Early specialized care after a first unprovoked epileptic seizure.
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.
EEG and Epilepsy Unit, Division of Neurology, Geneva University Hospitals, 4, Rue Gabrielle-Perret-Gentil, 1205, Geneva, Switzerland.
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Fisch
EEG and Epilepsy Unit, Division of Neurology, Geneva University Hospitals, 4, Rue Gabrielle-Perret-Gentil, 1205, Geneva, Switzerland.
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Lascano
Finance Directorate, Geneva University Hospitals, Geneva, Switzerland.|Medical Direction, Geneva University Hospitals, Geneva, Switzerland.
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Vernaz Hegi
Medical Direction, Geneva University Hospitals, Geneva, Switzerland.|Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland.
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Girardin
EEG and Epilepsy Unit, Division of Neurology, Geneva University Hospitals, 4, Rue Gabrielle-Perret-Gentil, 1205, Geneva, Switzerland.
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Kapina
EEG and Epilepsy Unit, Division of Neurology, Geneva University Hospitals, 4, Rue Gabrielle-Perret-Gentil, 1205, Geneva, Switzerland.
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Heydrich
Division of Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.
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Rutschmann
Division of Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.
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Sarasin
Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland.
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Vargas
EEG and Epilepsy Unit, Division of Neurology, Geneva University Hospitals, 4, Rue Gabrielle-Perret-Gentil, 1205, Geneva, Switzerland.
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Picard
EEG and Epilepsy Unit, Division of Neurology, Geneva University Hospitals, 4, Rue Gabrielle-Perret-Gentil, 1205, Geneva, Switzerland.
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Vulliémoz
EEG and Epilepsy Unit, Division of Neurology, Geneva University Hospitals, 4, Rue Gabrielle-Perret-Gentil, 1205, Geneva, Switzerland.
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Héritier-Barras
EEG and Epilepsy Unit, Division of Neurology, Geneva University Hospitals, 4, Rue Gabrielle-Perret-Gentil, 1205, Geneva, Switzerland. margitta.seeck@hcuge.ch.
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Seeck
D000293:Adolescent; D000328:Adult; D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging / Q000503:physiopathology; D003365:Costs and Cost Analysis; D019468:Disease Management; D004562:Electrocardiography; D004569:Electroencephalography; D004827:Epilepsy / Q000175:diagnosis* / Q000191:economics / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D012189:Retrospective Studies; D055815:Young Adult
Brain imaging; Cost analysis; EEG; Follow-up; Seizure recurrence