Abstracts

The rapid and accurate assessment of patients presenting to an emergency room (ER) with altered consciousness represents a special challenge. Early detection and treatment of status epilepticus in these types of patients is essential and the electroencephalogram represents a crucial diagnostic test. We retrospectively investigated the clinical features and outcome of a subset of patients for whom an EEG was requested in the ER to assess the possibility of status epilepticus (SE). An EEG database and a paper log of all EEGs performed from 5/97-4/2004 were reviewed. All patients who had an EEG performed in the ER at Parkland Memorial Hospital were identified. This preliminary report is based on the analysis of records obtained from the database which represented 27 % of the total identified records. Medical records were reviewed and clinical information abstracted. Patients were excluded if 1) insufficient clinical information was available 2) the patient was a prisoner 3) the EEG indication was not possible SE. Clinical SE was defined as [gt]/= 30 minutes of continuous seizure activity or two consecutive seizures without interval return to baseline consciousness. EEG SE was defined as an EEG demonstrating ongoing ictal activity in a patient with altered consciousness. EEGs were performed in the ER for 206 patients. Medical records of 56 patients were analyzed and 11 patients were excluded (5 prisoners, 3 inappropriate EEG indications, 3 with insufficient information). A total of 45 patients met inclusion criteria with a mean age of 51.4+/- 19 years, and 45% were females. Twelve patients did not have epileptic seizures, 3 had provoked epileptic seizures, 1 was uncertain, and 29 had unprovoked epileptic seizures. Among the patients with unprovoked epileptic seizures, 13 were new onset. Seventeen patients met clinical criteria for SE (Epilepsia Partialis Continua=3, Myoclonic=1, Tonic=1, tonic-clonic/other=12) preceding or during the ER evaluation. A single patient was in electrographic SE. Nine of 17 patients with SE were intubated compared with 8 of 28 who were not in status. Of the 16 patients in SE with known outcome, 14 were discharged at or near baseline neurologic condition, 1 had severe disability, and 1 died. While 38% of patients met a clinical definition of SE, only 2% showed evidence of EEG SE. This is considerably less than a previously reported figure of 37% (Privitera et al., Epilepsy Res. 1994; 18(2):155-166). This may reflect research design differences, sampling errors, or reflect the current strategy of an aggressive approach toward possible SE. Although 53% required intubation, there were no associated complications or additional morbidity and 88% of patients had a good outcome. (Supported by Once Upon A Time Foundation)