Abstracts

Rationale: Epilepsy has been shown to be one of the major neurologic conditions presenting to the emergency department (ED), accounting for a diagnosis of about 3.4 million people in the United States. The purpose of this study was to analyze demographics and trends in recurrent ED visits in patients with established epilepsy presenting with seizures in the ED.

Methods: A retrospective study was conducted on all patients aged 18 years or older who visited the ED at the Detroit Medical Center (DMC). We obtained data from June 1, 2018 through December 31, 2018 and reviewed a selected cohort of patients. We collected demographic data, diagnostic imaging and electroencephalography results, anti-seizure medication (ASM) and epilepsy history data, admission, discharge disposition, and repeat ED visit data for seizures. We excluded patients with a history of seizures who came to the ED for medication refills.

Results: Out of 679 patient encounters reviewed, 540 (79.5%) encounters in 371 unique patients presented with seizures in the ED had an established diagnosis of epilepsy. The average number of ED visits among all patients was 1.5 visits within the 6-month period. The average age was 49.1 years (range 18-91 years). Our patient population consisted of 59.4% males, 40.4% females, and 0.2% other. With regards to race, 85.4% identified as Black, 10.6% identified as White, and 4.1% of patients identified in another group. Of the 540 patient encounters, 65.6% had no acute substance use, 6.3% suffered from alcohol withdrawal in the ED and 4.2% suffered from acute alcohol intoxication. Amongst the patient encounters, 9.6% were diagnosed with status epilepticus. About 23.3% of the patient population experienced more than two seizures prior to their arrival in the ED. Imaging (Ct head, MRI Brain and/or both) were acquired in 43.7% of encounters and 0.2% were positive for an acute abnormality (space occupying lesion, blood, acute brain injury, acute stroke or acute cerebral venous thrombosis). EEG was performed in 10.6% of encounters and 61.4% were abnormal (encephalopathy, seizures, or focal abnormalities). With regard to etiology for breakthrough seizures, less than 1% of encounters presented with an acute stroke, 3.7% with an acute TBI, and 4.3% with metabolic causes. With respect to recurrent ED visits 62.8% had at least one recurrent ED visit in the same hospital system for breakthrough seizures in the one year after the ED encounter. Among the 540 encounters, 73.5% self-reported missing their ASM prior to the visit. Of these patient encounters who reported missing medications, 64.5% had a recurrent ED visit for breakthrough seizure in the one year after the ED encounter.

Conclusions: Patients with epilepsy presenting for breakthrough seizures is one of the most common reasons for ED visits. More than 70% of patients did not take their ASMs prior to their visit. Utilization of acute imaging and repetitive EEG may increase the cost of care without providing benefit. Quality studies focusing on improving patient adherence to ASMs and reducing unnecessary testing may reduce the burden of healthcare costs in patients with established epilepsy in the ED.

Funding: None.