Objective:

We analyzed the emergency department (ED) utilization among post-stroke patients presenting with seizures in Detroit.

Background:

Post-stroke epilepsy (PSE) accounts for about 11% of all adult epilepsy cases and 45% of epilepsy cases over 60 years of age. In the US, epilepsy healthcare costs are approximated at 9.6 billion dollars annually.  

Design/Methods:

A retrospective study was conducted from June 1, 2018 through December 31, 2018 on all adult ED visits at the Detroit Medical Center presenting with seizures. Data on demographics, diagnostic tests, epilepsy history and hospital disposition was collected. Patients who came for medication refills, non-seizure related reasons, syncope presentation, and all John or Jane Does were excluded. 

Results:

Of 997 ED visits for seizures, there were 103 patient visits (PVs) in 66 unique patients with a history of stroke. Sixty-eight PVs (66%) had at least one imaging scan (CT-Head and/or MRI brain) performed in the ED and 97% of them were normal or had chronic findings. Of these PVs, 18.6% presented with status epilepticus. Of those PVs who were admitted (42.2%), 48% had a length of stay between 1 day to 1 week and 10.8% of admissions were greater than 1 week. Recurrent ED visits for subsequent seizures were seen in 65.7% of the PVs. Nearly a third (30.4%) of PVs reported missing their medications prior to seizure. Only 27.5% of PVs had at least one outpatient follow-up with neurology after discharge. 

Conclusions:

Patients with PSE experience recurrent visits to the ED for breakthrough seizures with medication non-adherence being the most likely cause. Repeat neuroimaging in the ED is unlikely to yield findings. Further studies are needed to determine which patients would benefit from repeat imaging and focus on reducing breakthrough seizures with a history of stroke.