Authors :
Presenting Author: Jason Liu, BS – Wayne State University School of Medicine
Shatha Wahbi, BS – Wayne State University School of Medicine; Melissa Ly, BS – Wayne State University School of Medicine; Deepti Zutshi, MD – Wayne State University School of Medicine; Maysaa Basha, MD – Wayne State University School of Medicine
Rationale:
Status epilepticus (SE) refers to a seizure that lasts for more than five minutes associated with high morbidity and mortality. The purpose of this study is to evaluate the management of status epilepticus patients in an urban emergency department (ED).Methods:
Between June 1, 2018 and December 31, 2018, we collected data from adult patients who visited the Detroit Medical Center (DMC) ED for status epilepticus, defined clinically as continuous seizure activity lasting more than 5 minutes or recurrent seizures without interval return to baseline. The data consisted of patient demographics, seizure history, anti-seizure medication (ASM) history, diagnostics, discharge information, and subsequent seizure-related ED visits. Descriptive and categorical statistical analysis was completed.Results: We conducted a retrospective chart review of 673 ED patient encounters and analyzed 58 visits from 51 unique patients presenting with SE. The ages of the patients ranged from 36 to 82, with 31 visits from men (53.4%) and 51 of the visits from black patients (87.9%). Most encounters were for convulsive SE (n=55; 94.8%). Prior history of seizures was present in 48 encounters (82.9%) with the majority having prescribed home ASMs (n=45; 77.6% of overall visits and 93.8% of those with seizure history). Of these 45 cases, patients reported adherence to ASMs in 14 (31.1%) visits, adherence but with low ASM lab levels in seven (15.6%) visits, and non-adherence in 24 (53.3%) visits.
In 42 (72.8%) cases, the patient required acute administration of benzodiazepines for cessation of SE. Of the 16 encounters without benzodiazepines, 13 (81.3%) had ASMs administered. Overall, ASMs were administered acutely in 53 (91.4%) visits. Overall, there were 11 intubations (19.0%). Out of the 14 ASM adherent visits, there was only one (7.14%) intubation as compared to 10 (32.3%) intubations in the ASM not adherent or poorly adherent visits (p=0.07).
EEG was obtained in 37.9 % of the encounters (n=22) with seizures or epileptiform activity identified in eight EEGs (36.4%). A head CT was obtained in the majority of the visits (69.0%; n=4) with only four acute findings; three of which were in patients presenting with new onset seizures. Overall, 33 (56.9%) encounters were followed by a subsequent ED visit for seizure, with 27 encounters occurring within one year of the initial visit.
Conclusions:
Convulsive SE remains a complication of established epilepsy and results in recurrent ED visits. Patients with established epilepsy presenting with SE are more likely to require intubation if they were not adherent to prescribed ASMs. EEG has a high yield for relevant abnormal activity while acute neuroimaging was noncontributory in the vast majority of established epilepsy patients.Funding: None