Abstracts

This abstract has been invited to present during the Basic Science Poster Highlights poster session

Rationale: It is established that video-EEG monitoring in the epilepsy monitoring unit (EMU) is a valuable tool in the diagnosis and treatment of patients with seizures and seizure-like events, allowing providers to characterize habitual events and localize seizure onset. Not infrequently, however, the EMU evaluation is terminated prematurely or the goals of the admission are not achieved.  Several studies have identified socioeconomic barriers to seizure and epilepsy treatment and completion of epilepsy surgery. Although there have been disparities identified at the pre-surgical step of epilepsy specialist referral and ultimate outcome of completed surgery, there are no known studies to date investigating disparities involved in the specific step of successful completion of an EMU admission. 

Methods: This was a retrospective chart review of patients admitted to the EMU at Spectrum Health with referrals placed between January 2018 and June 2020. Included patients were 18 years and older and were admitted for diagnostic or pre-surgical epilepsy evaluation. Patients with repeat admissions and intracranial evaluations were excluded. Data collected included demographics (age, sex, race) and social determinants of health (insurance status, place of residence). Additional features of the underlying epilepsy diagnosis were recorded, including seizure frequency, history of a prior abnormal EEG, and the number of failed medications. Success of the admission was assessed by whether clinical events were captured and if the goal of the study was met as determined by the discharging provider. 

Results: This study included 841 patients admitted to the EMU for diagnostic or presurgical workup. A total of 37.5% were male, 83.3% were white, 5.5% were black, and 3.8% were hispanic. Clinical events were captured in 544 (64.7%) patients and the goal of the study was achieved in 95.1% of those patients. Patients with events captured and those that achieved the goal of the study had a higher rate of medication changes and change in diagnosis on discharge. There was no association between sociodemographic characteristics such as age, sex, race, and zip code of residence with whether the goal of the study was met. However, patients with an abnormal prior EEG were more likely to have the goal achieved than those with normal prior EEGs. 

Conclusions: Although prior studies have demonstrated negative associations between specific socioeconomic factors and referrals for epilepsy specialist evaluation, the findings of this study are reassuring and suggest that the majority of studied sociodemographic factors were not associated with the overall success of an EMU admission in this patient population. On the other hand, successful admissions occurred more often in patients with a prior abnormal EEG, which may serve as a surrogate marker for epilepsy severity. This study provides insight into possible predictors of successful EMU admissions; however, it is limited by the overall lack of diversity in sociodemographic features in this patient population. 

Funding: None