Abstracts

Rationale: EMU evaluation is a part of the diagnosis and management of patients with seizure disorders. We aimed to evaluate the short- and intermediate-term outcomes of patients discharged from EMU diagnosed with either epilepsy (ES) or psychogenic non-epileptic spells (PNES). Methods: All patients discharged with a diagnosis of either ES or PNES were eligible to participate. Demographics, weekly seizure frequency, number or AEDs, neurology clinic visits, ER visits, and hospital admission data were collected for the 3 months before EMU admission, at 1-2 weeks, 6-8 weeks, and 3-4 months following discharge. Standard statistical methods were used for comparisons between time points (paired-samples t-tests). Results: Of the patients with sole diagnosis of ES, 48% had non-lesional TLE, 24% non-lesional ETLE, 2% lesional epilepsy, 17% idiopathic generalized epilepsy, and 9% symptomatic generalized epilepsy. 79% (N=76) of patients followed up internally and 21% (N=20) followed up externally (defined as any providers affiliated or not affiliated with the epilepsy center, respectively). Of the 72 patients with sole diagnosis of PNES, 35% (N=25) followed up internally and 65% (N=47) followed up externally. Pre-admission differences between internal and external follow-up groups for ES were relatively minor including hospital admissions 3 months prior to admission (0.09 vs. 0.0; p=0.007). Pre-admission differences between groups for PNES patients were also minor and included number of visits to neurology providers 3 months prior to admission (1.5 vs. 0.9; p=0.006). For ES, changes in outcomes included decreases in seizure frequency at 1-2 weeks 5.6 14.4 vs. 3.4 10.3 (p=0.025) and 6-8 weeks 4.7 13.1 vs. 3.3 10.1 (p=0.025); no changes in AED use (all p>0.05); decreases in the number of visits to neurologist at 1-2 weeks 1.1 0.9 vs. 0.1 0.4 (p=0.000), at 6-8 weeks 1.1 0.9 vs. 0.4 0.5 (p=0.000), and at 3 months 1.2 0.8 vs. 0.9 0.7 (p=0.048); decreased number of ER visits at 1-2 weeks 0.2 0.6 vs. 0.09 0.3 (p=0.038) and at 3 months 0.5 0.9 vs. 0.00 (p=0.008); and a decrease in the number of hospitalizations at 1-2 weeks 0.08 0.3 vs. 0.0 (none; p=0.044) but not at other times (both p>0.05). For PNES, changes in outcomes included decreases in seizure frequency at 1-2 weeks 5.0 8.1 vs. 2.1 3.2 (p=0.012) and at 3 months 10.7 17.6 vs. 3.3 5.7 (p=0.045); decrease in AED use at 1-2 weeks 1.7 1.2 vs. 1.0 1.7 (p=0.023) and at 3 months 1.5 1.0 vs. 0.7 1.0 (p=0.0.26); visits to neurologists at 1-2 weeks 1.2 0.9 vs. 0.2 0.4 (p=0.000), 6-8 weeks 1.3 1.0 vs. 0.5 0.6 (p=0.000) decrease in the number of ER visits at 1-2 weeks 0.5 0.8 vs. 0.0 (p=0.000), 6-8 weeks 0.5 0.7 vs. 0.0 (none; p=0.003 and decrease in hospitalizations at 1-2 weeks 0.1 0.3 vs. 0.0 (p=0.023). Conclusions: Patients diagnosed with ES or PNES evaluated in the EMU showed improvements in outcomes after discharge. The relationship between internal vs. external follow-up requires further evaluation. Funding: No funding