Abstracts

RATIONALE: Despite the explosion of new antiepileptic drug (AED) availability, seizures continue to be refractory to AED therapy in 20-35% of patients with epilepsy. Acute repetitive seizures, prolonged seizures, or status epilepticus frequently complicates management outside the hospital setting, prompting emergency department (ED) visitation for administration of intravenous AEDs. Outpatient rectal diazepam gel has been proven safe and effective in selected, refractory epilepsy patients on stable AED regimens. The objective of our study was to address patient perception of outpatient emergency rectal AED administration in epilepsy.
METHODS: Epilepsy patients were asked to complete a survey form on emergency use of anti-seizure medications. An 18 question survey was prospectively given to 91 consecutive epilepsy patients in an epilepsy-based practice setting. The survey included 10 demographic, and 8 specific questions about receiving emergency seizure management. Information was obtained from patients, or their principal caretaker, whoever was most appropriate.
RESULTS: Ninety-one patients were surveyed with 80 (87.9%) respondents. Not all questions were answered in every case. Responders had a mean age of 42.8 years (range 12-82 yrs). Forty-eight of 80 patients (60%) were female and 32/80 (40%) male; 63/64 (98.4%) were heterosexual. Fifty-three of 71 patients (74.6%) achieved a high school diploma or less as the highest level of education. Forty-eight of eighty patients (60%) reported monthly seizures with a mean of 6.7/month. Twenty-eight of 80 (35%) respondents left seizure type blank, with the majority of responders describing partial and grand mal seizures.
Fifty-three of 76 patients (69.7%) had a history of visits to the ED (range 1-14). When asked, Are you embarrassed by the emergent use of rectal medicines for seizure control?, 43/64 (67.2%) answered no, and only 15/65 (23.1%) thought others would tease them. Despite the frequency of ED visitation in our population, only 7/55 (12.7%) thought their seizures were severe enough to warrant rectal medication. However, 57/61 (93.4%) patients would choose an antiseizure medication they could receive outside of the hospital as opposed to going to the ED for treatment.
CONCLUSIONS: The significance of these findings indicate that the majority of patients with epilepsy would not be embarrassed by rectal administration of an emergent seizure medication. Furthermore, nearly all patients would chose to receive emergency anti-seizure medication outside the hospital, with only a small percent of patients preferring treatment in the ED. The undesirable perception of using emergent rectal medication in epilepsy does not appear to be limited from the patients perspective.
Support: Elan Pharma