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Erschienen in: Journal of Neurology 12/2016

07.09.2016 | Original Communication

Early specialized care after a first unprovoked epileptic seizure

verfasst von: L. Fisch, A. M. Lascano, N. Vernaz Hegi, F. Girardin, V. Kapina, L. Heydrich, O. Rutschmann, F. Sarasin, M. I. Vargas, F. Picard, S. Vulliémoz, A. C. Héritier-Barras, M. Seeck

Erschienen in: Journal of Neurology | Ausgabe 12/2016

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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.
Literatur
1.
Zurück zum Zitat Begley CE, Durgin TL (2015) The direct cost of epilepsy in the United States: a systematic review of estimates. Epilepsia 56:1376–1387CrossRefPubMed Begley CE, Durgin TL (2015) The direct cost of epilepsy in the United States: a systematic review of estimates. Epilepsia 56:1376–1387CrossRefPubMed
2.
Zurück zum Zitat Berg AT, Shinnar S (1991) The risk of seizure recurrence following a first unprovoked seizure: a quantitative review. Neurology 41:965–972CrossRefPubMed Berg AT, Shinnar S (1991) The risk of seizure recurrence following a first unprovoked seizure: a quantitative review. Neurology 41:965–972CrossRefPubMed
3.
Zurück zum Zitat Brignole M, Alboni P, Benditt DG, Bergfeldt L, Blanc JJ, Thomsen PE, Gert van Dijk J, Fitzpatrick A, Hohnloser S, Janousek J, Kapoor W, Kenny RA, Kulakowski P, Masotti G, Moya A, Raviele A, Sutton R, Theodorakis G, Ungar A, Wieling W, Priori SG, Garcia MA, Budaj A, Cowie M, Deckers J, Burgos EF, Lekakis J, Lindhal B, Mazzotta G, Morais J, Oto A, Smiseth O, Menozzi C, Ector H, Vardas P (2004) Guidelines on management (diagnosis and treatment) of syncope-update 2004. Executive summary. Eur Heart J 25:2054–2072CrossRefPubMed Brignole M, Alboni P, Benditt DG, Bergfeldt L, Blanc JJ, Thomsen PE, Gert van Dijk J, Fitzpatrick A, Hohnloser S, Janousek J, Kapoor W, Kenny RA, Kulakowski P, Masotti G, Moya A, Raviele A, Sutton R, Theodorakis G, Ungar A, Wieling W, Priori SG, Garcia MA, Budaj A, Cowie M, Deckers J, Burgos EF, Lekakis J, Lindhal B, Mazzotta G, Morais J, Oto A, Smiseth O, Menozzi C, Ector H, Vardas P (2004) Guidelines on management (diagnosis and treatment) of syncope-update 2004. Executive summary. Eur Heart J 25:2054–2072CrossRefPubMed
4.
Zurück zum Zitat Dunn MJ, Breen DP, Davenport RJ, Gray AJ (2005) Early management of adults with an uncomplicated first generalised seizure. Emerg Med J 22:237–242CrossRefPubMedPubMedCentral Dunn MJ, Breen DP, Davenport RJ, Gray AJ (2005) Early management of adults with an uncomplicated first generalised seizure. Emerg Med J 22:237–242CrossRefPubMedPubMedCentral
5.
Zurück zum Zitat Eatock J, Baker GA (2007) Managing patient adherence and quality of life in epilepsy. Neuropsychiatric Dis Treat 3:117–131CrossRef Eatock J, Baker GA (2007) Managing patient adherence and quality of life in epilepsy. Neuropsychiatric Dis Treat 3:117–131CrossRef
7.
Zurück zum Zitat Fisher RS, van Emde Boas W, Blume W, Elger C, Genton P, Lee P, Engel J Jr (2005) Epileptic seizures and epilepsy: definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). Epilepsia 46:470–472CrossRefPubMed Fisher RS, van Emde Boas W, Blume W, Elger C, Genton P, Lee P, Engel J Jr (2005) Epileptic seizures and epilepsy: definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). Epilepsia 46:470–472CrossRefPubMed
8.
Zurück zum Zitat Gao L, Hu H, Zhao FL, Li SC (2016) Can the direct medical cost of chronic disease be transferred across different countries? Using cost-of-illness studies on type 2 diabetes, epilepsy and schizophrenia as examples. PLoS One 11:e0147169CrossRefPubMedPubMedCentral Gao L, Hu H, Zhao FL, Li SC (2016) Can the direct medical cost of chronic disease be transferred across different countries? Using cost-of-illness studies on type 2 diabetes, epilepsy and schizophrenia as examples. PLoS One 11:e0147169CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat Hakami T, McIntosh A, Todaro M, Lui E, Yerra R, Tan KM, French C, Li S, Desmond P, Matkovic Z, O’Brien TJ (2013) MRI-identified pathology in adults with new-onset seizures. Neurology 81:920–927CrossRefPubMed Hakami T, McIntosh A, Todaro M, Lui E, Yerra R, Tan KM, French C, Li S, Desmond P, Matkovic Z, O’Brien TJ (2013) MRI-identified pathology in adults with new-onset seizures. Neurology 81:920–927CrossRefPubMed
