to have medications lowered for seizure provocation. Electrographic and clinical information from the seizures are analyzed for the purpose of classifying and treating epilepsy. Clinical or ictal assessment is an interactive and demanding skill. Factors inherent in the seizures often limit the accuracy and detail of an ictal assessment. The literature suggests that an observational tool for use during ictal assessment may help to improve accuracy. To date, a standardized tool for use in seizure observation or ictal assessment has not been developed. The purpose of this article is to synthesize the current recommendations regarding the components of seizure observation and describe how they can be organized to formulate a standardized assessment tool. An observation tool that was developed with these recommendations in mind and is currently being used on a 10-bed EMU is described
