Abstracts

Rationale: Emergency Departments (EDs) are commonly the first location patients with new-onset focal epilepsy go-to for evaluation. Treatment decisions in the ED can influence likelihood of further seizure activity. Using data from The Human Epilepsy Project (HEP), which enrolled patients with newly diagnosed focal epilepsy, we assessed the factors effecting the diagnosis and treatment of new-onset focal seizures(szs) in EDs. Methods: We analyzed data from all participants enrolled in HEP. There were 447 patients with new-onset focal epilepsy seen within four months of treatment initiation who were eligible and enrolled in the study. Patients completed a sz diary documenting prior szs. Medical records pertaining to initial diagnosis and treatment were also collected and reviewed. Based on clinical descriptions from sz diaries and the medical record, szs were categorized as either subtle szs (SS; primarily motor arrest or focal aware without motor) or disruptive szs (DS; primarily motor activity or verbal output, including focal to bilateral tonic-clonic seizures). Parametric testing was used to compare normally distributed variables. Results: Baseline characteristics were similar between the 246 (55%) patients with SS and 201 (45%) patients with DS at onset of epilepsy. Among the 246 patients with SS, none presented to the ED for a first SS, but 134 (55%) presented to the ED after developing a first DS. Among 201 patients with DS, 117 (58%) presented to the ED with their first DS. In total, there were 325 presentations for a sz (initial or recurrent), of which the ED identified a sz in 258 cases. Of the total presentations, 310 were for recurrent szs, and only 102 of these were diagnosed with recurrent szs. Recurrent szs were identified in patients with DS twice as much as compared to patients with SS (51% vs 21%). Antiseizure medication was started in 125 patients; 99 were started on levetiracetam, which was continued as an outpatient in 57 patients. There were 112 admissions from the ED for sz presentations; of patients not admitted, there were 149 referrals to a neurologist. Conclusions: This study contributes to growing evidence of lengthy delays in diagnosing focal epilepsy, particularly with SS presentation. This also highlights the factors influencing this delay in new-onset patients presenting to EDs. These findings can support large-scale interventions aimed at improving recognition and treatment in ED settings. Funding: No funding