Abstracts

Rationale:
Correct first aid knowledge and use of seizure rescue therapies ensure the earliest possible treatment in seizure emergency to prevent permanent brain damage or mortality. Rectal diazepam is the only registered outpatient seizure rescue therapy available in Hong Kong. However, rectal route may be inconvenient and socially unacceptable for adults. There is a lack of local data comparing various seizure rescue therapies in terms of patients’ and caregivers’ perceptions. We designed a study to investigate 1) the level of seizure first aid knowledge 2) the awareness and perception of outpatient seizure rescue therapies among both adult epilepsy patients and their caregivers.
Method:
A cross-sectional single-center questionnaire study was conducted in 2019. Patients and their caregivers greater than 18 years old were recruited from the Epilepsy Clinic of the Queen Mary Hospital which is a teaching hospital. Subjects had to be mentally competent and understood written or spoken Chinese. A 7-item questionnaire was administered. It mainly included two parts. The first part focused on the level of self-perceived and actual understanding in the first aid for seizure of the subjects. Each subject was asked to score their level of understanding from 0 (nil understanding) to 100 (full understanding). Each subject was then asked to select the correct first-aid measures during seizure (score from -8 to 9, negative scores were given for wrong answers). Second part focused on the responders’ knowledge and acceptance of various seizure abortive therapies. Rectal, buccal and intranasal benzodiazepines (BZs) and magnet use with Vagal Nerve Stimulation (VNS) device implantation were included. Simple diagrams of abortive therapy were provided for illustration. Acceptance level of each modality was assessed by five-point Likert scale.
Results:
A total of 60 patients were recruited in the pilot phase of the study. More female subjects were recruited than male. Mean ages of patient and caregiver groups were of middle-age. About 58% caregivers reported the epileptic patient they were looking after had experienced cluster seizures (more than one attack within 24 hours), while 34% of patients reported cluster seizures. However, only a minority of overall subjects (17%) and caregivers had ever used abortive therapy. Majority of them (67%) had never heard of any of the rescue therapy (figure 1). Very small proportion of the responders knew about oral or intranasal therapies or VNS. Rectal BZ was considered by both patients and caregivers as the least acceptable therapy (figure 2). Buccal BZ was considered as the most acceptable among patients while both VNS and intranasal BZ was considered as the most acceptable among caregivers.
Conclusion:
First aid education is urgently needed for epilepsy patients and their caregivers given the poor understanding. Treatment gap existed between prevalence of cluster seizure and low awareness and utilization of abortive therapies. Rectal BZ was the least accepted therapy despite it was most commonly known and used. Alternative acute therapies may be needed to be introduced to local epilepsy patients.
Funding:
:No funding is involved.