Abstracts

Rationale: Seizure is defined as transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain. Around 6% of the population is likely to experience an afebrile seizure during their lifetime. The cumulative incidence of epilepsy is reported to be 3% with age adjusted incidence rate of 44/100000 persons per year, based on Rochester study. Seizures carry significant medical and psychosocial comorbidities if left untreated, thus, a thorough clinical evaluation and early diagnosis is essential to establish good quality of care. The classification of seizure semiology has evolved over the past several years. At John R.Oishei Children’s Hospital, the pediatric resident physicians lack the opportunity to rotate at the epilepsy monitoring unit during their training, which would limit their exposure. The aim of this project was to identify parts of a clinical history that are essential to define seizure semiology. The targeted audience were the resident physicians from the pediatric residency program and the combined internal medicine/pediatric residency program at the University at Buffalo. _x000D_
Methods: To implement and to improve the quality of seizure history taking, a comprehensive lecture was presented. During the lecture, seizure semiology was defined, video recording for seizures captured at the EMU were displayed, and seizure's classification was elaborated. Pre-lecture survey and post-lecture assessment were collected to assess for improvement. The main measurements that meant to be evaluated include the familiarity with seizure semiology, seizure classification and the epilepsy risk factors.  _x000D_
Results: A pre lecture survey was sent to the resident physicians at pediatric program and the combined internal medicine/pediatric program. A total of 31 residents have responded. Four percent of the survey responders indicated their non-familiarity in distinguishing epileptic paroxysmal events from the non-epileptic paroxysmal events based on the clinical description. Seventy-five percent indicated their lack of awareness of epilepsy risk factors. Ninety percent of the survey responders indicated they have suboptimal knowledge about the lateralizing and localizing seizure signs, and finally, 13% endorsed their awareness of the indications to treat new onset seizure. After the lecture, a survey was sent to the resident physicians to assess variety of measures that meant to be improved through this project.  A total of 27 residents have responded. 81.5% of the survey responders were able to characterize the patient’s paroxysmal events based on clinical description. Ninety-six percent of the survey responders were able to identify the epilepsy risk factors. Statistical analysis is in progress to show the statistical significance of our results.

Conclusions: The initial clinical evaluation remains essential for the diagnosis, treatment, and prognostication of the first seizure. The reliability of recognizing seizures based on clinical semiology varies based on physician’s experience. This study highlights the importance of improving the pediatric resident’s awareness of clinical seizure semiologic characteristics and the required steps needed for improvement. _x000D_
Funding: None