Abstracts

Rationale: Acute repetitive seizures (ARS) frequently result in emergency department (ED) visits and carry a significant risk for status epilepticus (Haut, 1999). Of particular concern are patients repeatedly admitted for urgent management of ARS. Greater attention has, thus, been directed to identifying potentially preventable seizure precipitants. Health care studies have shown medication non-compliance to be the most common cause of seizures requiring hospitalization (Tan, 2005; Irving, 1999). Similarly, an earlier study of ARS at the University of Maryland Medical Center (UMMC), found one of the most common precipitants in adult patients with ARS to be poor medication compliance. Given the substantial impact of non-compliance in repeated ED visits for ARS, this study aimed to determine the patterns of discharge care, including counseling and outpatient follow-up, in order to define parameters for best practices.Methods: Patients who presented to the UMMC Emergency Department (Baltimore, MD) with ARS between 07/01/05 through 2/1/06 were identified. Initial search criteria included all patients at least 18 years of age with discharge diagnosis code(s) for seizure(s). Patients who presented with status epilepticus or alcohol withdrawal seizures were excluded from this analysis. Records from ED admission(s) in the prior 12 months as well as the current ED admission were reviewed for documentation of patient counseling, recommendation for rescue benzodiazepine use, and follow-up care. Results: 16 of 37 (43%) patients with ARS had multiple ED admissions within a 12-month period. Of those with multiple admissions with ARS, 13 of 16 (81%) had been counseled about the importance of medication compliance at previous admissions. None of the patients with multiple ED admissions had received a prescription for a rescue benzodiazepine. Similarly, only 2 of 21 (10%) of patients with a single ED visit for ARS in 12 months had been prescribed a rescue benzodiazepine upon discharge. Follow up at the University outpatient clinics could only be confirmed in 9 of 37 (24%) patients. 6 of 16 (38%) patients with multiple admissions had documented outpatient follow-up. ED records did not indicate whether primary care physicians or treating neurologists outside the University system were contacted to discuss AED management or follow-up care.Conclusions: The majority of patients with multiple admissions with ARS had received counseling regarding the need for medication compliance prior to their current admission, raising the question of whether counseling in the acute setting is adequate or truly effective for improving compliance and preventing recurrent admissions. In contrast, only a minority of patients, either with a history of multiple admissions or only a single admission in the past 12 months, was given a prescription for a rescue benzodiazepine medication. Additionally, contact with treating physicians and subsequent follow-up care as documented may not be adequate to ensure the optimal management of patients with ARS, including the prevention of future seizure exacerbations.