Abstracts

Rationale: There is minimal epidemiologic data on the time needed to complete a medical assessment after a single unprovoked seizure. In this study we describe the waiting times for initial assessment, completion of investigations, final conclusions, outcomes and safety in 51 single unprovoked seizure patients in a Canadian neurological referral clinic Methods: We performed a retrospective chart review. Data was collected from January 2007 to March 2010 on all patients referred to the regional epileptologist. We identified 51 patients fulfilling the criteria for a single unprovoked seizure Results: Median age at single seizure was 40 years (range 17-84). Median waiting times to see epileptologist from date of single seizure was one month (range 0 to 223, mean 15.18 months), 54.9% of patients seen within 2 months. The median wait time for EEG was 2 months (0 - 226, mean 14.34 months), 59.6% of the EEGs were performed within 2 months. Mean wait time for CT-head scan was 11.11 (-10 to 225) months, 55% of these were performed within 48 hours of event. Median waiting time for brain MR-imaging was 5 (0 -102, mean of 13) months; 59.3% within 6 months. The initial assessment was performed in 42.6% by ER physician, 25.9% by family physician, 7.4% by internist, 14.8% by neurologist and 3.7 by unknown physician. The diagnosis of seizure disorder by epileptologist differed only by 9% from original assessment. Anti-epileptic medication was initiated in 20.4% of patients prior to referral. Most frequently used AEDs were phenytoin (33%) and lamotrigine (27.8%). The decision to treat was attributed to seizure recurrence in 16.7%, EEG abnormalities in 18.5%, 13% due to imaging findings, and other reasons in 51.8%. Seizure recurrence was 25.5% (n=13) and was associated with imaging-abnormalities in 46.2%, and EEG-abnormalities in 38.5%. During the waiting period, minor injuries were reported in two patients, but no reported mortalities. Driving restrictions were verifiably recommended in only 3% of patients by primary care physician Conclusions: This study showed referrals and assessment of single unprovoked seizure patients is being carried out in a reasonable time and was safe with no case fatalities. Although there were no major complications in patients, some of them waited more than one year to be assessed. Further improvement needs to be done with regards to obtaining earlier imaging (CT/MRI). Education of primary care physicians is important to avoid unnecessary delays and mismanagement of patients