Abstracts

Rationale: Acute symptomatic seizures (ASyS) account for around 40% of all non-febrile convulsive seizures. As patients with ASyS concerns routinely undergo continuous EEG (cEEG) monitoring, ASyS are more commonly encountered in clinical practice because a vast majority are non-convulsive. ASyS increase the 30-day mortality risk and epilepsy development. The impact of ASyS and its management with anti-seizure medications (ASMs) on patient reported outcome measures (PROMs) remains poorly investigated. Our study aims to address this knowledge gap.

Methods: A retrospective cohort study of adults admitted with strokes who underwent cEEG monitoring for ASyS concern at Cleveland Clinic between 1/1/2012-12/31/2018 and completed PROMs within 6 months of discharge through the Cleveland Clinic Knowledge Program, where by patients complete PROMs as standard care at their ambulatory visit. Patients fill in computer adaptive testing versions of PROMIS v1.0 scales (sleep disturbance, physical function, satisfaction with social roles and activities, pain interference, fatigue, anxiety and Global Health), NeuroQoL and Patient Health Questionnaire-9 (PHQ-9) depression scale were administered. If multiple PROMs were available, the PROMs closest to the cEEG date were used for analysis because the impact of seizure or ASMs on the patient are more likely to occur closer to the event. Demographics, clinical characteristics and PROMs were compared for patients with and without ASyS (clinical and/or electrographic), with and without ASMs (at discharge and at the day of first PROM). T-tests or Wilcoxon rank sum tests compared continuous variables across groups and chi-square tests or Fisher’s exact tests were used for categorical variables. All tests were two-sided and P-values less than 0.05 were considered statistically significant.

Results: A total of 508 patients (mean age 62.0±14.1 years, 51.6% female), including 165 (32.5%) with intracerebral hemorrhage (ICH), 99 (19.5%) with subarachnoid hemorrhage (SAH) and 244 (48%) with ischemic stroke (IS) were analyzed. There were 103 (20.3%) patients with ASyS. Additionally, 190 (37.4%) patients were on ASMs at discharge and 162 (31.9%) were on ASMs at the day of first PROM. Table 1 shows descriptive statistics for patients with and without ASyS. Descriptive statistics comparing patients with and without ASMs at discharge (and at the day of first PROM – calculated but not shown) are presented in Table 2. No significant differences were demonstrated on PROMs between the two groups based on ASyS, ASMs at discharge or ASMs at time of PROMs.

Conclusions: The lack of significant impact of ASyS or their management with ASMs on PROMs may mean that ASyS and ASMs do not impact patient’s perception of well-being, which is contrary to routine clinical experience. More likely, our findings highlight the limitations of currently used PROMs, which are domain-specific rather than being condition-specific. Given the large neurological burden of ASyS, condition-specific PROMs are needed.

Funding: Not applicable