Highlights
- •SSC reduced wait-times for assessment and investigations
- •The SSC corrects diagnoses and streamlines management decisions and workup
- •The SSC is an effective platform for evaluation of people with a first seizure in life
- •Predictors of epilepsy are: EEG and imaging abnormalities, being stratified as high or medium-risk for seizure recurrence, and event semiology
Abstract
Introduction
The effect of the single seizure clinic (SSC) model on patient diagnose, work-up,
wait-times, and clinical care is poorly characterized and its efficacy unclear. The
present study assesses patient characteristics and evaluates the impact of a single
seizure clinic (SSC) model on wait-times and access to care.
Material and methods
A prospective study of all patients (n = 200) referred to our SSC for first seizure evaluation. Demographic, clinical, and
paraclinicial variables were systematically collected and analyzed against a historical
cohort. Binary logistic regression analysis was performed to predict impact of dichotomized
variables on diagnosis of epilepsy. Diagnostic concordance between SSC nurses and
epileptologists was also assessed.
Results
Predominant referral sources were emergency department physicians and general practitioners.
Mean wait-time for first assessment was significantly reduced by 70.5% employing the
SSC model versus historical usual care. A diagnosis was established at first-contact
in 80.5% of cases while 16.0% of patients required a second visit. Eighty-two patients
(41.0%) were diagnosed with epilepsy. An abnormal EEG was found in 93.9% of patients
diagnosed with epilepsy. Sixty-three patients were started on anti-epileptic drugs
(63.5% lamotrigine, 7.0% levetiracetam, 5.0% phenytoin, and 5.0% topiramate). In 18%
of cases driving restrictions were initiated by the SSC. The most common non-seizure
diagnosis was syncope (24.0%).
Discussion
The SSC reduced wait-times for assessment and investigations, clarified diagnoses,
affected management decisions with respect to further workup, pharmacotherapy, and
driving. There was moderate correlation between SSC nurses and physicians (kappa = 0.54; p < 0.001) as physicians were significantly more likely to diagnose epilepsy. Key factors
identified as predictors of epilepsy were: presence of abnormalities on electroencephalography
and imaging studies, patients stratified as high or medium-risk for seizure recurrence,
semiological characteristics such as amnesia and limb stiffening, and presence of
tongue trauma, or incontinence.
Conclusions
The SSC model reduces wait-times, streamlines assessments, and impacts clinical care
decisions.
Keywords
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Article info
Publication history
Published online: June 06, 2016
Accepted:
May 31,
2016
Received in revised form:
May 30,
2016
Received:
November 15,
2015
Identification
Copyright
© 2016 Elsevier B.V. All rights reserved.
