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  3. Early specialized care after a first unprovoked epileptic seizure.
 

Early specialized care after a first unprovoked epileptic seizure.

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BORIS DOI
10.7892/boris.104844
Date of Publication
December 2016
Publication Type
Article
Division/Institute

Universitätsklinik fü...

Author
Fisch, L
Lascano, A M
Vernaz Hegi, N
Girardin, F
Kapina, V
Heydrich, Lukas Emmanuel Josef Marcorcid-logo
Universitätsklinik für Neurologie
Rutschmann, O
Sarasin, F
Vargas, M I
Picard, F
Vulliémoz, S
Héritier-Barras, A C
Seeck, M
Subject(s)

600 - Technology::610...

Series
Journal of neurology
ISSN or ISBN (if monograph)
0340-5354
Publisher
Springer-Medizin-Verlag
Language
English
Publisher DOI
10.1007/s00415-016-8272-3
PubMed ID
27604619
Uncontrolled Keywords

Brain imaging Cost an...

Description
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.
Handle
https://boris-portal.unibe.ch/handle/20.500.12422/154142
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