Authors :
Alexander Buslov, MD – Jersey Shore University Medical Center
Rahul Guha, MD – Jersey Shore University Medical Center
Rajesh Sachdeo, MD – Jersey Shore University Medical Center
Arun Antony, MD – Jersey Shore University Medical Center
Presenting Author: Diji Johnson, MBBS, MPH – Jersey Shore University Medical Center
Rationale:
Seizures, altered consciousness, and stroke are the most common reasons for patient referral among 3% of the admissions referred to the Neurology service. Notably, seizures (including status epilepticus) accounted for 12–15% of urgent consults in large series. Common consult indications include new-onset seizure, recurrent or breakthrough seizures, nonconvulsive status epilepticus, altered mental status/encephalopathy, and syncope vs. seizure workup. EEG was the single most recommended and performed test in these cases. Without prompt intervention from specialists, these patients are at a high risk of readmission, recurrent seizures, and declining functionality. In 2022, our center established a structured Epilepsy Consult Service aimed at providing early inpatient evaluations by epileptologists, EEG monitoring, and expedited outpatient follow-up. This study seeks to evaluate whether this consult service has improved seizure-related outcomes.
Methods:
A retrospective chart review was conducted to evaluate adult patients (18 years and older) admitted to a tertiary academic medical center between November 2022 and February 2025 and evaluated by the Epilepsy consult team. The consult team included 5 epileptologists, two nurse practitioners, and 24/7 EEG services, including continuous video EEG. Clinical features, outcome measures, and follow-up details were compared with inpatients who were managed by the Neurology service. The primary outcomes measured were the rate of ED revisits within three months, seizure-related readmissions, and length of stay.Results:
A total of 702 participants, including 369 males with a mean age of 55.13 years, accounted for 1,218 eligible emergency department visits. Preliminary analysis of 30 patients evaluated by a dedicated epilepsy service group had significantly fewer ED revisits at 3 months (mean of 0.5 visits) and readmissions for seizure-related events (mean of 0.27 readmissions), with an average length of stay of 6.5 days. Kaplan-Meier survival analysis indicated a longer median time to recurrence. A detailed analysis of the data will be presented.
Conclusions:
In the short sample analyzed, early inpatient consultations for epilepsy, combined with timely EEG testing, are associated with significantly improved outcomes in seizure management. This integrated specialized care model not only facilitates a smoother transition from acute emergency treatment to chronic seizure management but also should be considered a best practice pathway to reduce healthcare utilization and promote favorable long-term outcomes for patients with epilepsy.
References:
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Common Neurological Disorders Involving Inpatient Liaisons at a Secondary Referral Hospital in Taiwan: A Retrospective Cross-Sectional Study. Chih-Yang Liu et al. J Clin Neurol. 2016 Jan;12(1):93-100. English. Published online Dec 23, 2015. https://doi.org/10.3988/jcn.2016.12.1.93
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Analysis of urgent inpatient neurologic consultations in a large tertiary hospital center: Follow‐up on the effect of standardized training of residents. Jiafang Wang et al. Brain Behav. 2023 Mar 27;13(5):e2983. doi: 10.1002/brb3.2983
Funding: None.