Abstracts

Rationale: There is a dearth of published data on the quality of epilepsy healthcare provision in UK prison settings. Only one previous study was identified (Tittensor et al 2008), which highlighted poor compliance with national guidelines for epilepsy care in this population and limited collaboration with specialist epilepsy services. We sought to examine epilepsy focused healthcare provision in one of the largest prisons in England to determine exactly how care could be optimised for a patient group that is seldom seen in our epilepsy clinics within the National Health Service.  Methods: Standards were identified using the National Institute for Health and Care Excellence (NICE) guidance and UK Medicines Information. Standards included access to annual specialist review, use of a recently optimized anticonvulsant regimen, information provision regarding rescue medications and restrictions on duties or cell arrangements. The audit was conducted in one of the largest category B prisons in the UK (A closed prison for individuals who although not requiring maximum security, are considered to be a risk to the public). Fifty five adult male prisoners with a diagnosis of epilepsy were identified during the audit period. Pseudonymised audit data was collected using face to face interviews. Data was recorded using a standardized data collection proforma. Results: Our findings highlight some unique demographics of this subgroup within the epilepsy patient population. There was an increased prevalence of smoking (82%), recent heavy alcohol use (40%) and recent illicit drug misuse (82%). A history of comorbid mental health problems were identified in 82% of our patient sample. Collectively these findings highlight particular challenges with respect to (1) risk of development of mental and physical health comorbidities; (2) the presence of factors that may contribute to poor seizure control and (3) diversion potential for drugs such as pregabalin and benzodiazepines.There was an increased frequency of seizure onset in young to middle adulthood (63%).  Seizure semiology in 14.5% resembled non epileptic attacks and required further investigation. Recent increase in seizure frequency was noted in 18.3%; a reversible precipitant had been identified in only 60% of these cases. Further optimization of anticonvulsant regimen was required in 67.3% of the study sample and only 14.5% of participants had been seizure free for the last 12 months. This emphasized the need for regular specialist review; just 38% of participants had been reviewed in the last 12 months. Regular, timely delivery of anticonvulsant medication had been difficult in 43.6% of cases; reasons for this were multifactorial. Rates of provision of safety information relevant to epilepsy ranged from 12.7% (cell arrangements) to 67.3% (Driving). Conclusions: A nationwide initiative is required to improve standards of epilepsy healthcare in prison settings. We aim to pilot improvement initiatives locally whilst collecting further data with collaborators across the UK. Improvement initiatives will centre on staff education and training, an overhaul of rescue medication prescribing, provision of patient information and development of a specialist nurse led inreach service. Funding: No funding was received in support of  this abstract.