Early specialized care after a first unprovoked epileptic seizure.

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)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Heydrich, Lukas

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:

05 Nov 2019 10:42

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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