Abstracts

Rationale: We currently don't have a standardized protocol to treat patients who go to the emergency room after an acute seizure. The evaluation and treatment of the acute seizures may have significant implications for the patients and for the health system. This study is performed to assess the current practice at a university hospital to treat those patients. Methods: We performed a retrospective study at the University of South Alabama Medical Center in Mobile, AL. We reviewed the ED medical records from January 1-May 9, 2010 with an ICD-9 code of convulsion, seizure, or epilepsy of any type (780, 345). We included only those patients with a history of prior seizures who present to the ED after a breakthrough seizure. We excluded any patient with documented evidence of recent anoxic brain injury, acute stroke, new tumor, meningoencephalitis, ethanol withdrawal, benzodiazepine withdrawal, amphetamine intoxication, and suspected pseudoseizures. We suspected pseudoseizures if bilateral convulsions but no altered level of consciousness were described or witnessed or no antiepileptic treatment was given despite a convulsion was witnessed in the ED. We reviewed each patient's available history and physical, laboratory evaluation, and imaging performed in the emergency department.. Patients who met the inclusion criteria were enrolled in this study. We reviewed the demographic data and the description of seizure type, number of seizures prior ED admission, prior AED therapy, type, route, dose and administration time of any antiepileptics or benzodiazepines given in the ED. We also reviewed the imaging and laboratory data, length of stay, discharge disposition, and record of recurrent seizures within 24 hours after discharge from the ED. Results: 66 patients met the inclusion criteria. Of these, four patients who left against medical advice and one patient with incomplete records,were excluded from this analysis. 60% were male and the mean age was 37 years. Seizure types were not clearly documented but majority of them were described as convulsive (92%). Neurology was consulted in 21% of these cases. 40% were evaluated with a CT scan and none of these imaging studies demonstrated an acute abnormality. Five different treatment groups were identified. 25 patients received no initial treatment in the ED for the seizure, and 3 of these patient had a second seizure in the ED (12%). 18 patients received IV phenytoin load without benzodiazepine, 6 patients received IV lorazepam without further AED therapy, 2 patients received IV lorazepam followed by IV AED, 10 patients received oral AED while in the ED, and 2 patients received oral AED after IV lorazepam. The patients who recieved IV phenytoin loading had a longer ED stay (5.6 hours) compared to patients treated with either IV lorazepam or oral AED (3.5 hours). Conclusions: This study demonstrated a lack of uniform criteria from ED physicians when treating patients after a seizure event. Seizure recurrence in the ED is a risk for untreated patients but IV AED loading may not be necessary and it appears to be associated with a longer ED stay.