Abstracts

Rationale: Epilepsy and seizures are common in nursing homes (NH) with a prevalence of nearly 8% and incidence of 16/1000 pt. yrs. However, little is known regarding the current treatment of seizures in this vulnerable population._x000D_
Methods: An internet survey was conducted via email to all members of the American Medical Directors Association (AMDA) during 2021. Survey information was included for individuals who have served as NH medical directors and who had at least 1 case of new onset/epilepsy in the last 3 years. The surveys were distributed by MedPanel (Walthem, MA) and included questions related to NH demographics, medical directors’ experience, and clinical data pertaining to acute seizure management including a description of protocols, types of personnel involved, and treatment. A distinction was made between first seizure and history of seizures and practices in urban and rural locations. Data were summarized by MedPanel and the Epilepsy Education and Research Program, University of Minnesota._x000D_
Results: Overall, 91 US NH medical directors responded with all US regions represented (69% urban; 31% rural). Most respondents were geriatrics, internal/family medicine specialists with 11-30 years of experience. Seizure protocols were present in 52% of NHs. Nurses were responsible for protocol activation in the majority (87%) of NH, with only minor differences between urban and rural settings (89% vs 82%). More involvement of on-call physicians in protocol activation was seen in urban (47%) compared to rural (27%) NHs. After a first seizure, 36% of NH would never and 45% would sometimes initiate treatment with an antiseizure medication (ASM). Levetiracetam was the most common ASM prescribed followed by lamotrigine, based mostly on experience with the agent. Overall, 66% of family or guardians wanted transfer to hospital after a seizure. On the other hand, 47% of physicians considered it highly important and 35% considered it important to avoid calling EMS for every seizure. Actual transfers to a hospital occurred in 7.7% of persons who had a known neurological condition, and for 16.5% with no known neurological condition. Urban NHs were more likely to transfer to a hospital rather than rural hospitals. However, during the COVID-19 pandemic, physicians were less likely to transfer to hospitals and more likely to seek a remote consultation. The majority of physicians reported that more education would be beneficial, with urban NH reporting a greater interest in educational programing per year than rural NH._x000D_
Conclusions: Only half of all NH have epilepsy protocols in place. Interestingly families/guardians are more likely to request transfer to hospitals than what physicians feel necessary. Our study demonstrates and acknowledges the absence of standard practices for treatment of epilepsy across NHs and lays the foundation for development of educational programs for NH physicians, staff, and families._x000D_ _x000D_ Funding: Epilepsy Innovation Fund of the University of Minnesota and award from UCB Pharma