Abstracts

Rationale: Epilepsy and intellectual disability are often co-morbid conditions, as up to one third of people with active epilepsy may have an intellectual disability and up to half of people with a severe intellectual disability may have a seizure disorder. An accurate seizure history and a description of the clinical events is essential in the management of these patients; however patients usually have communication difficulty and caregivers/group home nurses are often unable to give reliable and sufficient information. In this study, we evaluated the importance of providing a seizure diary for better management of seizures in disability patients and ultimately decrease their hospital admissions. Methods: We retrospectively reviewed medical records of epilepsy patients with intellectual disability and/or developmental delay who were managed in our epilepsy clinic between January 2013 and January 2017. We excluded epileptic patients without disability and with acquired disability such as post-stroke or post-traumatic disabilities. Patients are stratified by presence of seizure diaries documented in medical record, If not provided, we collected information about their seizures, either from parents or care givers accompanying the patient or by phone from group home nurses. Seizure types and frequencies, anti-epileptic medications (AED), EEG and MRI reports and hospital admissions were assessed. T-test and chi square test were used for data analysis. Results: 239 patients were identified with a mean age of 44.1 years. Seizure diaries were used and mentioned in physician notes for 17 patients (7.1% of all patients).  Seizure type was more likely identified in patients who provided a seizure dairy vs the other group without a seizure dairy (46.4% vs. 11.8%, p=0.005). We also found that patients with a seizure dairy had higher seizure frequency and were on more AED (4.77/year vs. 1.18/year. p Conclusions: The first step in the seizure management is to confirm that seizures are epileptic in nature and to define seizure type. In our study, few patients provided a seizure diary, we demonstrated that it was easier to identify seizure type and frequency, if seizures were documented in a seizure diary. Similar numbers of seizures related hospital admissions may suggest that there might be missing reported seizures in patients without seizure diary. Documentation should be reinforced for all patients regardless of the seizure frequency. Best approach would be using standardized seizure dairy by all caregivers and all group homes. These documentation will help reduce, the consistency problems regarding the seizure type, frequency and for better patient care and ultimately offer a better quality of life for epilepsy patients with disabilities. This study has the limitations of a retrospective study and we hope to address these issues in the future. Funding: None