Abstracts

Rationale: Obtaining brain imaging and electroencephalogram (EEG) studies after new-onset seizure is standard practice. In 2007, the American Academy of Neurology released a guideline recommending screening patients in the emergency room presenting with new-onset seizure with immediate computerized tomography (CT) brain scan based on a structured literature review by Harden et al. (2007) which found that CT scan findings resulted in a change of management in up to 17% of adults and 8% of children. Additional research is needed to explore the utility of brain magnetic resonance imaging (MRI) in this setting in comparison to CT. Patients who are awaiting inpatient MRI frequently have an inpatient EEG as well. The objective of this study is to investigate whether inpatient MRI and EEG obtained after new-onset seizure led to a diagnosis of epilepsy, initiation of antiepileptic therapy, or otherwise changed management in a single hospital’s patient population. Methods: We performed a retrospective chart review on patients at Memorial Hermann Hospital in the Texas Medical Center between 2013 and 2017 who had diagnoses of seizure, convulsion, epilepsy, or focal epilepsy as well as a head CT and brain MRI ordered on the same admission. Patients with a prior history of seizure or epilepsy were excluded. There is no institutional protocol in place for testing in this population; therefore, the choice to obtain testing was at the discretion of the primary and consulting physicians. Results: Sixty-five patients (51% male) between ages 7 months and 91 years (mean 56.5 years) met the above criteria. Fifty-eight patients within this group (89%) had an abnormal neurologic exam at the time of evaluation with most patients (94%) evaluated by a neurologist during admission. Forty patients subsequently had brain MRIs completed and 25 had MRIs ordered but either not completed or cancelled. Of the forty patients with MRIs completed, 30 (75%) had abnormalities detected by MRI that were not previously detected by CT (p-value: <0.05). MRI results led to an acute management change in 9 patients (22.5%), no management change in 13 patients (32.5%), and an anticipated change in future outpatient management in 11 patients (27.5%). Fifty-six patients had EEGs completed during admission with 51 (91%) being abnormal (p-value: <0.05), and 27 (48%) with epileptiform abnormalities. EEG results led to acute management change in 28 patients (50%). Of the sixty-five patients reviewed, 26 (40%) were diagnosed with epilepsy in the discharge summary, last neurology note, or both, and 55 (84%) were prescribed one or more antiepileptic drugs (AED) at discharge/last day of admission. The most commonly prescribed AEDs were levetiracetam (78%), phenytoin (29%), lacosamide (20%), and valproic acid (16%). Conclusions: At our institution, patients presenting with new-onset seizure and a normal neurologic exam typically have additional testing such as MRI brain and EEG as an outpatient, whereas those who present with an abnormal neurologic exam often have these tests done on an inpatient basis. This retrospective chart review of the utility of such testing in the inpatient setting supports the continued practice of obtaining these tests when deemed necessary by a neurologist as they frequently led to a change in acute management or an anticipated change in future outpatient management. Funding: No funding