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Early specialized care after a first unprovoked epileptic seizure

Fisch, L
Heydrich, L
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Published in Journal of Neurology. 2016, vol. 263, no. 12, p. 2386-2394
Abstract A first seizure is a life-changing event with physical and psychological consequences. We aimed to assess the role of early comprehensive patient care after a first unprovoked seizure to improve diagnostic accuracy and follow-up adherence. From April 2011 to March 2012, patients presenting a first unprovoked epileptic seizure received standard patient care (SPC), i.e., a consultation in the ED, an EEG and a CT scan. The patients were notified of the follow-ups. We compared this protocol to subsequently acquired "early comprehensive patient care" (ECPC), which included a consultation by an epileptologist in the emergency department (ED), a routine or long-term monitoring electroencephalogram (LTM-EEG), magnetic resonance imaging and three follow-up consultations (3 weeks, 3 months, 12 months). 183 patients were included (113 ECPC, 70 SPC). LTM-EEG and MRI were performed in 51 and 85 %, respectively, of the patients in the ECPC group vs in 7 and 52 % of the patients in the SPC group (p < 0.001). A final diagnosis was obtained in 64 vs 43 % of the patients in the ECPC vs SPC group (p < 0.01). Patient attendance at 3-month was 84 % in the ECPC group vs 44 % in the SPC group (p < 0.001). At 12-month follow-up, the delay until the first recurrence was longer in the ECPC group (p = 0.008). An early epileptologist-driven protocol is associated with clinical benefit in terms of diagnostic accuracy, follow-up adherence and recurrence. This study highlights the need for epilepsy experts in the early assessment of a first epileptic seizure, starting already in the ED.
PMID: 27604619
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Research groups Epilepsie et Chirurgie (149)
Groupe Desmeules Jules (pharmacologie/toxicologie) (567)
Epilepsie et réseaux cérébraux (1002)
Médecine d'urgence (24)
Optimisations des techniques avancés en neuroimagerie (985)
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FISCH, L et al. Early specialized care after a first unprovoked epileptic seizure. In: Journal of Neurology, 2016, vol. 263, n° 12, p. 2386-2394. doi: 10.1007/s00415-016-8272-3 https://archive-ouverte.unige.ch/unige:88755

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Deposited on : 2016-11-09

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