10.
Zurück zum Zitat Hauser WA, Annegers JF, Kurland LT (1993) Incidence of epilepsy and unprovoked seizures in Rochester, Minnesota: 1935–1984. Epilepsia 34:453–468CrossRefPubMed Hauser WA, Annegers JF, Kurland LT (1993) Incidence of epilepsy and unprovoked seizures in Rochester, Minnesota: 1935–1984. Epilepsia 34:453–468CrossRefPubMed
11.
Zurück zum Zitat King MA, Newton MR, Jackson GD, Fitt GJ, Mitchell LA, Silvapulle MJ, Berkovic SF (1998) Epileptology of the first-seizure presentation: a clinical, electroencephalographic, and magnetic resonance imaging study of 300 consecutive patients. Lancet 352:1007–1011CrossRefPubMed King MA, Newton MR, Jackson GD, Fitt GJ, Mitchell LA, Silvapulle MJ, Berkovic SF (1998) Epileptology of the first-seizure presentation: a clinical, electroencephalographic, and magnetic resonance imaging study of 300 consecutive patients. Lancet 352:1007–1011CrossRefPubMed
12.
Zurück zum Zitat Krumholz A, Wiebe S, Gronseth G, Shinnar S, Levisohn P, Ting T, Hopp J, Shafer P, Morris H, Seiden L, Barkley G, French J (2007) Practice parameter: evaluating an apparent unprovoked first seizure in adults (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology 69:1996–2007CrossRefPubMed Krumholz A, Wiebe S, Gronseth G, Shinnar S, Levisohn P, Ting T, Hopp J, Shafer P, Morris H, Seiden L, Barkley G, French J (2007) Practice parameter: evaluating an apparent unprovoked first seizure in adults (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology 69:1996–2007CrossRefPubMed
13.
Zurück zum Zitat Krumholz A, Wiebe S, Gronseth GS, Gloss DS, Sanchez AM, Kabir AA, Liferidge AT, Martello JP, Kanner AM, Shinnar S, Hopp JL, French JA (2015) Evidence-Based Guideline: management of an Unprovoked First Seizure in Adults: Report of the Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Epilepsy Curr/Am Epilepsy Soc 15:144–152CrossRef Krumholz A, Wiebe S, Gronseth GS, Gloss DS, Sanchez AM, Kabir AA, Liferidge AT, Martello JP, Kanner AM, Shinnar S, Hopp JL, French JA (2015) Evidence-Based Guideline: management of an Unprovoked First Seizure in Adults: Report of the Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Epilepsy Curr/Am Epilepsy Soc 15:144–152CrossRef
14.
Zurück zum Zitat Mendez M, Radtke RA (2001) Interactions between sleep and epilepsy. J Clin Neurophysiol 18:106–127CrossRefPubMed Mendez M, Radtke RA (2001) Interactions between sleep and epilepsy. J Clin Neurophysiol 18:106–127CrossRefPubMed
15.
Zurück zum Zitat Michel V, Mazzola L, Lemesle M, Vercueil L (2015) Long-term EEG in adults: sleep-deprived EEG (SDE), ambulatory EEG (Amb-EEG) and long-term video-EEG recording (LTVER). Clin Neurophysiol 45:47–64CrossRef Michel V, Mazzola L, Lemesle M, Vercueil L (2015) Long-term EEG in adults: sleep-deprived EEG (SDE), ambulatory EEG (Amb-EEG) and long-term video-EEG recording (LTVER). Clin Neurophysiol 45:47–64CrossRef
17.
Zurück zum Zitat Noda AH, Hermsen A, Berkenfeld R, Dennig D, Endrass G, Kaltofen J, Safavi A, Wiehler S, Carl G, Meier U, Elger CE, Menzler K, Knake S, Rosenow F, Strzelczyk A (2015) Evaluation of costs of epilepsy using an electronic practice management software in Germany. Seizure 26:49–55CrossRefPubMed Noda AH, Hermsen A, Berkenfeld R, Dennig D, Endrass G, Kaltofen J, Safavi A, Wiehler S, Carl G, Meier U, Elger CE, Menzler K, Knake S, Rosenow F, Strzelczyk A (2015) Evaluation of costs of epilepsy using an electronic practice management software in Germany. Seizure 26:49–55CrossRefPubMed
