Implementation of Early Neurologist Evaluation after a First Epileptic Seizure

Abstract

Abstract Degree project, Programme in medicine Implementation of Early Neurologist Evaluation after a First Epileptic Seizure Therese Öqvist, 2018, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Neuro Health Care at Sahlgrenska University Hospital, Gothenburg, Sweden Introduction: A seizure is a frightening experience and 10% of the population will experience one. A short wait-time from suspected seizure to neurologist visit is important both physically and psychologically. To shorten the wait-time at Sahlgrenska University hospital (SU) a new routine for managing first seizures at the emergency room (ER) was introduced in July 2016 and a first seizure clinic was established. Other prospects of the change were to increase the proportion of referrals from the ER leading to seizure diagnosis as opposed to differential diagnoses e.g. syncope and to reduce unnecessary examinations. Aim: To evaluate the introduction of the first seizure clinic at SU in terms of efficient resource utilization. Method: A retrospective medical chart review of 65 patients referred from the ER at SU to the neurologist at SU due to a suspected seizure. Results: The time from suspected seizure to neurologist visit was significantly shorter in 2017 compared to 2016 (P=0.004). There was no significant difference in diagnoses set after the neurologist visit, time from seizure to magnetic resonance imaging (MRI) or electroencephalography (EEG) or in amount of MRI and EEG examinations between 2016 and 2017. Conclusions: The shorter wait-time from seizure to neurologist visit is important in minimizing the risk of seizure recurrence as patients are informed of prognosis and can, if 4 necessary, begin treatment. The streamline of the first seizure clinic shown in this study can hopefully aid in its establishment elsewhere.