Abstracts

Rationale: Newly diagnosed epilepsy patients are often not referred to a specialist. This delays diagnosis, impedes proper treatment, and affects quality of life. Neurologists remain under-utilized. This study seeks to determine why by looking at emergency department (ED) usage, and quality of care in patients referred to a busy community epileptologist in a mandatory driver reporting state.Methods: This study examines 50 consecutive patients referred for initial consultation for seizures to a community epileptologist in late 2012 and early 2013 by retrospective chart review. Patient rate of emergency department (ED) usage before and after consult, and factors determining ED usage/avoidance are evaluated. Patients were between the ages of 10 - 82, with private insurance (or Medicare and private secondary), living in a relatively affluent suburban area.Results: 1. Diagnoses: Epilepsy was newly diagnosed in 38% of the patients, 6% had alcohol or substance related seizures (including status epilepticus), 6% had movement or sleep disorders, and 8% had non-epileptic events. The remaining 42% already had a diagnosis of epilepsy at some point in their lives. 2. ED usage: 30% used the ED in the 6 months prior to consult (half chronic and half newly diagnosed) and 2% in the 6 months after. 3. Seizure rate and ED decision: Prior to consult besides the 30% who used any ED, another 42% had seizures (24% new and 18% chronic), most of whom did not seek medical care within the first few weeks, even those with loss of awareness. Of those 42%, none went to the ED and only 3 patients sought a physician immediately. Reasons given for avoiding ED were: 1. Perceived lack of usefulness of ED, 2. Cost and time of ED, and 3. Potential loss of driving privileges. Conclusions: ED use dropped dramatically among these seizure patients after neurology consult. Yet, many seizure patients, even those with commercial insurance are not rushing to get necessary medical care. Impediments to care that need to be addressed include lack of knowledge of what epileptologists do and how much we can help. Epilepsy specialists must educate the public and urge better support from insurers, including better information to differentiate sub-specialists than internet rating sites.