Abstract Details

Title An Analysis of Acute Seizure Presentation in Post-stroke Patients in the Emergency Department in Detroit

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P6 - Poster Session 6 (8:00 AM-9:00 AM)

Poster/Presentation
Number 1-003

Objective We analyzed the emergency department (ED) utilization among post-stroke patients presenting with seizures in Detroit.

Background Post-stroke epilepsy (PSE) accounts for about 11% of all adult epilepsy cases and 45% of epilepsy cases over 60 years of age. In the US, epilepsy healthcare costs are approximated at 9.6 billion dollars annually.

Design/Methods A retrospective study was conducted from June 1, 2018 through December 31, 2018 on all adult ED visits at the Detroit Medical Center presenting with seizures. Data on demographics, diagnostic tests, epilepsy history and hospital disposition was collected. Patients who came for medication refills, non-seizure related reasons, syncope presentation, and all John or Jane Does were excluded.

Results Of 997 ED visits for seizures, there were 103 patient visits (PVs) in 66 unique patients with a history of stroke. Sixty-eight PVs (66%) had at least one imaging scan (CT-Head and/or MRI brain) performed in the ED and 97% of them were normal or had chronic findings. Of these PVs, 18.6% presented with status epilepticus. Of those PVs who were admitted (42.2%), 48% had a length of stay between 1 day to 1 week and 10.8% of admissions were greater than 1 week. Recurrent ED visits for subsequent seizures were seen in 65.7% of the PVs. Nearly a third (30.4%) of PVs reported missing their medications prior to seizure. Only 27.5% of PVs had at least one outpatient follow-up with neurology after discharge.

Conclusions Patients with PSE experience recurrent visits to the ED for breakthrough seizures with medication non-adherence being the most likely cause. Repeat neuroimaging in the ED is unlikely to yield findings. Further studies are needed to determine which patients would benefit from repeat imaging and focus on reducing breakthrough seizures with a history of stroke.

Authors/Disclosures
Melissa Ly, MD PRESENTER	Miss Ly has nothing to disclose.
Tabassum Chowdhury, MD	Ms. Chowdhury has nothing to disclose.
Jason Liu, MD	Mr. Liu has nothing to disclose.
Manik Tetarbe, MD (Detroit Medical Center)	Dr. Tetarbe has nothing to disclose.
Shatha Wahbi	Ms. Wahbi has nothing to disclose.
Maysaa M. Basha, MD, FAAN (Wayne State University, Detroit Medical Center)	Dr. Basha has nothing to disclose.
Deepti Zutshi, MD, FAAN (Wayne State University School of Medicine)	Dr. Zutshi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Xenon pharmaceuticals. An immediate family member of Dr. Zutshi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Boston Scientific. Dr. Zutshi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Aucta Pharmaceuticals. Dr. Zutshi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Aucta.

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