Abstracts

Rationale: Patients suffering from epileptic disorder are frequently admitted in emergency department (ED) for seizures occurrence. If the interest of the Electro-encephalogram (EEG) in the syndromic classification is well-known, its relevance in the ED for acute seizure management is not clearly defined. Indeed, the actual experts recommendations are more dedicated to inaugural seizure or non epileptic patients. The aim of the study was to evaluate in this particular population of known epileptic patients the use of emergent EEG and its real usefulness. Methods: We conducted a prospective study at an academic ED involving consecutive patients admitted for seizures, categorized as known epileptic patient and unknown epileptic patient from the 7th November 2011 until the 7th November 2012. We excluded patients who were admitted directly in intensive care unit. Pre and intra-hospital data were collected in ED with the help of a pre-established questionnaire. We collected biographic and clinical features, characteristics of epilepsy, information about EEG and its relevance. The EEG was considered useful when it provides valuable information that could improve the patient care management (i.e: repetitive electrical seizures or non convulsive status epilepticus (NCSE), psychogenic non epileptic seizure or information that could precise the syndromic diagnosis). A known EEG epileptic focus was considered as unuseful. Retrospective chart review was used to gather intra-hospital data upstream to the ED. Results: During this period of recruitment, 516 admissions in ED were analyzed for 409 patients (mean age 45 20.3 years). Among these 516 files, 74% involved patients with symptomatic partial epilepsy and 42% involved patients treated at least with 2 anti-epileptic drugs. Patients were admitted for usual seizures (in type and in number) in 298 cases (57.8%). An EEG was performed in 197 cases (38.2%), 61 in ED and 136 in conventional care units. EEG was significantly more ordered in aged patients and when the epileptic syndrome was not clearly identified. Patients admitted in ED for a usual seizure were less likely to benefit of EEG. However, in this specific group of less severe patients (usual seizures), EEG was ordered in 19.5%. Only eight of these 58 EEG were considered as useful. Considering all the EEG performed, 44 out of 197 (22.3%) were considered as useful. The relevance of the EEG was greater in aged patients, in NCSE suspicion and in case of EEG performed within the 6 hours of the ED admission. Thirteen out of 31 (42%) of the NSCE suspicion were confirmed. The EEG usefulness did not differ significantly considering the epileptic syndrome or the number of anti-epileptic drugs. Conclusions: This study shows that EEG can be useful in ED for patients with known epilepsy in clearly defined situations. If EEG appears relevant in the NCSE management, it seems less useful in case of usual seizures recurrence. These results suggest that recommendations on EEG use in known epileptic patients should be defined in order to optimize the neurophysiological resources and the patient care management in ED.