Abstracts

Rationale: Epilepsy surgery remains an underutilized resource despite proven long-term benefits, including seizure freedom, psychological well-being and health care utilization costs1. The National Institute for Health Care and Excellence (NICE) in the United Kingdom provides specific guidelines on when to consider patient referral to a tertiary epilepsy center2. The aim of this audit was to assess the management of patients with epilepsy attending a general neurology clinic compared to NICE guidelines (published 2012, updated 2016) and identify potential candidates who fulfill criteria for referral to a tertiary epilepsy center. Methods: A retrospective audit was performed on consecutive patients with a diagnosis of epilepsy attending two general neurology clinics per week over a three-month period, Jan 2016-Mar 2016. Clinic letters, electroencephalogram (EEG) and imaging results from identified patients were analysed to identify demographic and epilepsy data including seizure freedom for more than one year, EEG and imaging results, and response to current and previous anti-epileptic medication (AED). Results: A total of 67 patients with epilepsy were identified and included for analysis. The median age was 54 (IQR 45-65). Fifty percent (n=34) were male. Sixty-five percent (n=43) were seizure free for more than one year. We identified 22.4% (n=15) potential candidates for referral. The most common reason for consideration was failure of control after two years attending the service, which was present in all patients. Forty two percent (n=7) of those identified for referral had a diagnosis of epilepsy for more than 30 years. Seven patients also qualified for referral based on failure of two appropriate, maximum dose AEDs. The remaining patients had not yet reached maximum AED dose despite ongoing seizures. Six patients (6/15) had structural abnormalities present on brain imaging. Conclusions: We identified a significant number of patients who may be suitable for referral to a tertiary epilepsy center based on application of the NICE guidelines to our patient cohort, and yet previous referral had not been considered. A significant number of these patients have had epilepsy for more than three decades. This study highlights the importance of auditing clinical practice against standardized guidelines, increasing awareness of tertiary centers for referrals for refractory cases, maximizing AED doses when appropriate and of 'keeping an open mind' to the potential for referral when meeting lifelong epilepsy patients at routine outpatient reviews. Funding: None to declare