Fisch, L; Lascano, A M; Vernaz Hegi, N; Girardin, F; Kapina, V; Heydrich, Lukas; Rutschmann, O; Sarasin, F; Vargas, M I; Picard, F; Vulliémoz, S; Héritier-Barras, A C; Seeck, M (2016). Early specialized care after a first unprovoked epileptic seizure. Journal of neurology, 263(12), pp. 2386-2394. Springer-Medizin-Verlag 10.1007/s00415-016-8272-3
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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.
Item Type: |
Journal Article (Original Article) |
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Division/Institute: |
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology |
UniBE Contributor: |
Heydrich, Lukas Emmanuel Josef Marc |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
0340-5354 |
Publisher: |
Springer-Medizin-Verlag |
Language: |
English |
Submitter: |
Stefanie Hetzenecker |
Date Deposited: |
04 Jun 2018 12:23 |
Last Modified: |
02 Mar 2023 23:29 |
Publisher DOI: |
10.1007/s00415-016-8272-3 |
PubMed ID: |
27604619 |
Uncontrolled Keywords: |
Brain imaging Cost analysis EEG Follow-up Seizure recurrence |
BORIS DOI: |
10.7892/boris.104844 |
URI: |
https://boris.unibe.ch/id/eprint/104844 |
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