Abstracts

RATIONALE: Many studies on acute seizure management have focused on status epilepticus or new onset seizures, while self-limited seizures from patients with an established diagnosis of epilepsy remain a significant problem. This project seeks to identify the presentation, investigation and treatments used in adult epilepsy patients presenting to the ED with seizures, including pre and post ED care, counseling and follow-up. METHODS: Medical records of patients with diagnosis of epilepsy and ED visits for seizures over a period from 1/1/99 to 10/1/99 were identified. Prehospital care, investigations, treatments and follow-up arrangements were analyzed. RESULTS: Charts from 14 patients were available for review, representing 41 ED visits (range of 1 to 10 visits per patient, mean 2.9). 17% of visits were initiated at public places, 44% from home and 34% from group care facilities. 68% were transported by ambulance. In only one case was a benzodiazepine used en route. Non-compliance with medications was identified as a cause in only 34%. Investigations performed included AED levels in 76% of visits. 46% received additional parenteral or oral doses of AED's. Other laboratory and radiologic data was obtained at 90% of visits, but altered treatment at only one visit. 17% were treated for minor trauma, and only one was admitted for overnight observation. 9% had documented counseling on medication at discharge. CONCLUSIONS: Management of seizures in established epilepsy patients in the ED is extremely variable and only requires active intervention in a minority of cases. Improved out-of-hospital management and education for these patients and their caregivers could reduce ED visits, ambulance transport and unnecesary testing. Improved protocols for investigation and treatment at the ED and en route could also have a significant impact on health care resource utilization.