Abstracts

Rationale: The majority of emergency department (ED) visits for 'seizure' involve patients with new onset seizures. On the other hand, characteristics of patients with known epilepsy and their management in the emergency setting are currently lacking. Despite this paucity of data, general recommendations have been published by the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology regarding diagnostics tests in emergency patients with chronic epilepsy. In a recent reassessment of these practice parameters, no recommendation regarding an emergency computed tomography (CT) in persons with chronic seizures was made due to inadequate evidence to support or refute its usefulness. The aim of this study was to describe the characteristics of patients with known epilepsy likely to have a neuroimaging study when they presented to the ED and provide further analysis regarding the usefulness of neuroimaging in chronic epilepsy in the acute setting. Methods: This is a retrospective study. We reviewed the medical records of patients 18 years and above with chronic epilepsy, who presented to a trauma level I ED with a complaint of seizure during the period of January 1, 2014 until October 31, 2015. To be included in the study, patients had to be on at least one antiepileptic drug and had a documented neurological exam. Both patients who did and did not underwent a head CT were included in this study for means of comparison. Results: Our inclusion criteria were met by 100 patients. Average age of the included patients was 42.06 years (SD 15.53), 61% were male and 39% were female. Among a total of 63 patients who underwent a head CT in the ED, 5 had an abnormal neurological examination due to either sedative medications given in the ED or residual deficits from prior stroke. 35% of the patients who completed a CT scan, had a history of non-compliance with antiepileptics medications upon presentation to the ED. Head CT did not show acute findings in any of the patients. Conclusions: With the current emphasis on cost containment, neuroimaging in the acute setting has become the subject of increasing scrutiny. Most studies conclude that CT, although useful in selected seizure patients, should not be applied indiscriminately as part of a standard ED evaluation. In our study, the absence of defined high-risk factors in patients with chronic epilepsy, such as an abnormal neurological examination, and the overwhelming number of patients with a history of non-compliance, argues toward deferral of emergency CT in this population. Funding: None