Abstracts

Rationale: Specialized epilepsy centers have been established to help coordinate epilepsy care, and ultimately to improve outcomes. VA Epilepsy Centers of Excellence (ECoE) were established in 2009 to optimize epilepsy care among veterans. Five years after the creation of ECoE, the precise impact on patient management and outcomes has not been established. The primary objective of this study is to determine whether consultation at the Portland VA Medical Center ECoE influenced management as measured by a change in diagnosis or alteration in medications. The secondary objective is to examine whether epilepsy consultation is associated with improved patient outcomes including event frequency, occupational status, ER visits, and hospitalizations one year after diagnosis. Methods: Data from 100 consecutive patient consultations to the Portland VA Medical Center ECoE beginning in January 2011 were reviewed retrospectively via CPRS and Vista. Data collected included: age at onset of condition; age at initial visit; diagnosis prior to and after initial visit; seizure/event type at initial visit and at 1 year after; ED visits in preceding 1 year, and 1 year after initial visit; hospitalizations in preceding 1 year, and 1 year after initial visit; occupational status at initial visit and 1 year later; driving status at initial visit and 1 year later. A change in management was defined as a change in diagnosis or a change in seizure or non-seizure medication after initial visit. Results: After initial visit and workup, 65% of patients had a diagnosis of seizures or epilepsy; 16% non-epileptic, physiologic events (non-syncope); 10% non-epileptic, psychogenic events; 7% syncope; and 2% unknown. Seventy-two out of 100 patients (72%) had a change in management after initial visit. Among these patients, 51% had a change in diagnosis and 58% had a change in medication. 30% of patients had reduction in event frequency at 1 year; 22 % had no change in event frequency at 1 year; 8% had increase in event frequency at 1 year; in 28% there was insufficient documentation to assess event frequency at 1 year; and in 12% there was no 1 year follow up visit. One year prior to initial visit, there were 45 event related ED visits and 20 hospitalizations among all patients, while one year after initial visit there were 12 ED visits and 7 hospitalizations. No significant changes were observed in driving status or occupational status, but assessment of this was limited as in nearly 50% of patients there was a lack of documentation. Conclusions: Our results indicate that in the majority of patients, epilepsy consultation led to a change in management. Study limitations include limited documentation in some patients about seizure outcomes, but among patients with available data 50% had a reduction in event frequency at 1 year, compared with 13% with increase in event frequency. Related ED visits and hospitalizations were significantly reduced 1 year after initial visit, as compared to 1 year prior. The results suggest that specialty epilepsy consultation leads to changes in management in most patients, and improves patient outcomes.