Profile of patients presenting with seizures as emergencies and immediate noncompliance to antiepileptic medications

Abstract

Introduction:Seizure is a common manifestation of the many neurological conditions faced by primary care physicians. This study aims to determine the prevalence, etiology, and predictors of immediate noncompliance of adult patients presenting with seizures to the department of emergency (ED).Materials and Methods:We conducted this study in the ED of CMC, Vellore from November 2015 to February 2016. Retrospective chart review was used to gather specific data regarding these consecutive cases.Results:During the study period, 477 patients presented with seizures. The prevalence of nontrauma seizures in the ED was 2.3% [Figure 1]. The mean age was 41.4 ± 17.25 years. There was a male predominance (63.1%). About 11.7% had active seizures at presentation to the ED and less than a quarter (21.8%) were determined to have status epilepticus. Nearly 41% had new-onset seizures with common etiologies being idiopathic generalized epilepsy (22.6%), metabolic causes (17.9%), acute febrile illnesses (14.42%), and space-occupying lesions (12.3%). Among those with a history of seizures (58.9%), 87.9% were advised regular medications but 58.5% of them were immediately noncompliant. Phenytoin (58.6%), sodium valproate (20.5%), and levetiracetam (18%) were the most commonly used antiepileptics with 23% on multidrug therapy. About 60% were discharged stable from the ED. Univariate analysis showed chronic alcohol consumption (OR: 2.78; 95% CI: 1, 7.7) and female sex (OR: 1.45; 95% CI: 1–2.5) to be predictors of immediate noncompliance to antiepileptics.Conclusion:Common etiologies of new-onset seizures in the ED are idiopathic generalized epilepsy, metabolic causes, and acute febrile illnesses. More than half the patients with a known seizure disorder are immediately noncompliant to the advised medications. Knowledge among primary healthcare physicians about the importance of emphasizing compliance will greatly reduce the burden of seizures.

Decreasing Emergency Department Visits for Children With Epilepsy

“…Studies have evaluated risk factors for ED use in patients with epilepsy, which consist of prior excessive ED utilization for seizure and nonseizure care, lower socioeconomic status, inadequate dosing or lack of seizure rescue medication, limited knowledge about seizure and epilepsy care, and poor daily adherence to antiseizure medication use. [1][2][3]8,9,11,[14][15][16][17][18][19][20][21][22] Interventions to address these factors have been implemented with some success in reducing ED visits for patients with epilepsy. [8][9][10][11] However, the published use of quality improvement (QI) methodology to decrease ED utilization is limited.…”