18.
Zurück zum Zitat Nowack WJ, Janati A, Metzer WS, Nickols J (1988) The anterior temporal electrode in the EEG of the adult. Clin Electroencephalogr 19:199–204CrossRefPubMed Nowack WJ, Janati A, Metzer WS, Nickols J (1988) The anterior temporal electrode in the EEG of the adult. Clin Electroencephalogr 19:199–204CrossRefPubMed
19.
Zurück zum Zitat Paliwal P, Wakerley BR, Yeo LL, Ali KM, Ibrahim I, Wilder-Smith E, Sim TB, Pohlmann-Eden B, Rathakrishnan R (2015) Early electroencephalography in patients with Emergency Room diagnoses of suspected new-onset seizures: diagnostic yield and impact on clinical decision-making. Seizure 31:22–26CrossRefPubMed Paliwal P, Wakerley BR, Yeo LL, Ali KM, Ibrahim I, Wilder-Smith E, Sim TB, Pohlmann-Eden B, Rathakrishnan R (2015) Early electroencephalography in patients with Emergency Room diagnoses of suspected new-onset seizures: diagnostic yield and impact on clinical decision-making. Seizure 31:22–26CrossRefPubMed
20.
Zurück zum Zitat Panayiotopoulos CP (2005) Idiopathic generalized epilepsy. In: The Epilepsies: Seizures, Syndromes and Management. Bladon Medical Publishing, Oxfordshire, UK Panayiotopoulos CP (2005) Idiopathic generalized epilepsy. In: The Epilepsies: Seizures, Syndromes and Management. Bladon Medical Publishing, Oxfordshire, UK
21.
Zurück zum Zitat Pohlmann-Eden B, Newton M (2008) First seizure: EEG and neuroimaging following an epileptic seizure. Epilepsia 49(Suppl 1):19–25CrossRefPubMed Pohlmann-Eden B, Newton M (2008) First seizure: EEG and neuroimaging following an epileptic seizure. Epilepsia 49(Suppl 1):19–25CrossRefPubMed
22.
Zurück zum Zitat Pugh MJ, Leykum LK, Lanham HJ, Finley EP, Noel PH, McMillan KK, Pugh JA (2014) Implementation of the Epilepsy Center of Excellence to improve access to and quality of care—protocol for a mixed methods study. Implement Sci 9:44CrossRefPubMedPubMedCentral Pugh MJ, Leykum LK, Lanham HJ, Finley EP, Noel PH, McMillan KK, Pugh JA (2014) Implementation of the Epilepsy Center of Excellence to improve access to and quality of care—protocol for a mixed methods study. Implement Sci 9:44CrossRefPubMedPubMedCentral
23.
Zurück zum Zitat Schreiner A, Pohlmann-Eden B (2003) Value of the early electroencephalogram after a first unprovoked seizure. Clin Electroencephalogr 34:140–144CrossRefPubMed Schreiner A, Pohlmann-Eden B (2003) Value of the early electroencephalogram after a first unprovoked seizure. Clin Electroencephalogr 34:140–144CrossRefPubMed
24.
Zurück zum Zitat Smith SJ (2005) EEG in the diagnosis, classification, and management of patients with epilepsy. J Neurol Neurosurg Psychiatry 76(Suppl 2):ii2–ii7PubMedPubMedCentral Smith SJ (2005) EEG in the diagnosis, classification, and management of patients with epilepsy. J Neurol Neurosurg Psychiatry 76(Suppl 2):ii2–ii7PubMedPubMedCentral
25.
Zurück zum Zitat van Donselaar CA, Schimsheimer RJ, Geerts AT, Declerck AC (1992) Value of the electroencephalogram in adult patients with untreated idiopathic first seizures. Arch Neurol 49:231–237CrossRefPubMed van Donselaar CA, Schimsheimer RJ, Geerts AT, Declerck AC (1992) Value of the electroencephalogram in adult patients with untreated idiopathic first seizures. Arch Neurol 49:231–237CrossRefPubMed
Metadaten
Titel
Early specialized care after a first unprovoked epileptic seizure
verfasst von
L. Fisch
A. M. Lascano
N. Vernaz Hegi
F. Girardin
V. Kapina
L. Heydrich
O. Rutschmann
F. Sarasin
M. I. Vargas
F. Picard
S. Vulliémoz
A. C. Héritier-Barras
M. Seeck
Publikationsdatum
07.09.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
Journal of Neurology / Ausgabe 12/2016
Print ISSN: 0340-5354
Elektronische ISSN: 1432-1459
DOI
https://doi.org/10.1007/s00415-016-8272-3

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