Abstracts

Rationale: There is no evidence-based standard of care for the evaluation of a patient who presents with their first seizure. Current literature suggests that care is delayed, disorganized, and suboptimal. This study provides an evidence-based approach to resolving the value of specialized outpatient care through a single-seizure clinic (SC) on key determinents of health including access to care, wait-times, and clinical outcomes.Methods: All patients (n=200) referred to our SC were prospectively enrolled in this observational study. Demographic, clinical, and paraclinicial variables were analyzed against ""usual care"" by use of a historical control population. Binary logistic regression analysis was performed to determine the impact of impact of various clinical predictors and patient characteristics on the risk of development of epilepsy. Kappa-coefficient was calculated to determine diagnostic correlation between SC epileptologist physicians and nursing staff.Results: A significant advantage was reduction in wait-times by 71% for epilepsy-specialist assessment, electroencephalography (90% reduction in wait-times), and neuroimaging (50% reduction in wait-times). The major referral sources were general practioners and emergency department physicians. SC epileptologists diagnosed 81% of patients at first visit. The preponderance of epilepsy was high in this cohort as 41% of patients carried this diagnosis after assessment at the SC while syncope was the most common non-seizure diagnosis (25%). When anti-seizure medication was initiated SC physicians were most likely to prescribe newer-generation drugs such as lamotrigine (64%). Specific EEG abnormalities (Odds-ratios (ORs)=7-13), event semiology (ORs=2-14), and referring physician risk stratification of risk for seizure recurrence (ORs=2-11) highly predicted a diagnosis of epilepsy. The study highlights the need for diagnostic evaluation by an epileptolgist, as the SC nursing staff were less likely to make a diagnosis of epilepsy and there was only modest diagnostic correlation (kappa=0.5)Conclusions: The Single-Seizure Clinic model offers a stremlined, evidence-based approach to resolving the demands for timely access to care and serves as an effective unified point of access to specialized epilepsy care.