Necessity of Emergency Medical Care for Patients with Epilepsy Presenting with Typical Seizures (P5.050)

OBJECTIVE: To evaluate if there is a group of patients with known epilepsy that present to the emergency department (ED) unnecessarily for typical breakthrough seizures. BACKGROUND: Typical breakthrough seizures in a known epilepsy patient do not require further emergent work-up and medication adjustments can be made safely in the outpatient setting. DESIGN/METHODS: A retrospective chart review was performed for patients presenting with seizure to our tertiary medical center. One hundred ninety-seven charts were reviewed. Ninety-seven patients with new-onset seizure, new seizure type, status epilepticus, secondary injuries from the seizure, or secondary medical problems were excluded. One-hundred patients met our criteria, having known epilepsy and presenting with a typical breakthrough seizure without other illness or medical problem. RESULTS: Forty-eight percent of patients had convulsive events, 10% had unresponsive events, and for 42% of patients, the type of seizure was not documented. Forty-two percent had their seizure at home, 13% in public, 13% in a health-care setting, and 32% in an undocumented setting. Six percent were transported to the ED by private vehicle, 49% by emergency medical services, and 45% by unknown means. Thirty-three percent had brain imaging done in the ED. Eighty-nine percent of patients were discharged and 11% were admitted to the hospital. When divided by the two separate ED sites, 94% of the patients at the Main Campus ED and 79% of the patients at University Hospital East ED were discharged. Neurology residents are available to evaluate patients at the Main Campus ED. Patients at the other ED site, however, are often admitted just to be seen by a neurologist. CONCLUSIONS: A high percentage of patients with known epilepsy presenting to the ED with a typical breakthrough seizure were able to be discharged home safely. These findings highlight the unnecessary ED visits and healthcare costs associated with typical breakthrough seizures. Disclosure: Dr. Rust has nothing to disclose. Dr. Shneker has received personal compensation for activities with Supernous. Dr. Shneker has received research support from UCB Pharma, GlaxoSmithKline Inc., Eisai Inc., Sunovion Pharmaceuticals, and SK Life Sciences.