Authors :
Presenting Author: Cody Nathan, MD – Northwestern Memorial Hospital
Morgan Kinsinger, BA – Northwestern Memorial Hospital; Elizabeth Cunningham, MPH – Northwestern Memorial Hospital; Elizabeth Gerard, MD – Northwestern Memorial Hospital; Asia Giammarco, MS, MMS, PA-C – Northwestern Memorial Hospital; Stephan Schuele, MD – Northwestern Memorial Hospital; Stephen VanHaerents, MD – Northwestern Memorial Hospital
Rationale:
Evaluation by an epileptologist can help distinguish epileptic seizures from seizure mimickers. Proper diagnosis of a seizure/epilepsy is of critical importance due to implications regarding treatment, prognosis, quality of life, morbidity and mortality. Studies outside of the United States have shown that establishing a first seizure clinic is a feasible, cost effective, and useful way to provide patients with possible seizure expedited care (McManus E, et al. Long-term outcome of 200 patients referred to a first seizure clinic. Acta Neurol Scand. 2021 Feb;143(2):140-145). However, there is a paucity of studies evaluating the use and demographic data for patients evaluated in a first seizure clinic within the United States. The goal of our study is to describe the demographics and clinical characteristics of patients referred to a first seizure clinic at an academic center within the city of Chicago, Illinois. By studying this patient population, we hope to understand what factors indicate a higher risk for seizure recurrence and subsequent development of epilepsy.
Methods:
This is a retrospective cohort study of adult patients referred to first seizure evaluation clinic at Northwestern’s Neurologic Comprehensive Epilepsy Center. Research participants were identified through Epic from March 2021 to March 2022. Charts were reviewed to assess pertinent clinical characteristics and patient demographic data. All of the data was ascertained from the first clinic visit and subsequent two clinic visits (if available).
Results:
A total of 123/138 (89.0%) patients showed up to the scheduled visit between March 2021 and March 2022. The patient demographics are listed in Table 1. A total of 87/123 (70.7%) patients were diagnosed with seizure, 73/87 (83.9%) of which were unprovoked and 14/87 (16.1%) were provoked. The other diagnoses included syncope (17/123, 13.8%), undifferentiated event (16/123, 13.0%), psychogenic non-epileptic event (2/123, 1.6%), and migraine (1, 0.8%). The vast majority of patients had an EEG prior to or after the visit (121/123, 98.4%). EEG findings included normal studies (62/121, 51.2%), epileptiform abnormalities (24/121, 19.8%), and non-epileptiform abnormalities (35/121, 28.9%). Findings contributing to the patient’s cause of epilepsy were identified in 26/108 (24.1%) of patients who underwent an MRI or CT scan of the brain. There were 40/123 (32.5%) patients prescribed antiseizure medications (ASM) prior to the first office visit, of which 6/40 (15.0%) were discontinued after the first visit. There were 65/123 (52.8%) patients prescribed an ASM within the first three office visits. The most commonly prescribed ASM was levetiracetam (43/71, 60.6%), followed by lamotrigine (11/71, 15.5%), then zonisamide (8/71, 11.3%).
Conclusions:
A first seizure evaluation clinic in an urban setting is an achievable and efficient way to evaluate patients with paroxysmal events concerning for seizure. The vast majority of patients in this clinic were diagnosed with epileptic seizures. Expedited ancillary testing with head imaging and EEG can help contribute to the diagnosis of epilepsy.
Funding: None