Abstracts

Rationale: The Kern Medical Epilepsy Monitoring Unit ( KM EMU) was opened in 2018 with the purpose of admitting patients from the Central Valley, which is known to be medically underserved. Since opening, a review of EMU data has not been conducted. Retrospective reviews are a crucial part of EMU success, allowing healthcare providers to review past performance and make improvements.

Methods: Data collection was conducted through chart review and patient interviews. This included epilepsy diagnosis, medical comorbidities, medical interventions past and present, medications, demographics, and pre and post EMU stay seizure burden.

Results: In terms of demographics, we found that in concordance with Kern County’s general population, a majority of patients were of Hispanic descent (45.31%) with the next largest ethnic group being patients who identified as White (44.9%). Further, it was found that the percentage of EMU patients with Medicare/Medicaid insurance (76%) was far higher than the national percentage of individuals with Medicare/Medicaid (34%). A majority of patients (72.4%) were Medicare/Medicaid plan holders under the age of 65.
_x000D_ At the KM EMU, there were about 246 evaluations throughout the span of 4 years. Of these evaluations, 121 patients were diagnosed with focal epilepsy while 16 were diagnosed with generalized epilepsy. Of which, 5 patients were misdiagnosed with psychogenic nonepileptic seizures prior to EMU admission. When examining the epilepsy distribution using EEG corresponding with MRI findings, it was seen that about 45.5% of patients have temporal lobe epilepsy. 18 of the 55 patients with temporal lobe epilepsy had non-lesional MRI findings. _x000D_ _x000D_ Of the 23 epileptic patients who had VNS implantation, only 8 patients experienced seizure freedom or rare and non disabling seizures (based upon Engel’s Modified Scoring). Through Neuropace data, it was found that of the 6 patients who had RNS implanted at USC. 4 experienced >50% improvement in seizure frequency. Since the opening of the EMU, 8 patients have had resective surgery with about 75% receiving an Engel modified score of Class II or better. _x000D_ _x000D_ While through the KM EMU patients reported a number of barriers to their care. Many treatment options require referring the patients to large academic centers. Patients reported they had issues with transportation, payment for treatment, insurance coverage issues, and slow treatment processes.

Conclusions: An NAEC analysis of most EMUs (L3 and L4) showed growth in terms of access to specialized testing and services in a 4 year span from 2012 to 2019. Between 2018 to 2021, the KM EMU has not increased in the number of beds, admissions, epileptologist, or full time staff since opening. This could be partially due to the COVID-19 pandemic which caused a 23% reduction nationally in the amount of elective admissions in 2019 and 2020. Level 3 center admissions, including Kern Medical, declined a steeper 44%. Despite the limitations that KM EMU faces, it continues to service epilepsy patients throughout the Central Valley with the same standard of care.

Funding: Not applicable