Abstracts

Rationale: The traditional mission of a tertiary epilepsy center is the evaluation and treatment of refractory epilepsy. Prior surgery series indicate that patients are not referred for subspecialty epilepsy care for an average of 15-20 years. We developed a new onset seizure clinic (NOSC)for adults with suspected seizures in order to provide early subspecialty care and to provide an infrastructure for clinical trials. Methods: The NOSC was started in November 2005 and is held two half days per week. The clinic is staffed by two epileptologists and a nurse practitioner. Schedulers are given specific criteria for scheduling patients in the clinic. Dedicated time slots are set aside and held for new onset patients. Our aim is to provide an appointment within 2-5 business days of the referral. At the launch of the clinic, we provided education to local emergency rooms on the management of new onset seizures and marketed our services to the local primary care community. We reviewed the charts of patients seen in the NOSC in 2007. The UC IRB approved this study. Results: 121 patients were seen in the NOSC (mean age 44 years, range 16-87). The referral sources were included emergency rooms (n = 30), primary care providers (n = 53), neurologists (n = 18), neurosurgeons (n = 12) and other (n = 8). Fifty six patients (46%) were taking an AED at the first visit (levetiracetam n = 25, phenytoin n = 12). Seventy eight patients had EEG studies performed (17 had epileptiform abnormalities, 11 had focal slowing and 50 were normal). Eleven patients underwent ambulatory EEG (10 were normal and 1 had nonepileptic seizures). Twelve patients had inpatient video/EEG monitoring (7 had psychogenic nonepileptic seizures [PNES], 1 had frontal lobe seizures, 1 had reading epilepsy, 1 had cardiogenic syncope, and 2 were normal studies without events captured). Neuroimaging was performed at our center in 53 patients (other patients already had imaging performed prior to being seen). (3 had cerebral ischemia, 3 had brain tumors, 2 had encephalomalacia and 2 had schizencephaly). The diagnoses of the 121 patients were as follows: partial epilepsy in 41 (33.9%), generalized onset epilepsy in 3 (2.5%), single seizure in 28 (23.1%), syncope in 19 (15.7%), PNES in 8 (6.6%), provoked seizures in 10 (8.3%), indeterminate spells in 7 (5.8%) and other diagnoses in 5 (4.1%). Conclusions: A new onset seizure clinic is feasible at a tertiary care center and may provide advanced epilepsy care early in the diagnosis of a patient. Our clinic has been successful and sustaining. The majority of patients seen at our center had epilepsy or a single seizure. The low percentage of provoked seizures may be the result of our educational efforts to the emergency medicine community.