Abstracts

Rationale: Optimal control of seizures is accomplished through consistent and regular outpatient management. However, many people with epilepsy make use of the emergency room (ER) for each breakthrough seizures. In fact, current literature provides evidence that poor seizure control is associated with regular use of the ER and inconsistent follow up with outpatient neurologists. The aim of this study, therefore, was to describe patients using the ER for management of epileptic seizures so that targeted education care can be recommended. Methods: This retrospective cohort study collected data on adult patients presenting at the emergency room of Winthrop University Hospital between June 1, 2011 and December 31, 2011 with a first unprovoked, recurrent unprovoked, or a provoked seizure. For patients presenting more than once during the study period, the most recent visit was included in these analyses. Results: A total of 155 patients presented with seizures as follows: recurrent unprovoked (epileptic) seizures, 71.0%; first unprovoked seizures, 16.8%; and, provoked seizures, 12.3%. Subjects with epileptic seizures (n=110) were 44.9 ± 21.8 years of age on average (range: 18 - 96) and 58.2% were male. Almost 60% of subjects were Caucasian and 31.8% were African-American. Most patients experienced generalized seizures (93.6%). Sixty percent of subjects were under the care of a neurologist; primary care physician, 20.9%; no provider, 15.5%; and, epileptologist, 3.5%. For patients presenting at the ER multiple times (n=22, 20%), these preliminary analyses did not reveal any differences in patient demographic characteristics. Acute seizure related injuries were present among 31.6% of patients (n=49). Though definitive causes for most seizures (59.1%) could not be determined based on evaluation in the ER, others were thought to be secondary to medication noncompliance (18.4%), toxic intake (8.7%), and metabolic abnormalities (6.2%). Conclusions: Most acute care evaluations for seizures in the ER were for breakthrough epileptic seizures. Unlike prior studies, our initial analyses revealed no differences in patient characteristics between patients visiting the ER once versus those visiting multiple times. Acute seizure related injuries were commonly encountered. Investigators will continue to evaluate and compare these groups as more patients are enrolled in our study. Further study indentifying potential factors associated with ER care for seizures in our patient population could lead to ways to possible minimize ER visits, and shift most care to the outpatient setting, if appropriate.