title: Use of emergency departments by known epileptic patients: An underestimated problem?
abstract: OBJECTIVE
  Seizure is a frequent reason of admission in emergency department (ED) but little is known about the proportion and the characteristics of known epileptic patients (KEPs) who used emergency services.
  
  
  METHODS
  Over a 12-month period, we prospectively recruited adults admitted for seizure to a tertiary hospital ED. For KEPs, clinical epilepsy features and characteristics of the admission were collected.
  
  
  RESULTS
  Of the 60,578 ED admissions, 990 were related to seizure; 580 of these admissions concerned 448 different KEPs (257 males; median age: 44); 339 were residents in the health district. Epilepsy was structural/metabolic in 268 (59.8%) patients, genetic in 44 (9.8%) and unknown/undetermined in 136 (30.3%); 218 (48.7%) patients were under a single antiepileptic drug and 135 (30.1%) were followed by an epileptologist. Of the 580 KEP admissions, 440 (75.8%) concerned patients who had called the emergency medical assistance number, 252 (43.4%) with a discharge diagnosis of usual seizure and 43 (7.4%) of a status epilepticus. Half the KEPs were discharged without hospitalization. We estimated that 9.0% of KEPs residing in the district had used the ED during the period.
  
  
  CONCLUSIONS
  Proportion of KEPs using ED is high. Most of the admissions concerned usual seizures suggesting that staff training and educational programmes for patients and for their relatives need to be improved. The organization of the prehospital and of the emergency medical services should also be adjusted to this specific need. Further research should be conducted to optimize the seizure care pathway for KEPs.
authors.affiliation: Department of Emergency Medicine and SAMU 59, University of Lille Nord de France, Lille, France. Electronic address: marie.girot@chru-lille.fr.
authors.forename: Marie
authors.initials: M
authors.lastname: Girot
authors.affiliation: Department of Public Health and EA 2694, University of Lille Nord de France, Lille, France. Electronic address: herve.hubert@univ-lille2.fr.
authors.forename: Herve
authors.initials: H
authors.lastname: Hubert
authors.affiliation: INSERM UMR 744, University of Lille Nord de France, Lille, France. Electronic address: florence.richard@chru-lille.fr.
authors.forename: Florence
authors.initials: F
authors.lastname: Richard
authors.affiliation: Department of Clinical Neurophysiology, EA 1046, University of Lille Nord de France, Lille, France. Electronic address: maxime.chochoi@chru-lille.fr.
authors.forename: Maxime
authors.initials: M
authors.lastname: Chochoi
authors.affiliation: Department of Pharmacology, EA 1046 and CIC 1403 INSERM, University of Lille Nord de France, Lille, France. Electronic address: dominique.deplanque@chru-lille.fr.
authors.forename: Dominique
authors.initials: D
authors.lastname: Deplanque
authors.affiliation: Department of Clinical Neurophysiology, EA 1046, University of Lille Nord de France, Lille, France. Electronic address: philippe.derambure@chru-lille.fr.
authors.forename: Philippe
authors.initials: P
authors.lastname: Derambure
authors.affiliation: Department of Emergency Medicine and SAMU 59, University of Lille Nord de France, Lille, France. Electronic address: patrick.girardie@chru-lille.fr.
authors.forename: Patrick
authors.initials: P
authors.lastname: Girardie
authors.affiliation: Department of Emergency Medicine and SAMU 59, University of Lille Nord de France, Lille, France. Electronic address: nicolas.pauchet@chru-lille.fr.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Pauchet
authors.affiliation: Department of Emergency Medicine and SAMU 59, University of Lille Nord de France, Lille, France. Electronic address: stephani.leblanc@gmail.com.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Leblanc
authors.affiliation: Department of Emergency Medicine and SAMU 59, University of Lille Nord de France, Lille, France. Electronic address: alice.lim@chru-lille.fr.
authors.forename: Alice
authors.initials: A
authors.lastname: Lim
authors.affiliation: Department of Emergency Medicine and SAMU 59, University of Lille Nord de France, Lille, France. Electronic address: eric.wiel@chru-lille.fr.
authors.forename: Eric
authors.initials: E
authors.lastname: Wiel
authors.affiliation: Department of Emergency Medicine and SAMU 59, University of Lille Nord de France, Lille, France. Electronic address: pierre.williate@chru-lille.fr.
authors.forename: Pierre
authors.initials: P
authors.lastname: Williate
authors.affiliation: Department of Clinical Neurophysiology, EA 1046, University of Lille Nord de France, Lille, France. Electronic address: william.szurhaj@chru-lille.fr.
authors.forename: William
authors.initials: W
authors.lastname: Szurhaj
authors.affiliation: Department of Medical Information, University of Lille Nord de France, Lille, France. Electronic address: xavier.lenne@chru-lille.fr.
authors.forename: Xavier
authors.initials: X
authors.lastname: Lenne
authors.affiliation: Department of Clinical Neurophysiology, EA 1046, University of Lille Nord de France, Lille, France. Electronic address: l.tyvaert@chu-nancy.fr.
authors.forename: Louise
authors.initials: L
authors.lastname: Tyvaert
mesh_terms: D000328:Adult; D004632:Emergency Medical Services / Q000379:methods / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004827:Epilepsy / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
keywords: Demographic description; Emergency medical services; Epilepsy; Quantitative study; Seizure