Authors :
Presenting Author: Brian Emmert, MD – University of Pennsylvania Health System
Kevin Xie, M.S. – University of Pennsylvania; Erin Conrad, M.D. – University of Pennsylvania; Nina Ghosn, B.S. – University of Pennsylvania; Kristie Bauman, M.D. – University of Pennsylvania; Jacob Korzun, M.D. – University of Pennsylvania; Catherine Kulick-Soper, M.D. – University of Pennsylvania; Omer Naveed, M.D. – University of Pennsylvania; Nicole Hartmann, D.O. – University of Pennsylvania; Joshua LaRocque, M.D., Ph.D. – University of Pennsylvania; Taneeta Mindy Ganguly, M.D. – University of Pennsylvania; James Gugger, M.D., Pharm.D. – University of Pennsylvania; Ramya Raghupathi, M.D. – University of Pennsylvania; Michael Gelfand, M.D., Ph.D. – University of Pennsylvania; Kathryn Davis, M.D., MTR – University of Pennsylvania; Saurabh Sinha, M.D., Ph.D. – University of Pennsylvania; Brian Litt, M.D. – University of Pennsylvania; Colin Ellis, M.D. – University of Pennsylvania
Rationale:
Seizure induction techniques are often used in the epilepsy monitoring unit (EMU) to increase the yield of the admission and reduce length of stay. There currently is a dearth of data on the efficacy of alcohol administration as an induction technique in the epilepsy monitoring unit. The goal of the present study was to determine the efficacy of alcohol administration as an induction technique in the epilepsy monitoring unit.
Methods:
We completed a retrospective cohort study of six years of epilepsy monitoring unit data at a large urban tertiary care hospital. We identified patients who received alcohol for seizure induction and compared them to matched controls who did not receive alcohol. The cohorts were matched on the following variables: age, reason for admission, length of stay, ASM taper, number of ASMs at admission, and presence of interictal epileptiform discharges. We compared the likelihood of epileptic seizures and psychogenic non-epileptic events (PNEE) in cases versus controls at the level of the entire admission. We also performed time-to-event analyses for the likelihood of either event in the first 48 hours after alcohol was administered.
Results:
The cohort included 284 patients who received alcohol and 284 matched controls. Overall, patients who received alcohol were no more likely than controls to have a seizure (OR 0.79, p=0.20) or non-epileptic event (OR 0.94, p=0.85) during the admission. There was also no difference between case and controls in subgroups stratified by the following variables: reason for admission, presence of interictal epileptiform discharges, ASM taper strategy, alcohol type or dose. Kaplan-Meier analysis revealed no difference between cases and controls in the likelihood of epileptic seizures (X2(1) = 2.64, p = 0.10) or non-epileptic events (X2(1) = 0.01, p = 0.96), or need for a rescue medication (X2(1) = 0.16, p = 0.69) in the first 48 hours after alcohol was given. Conclusions:
Alcohol was not effective as a technique to induce seizures or non-epileptic events in the epilepsy monitoring unit. This finding has implications for counseling patients with epilepsy about the risks of drinking alcohol in moderation in their daily lives.
Funding: No funding was received for this study.