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Early specialized care after a first unprovoked epileptic seizure

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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.

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Acknowledgments

We thank the EEG and MRI technicians for their efficient and rapid patient care. This work was funded by Swiss National Foundation grants SNSF 140332 (M.S., S.V.), 127608 (F.P., M.S.), 141165 (S.V.) and 146633 (M.S.).

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Authors and Affiliations

  1. EEG and Epilepsy Unit, Division of Neurology, Geneva University Hospitals, 4, Rue Gabrielle-Perret-Gentil, 1205, Geneva, Switzerland

    L. Fisch, A. M. Lascano, V. Kapina, L. Heydrich, F. Picard, S. Vulliémoz, A. C. Héritier-Barras & M. Seeck

  2. Finance Directorate, Geneva University Hospitals, Geneva, Switzerland

    N. Vernaz Hegi

  3. Medical Direction, Geneva University Hospitals, Geneva, Switzerland

    N. Vernaz Hegi & F. Girardin

  4. Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland

    F. Girardin

  5. Division of Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland

    O. Rutschmann & F. Sarasin

  6. Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland

    M. I. Vargas

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  1. L. Fisch
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  2. A. M. Lascano
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  3. N. Vernaz Hegi
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  4. F. Girardin
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  9. M. I. Vargas
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  10. F. Picard
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  11. S. Vulliémoz
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  12. A. C. Héritier-Barras
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  13. M. Seeck
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Corresponding author

Correspondence to M. Seeck.

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Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical standards

Our study was approved the ethical committee.

Financial disclosures

L Fisch reports no disclosures, A. Lascano reports no disclosures, N. Vernaz Hegi reports no disclosures, F. Girardin reports no disclosures, V. Kapina reports no disclosures, L. Heydrich reports no disclosures, O. Rutschmann reports no disclosures, F. Sarasin reports no disclosures, M-I. Vargas reports no disclosures, F. Picard reports no disclosures, S. Vulliémoz reports no disclosures, A-C. Héritier-Barras reports no disclosures, and M. Seeck reports consulting and speaker fees from UCB, GSK, and EISAI.

Study funding

This work was funded by Swiss National Foundation grants SNSF 140332 (M.S., S.V.), 141165 (S.V.), 146633 and 163398 (M.S.). M.S. received consulting and speaker fees from UCB, GSK and EISAI.

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Fisch, L., Lascano, A.M., Vernaz Hegi, N. et al. Early specialized care after a first unprovoked epileptic seizure. J Neurol 263, 2386–2394 (2016). https://doi.org/10.1007/s00415-016-8272-3

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  • DOI: https://doi.org/10.1007/s00415-016-8272-3

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