Beyond the Hospital Walls: Unpacking the Complexities of Acute ASM Initiation and Patient Follow-up
Lorena Figueredo Rivas1, Leonid Gozman1, Michael Siegel1, Steven Carter1, Lindsey Le1, Maria Bruzzone2
1Neurology, University of Florida, 2University of Florida
Objective:
To explore the relationship between racial disparities and post-hospitalization follow-up in patients discharged on antiseizure medications (ASM) after continuous electroencephalography (cEEG).
Background:
The growing availability of in-patient EEG has led to increased diagnosis and treatment of acute symptomatic seizures (ASyS) and hyperexcitable EEG patterns. Prior studies indicate 50-90% of patients with ASyS or rhythmic and periodic patterns (RPPs), discharged on ASM, stay on them for 12-32 months. This often occurs without a clear need, promoting polypharmacy. Outpatient (OP) neurology evaluation is advised to determine the need for continuous ASM treatment.
Design/Methods:
Retrospective review of patients admitted to UF hospital between January 2020 and December 2022, without prior epilepsy, who required in-patient cEEG monitoring for over 24 hours. We investigated ASM prescription patterns at discharge and at OP follow-up with neurology, neurosurgery or neuro-oncology, within 1 year post hospitalization.
Results:
The cohort had 51 adult patients (25 females, 26 males). Eleven were Black, 39 were White, and 1 was identified as “Other.” While 67% were discharged on ASM and 24% were still refilling this medication at least a year later, only 44% of individuals had neurology follow-up within 6 months. Among those with follow-up, 83% were white and 13% blacks. In the group discharged with ASM, 63% of white patients had a follow-up at 1 year, as opposed to 38% of black patients. Only 1 patient in this group had seizure recurrence within 6 months.
Conclusions:
Our research indicates a prevailing tendency for physicians to prescribe ASM post-discharge, irrespective of assured post-hospitalization follow-up. This study highlights notable discrepancies in OP clinic attendance, with Whites having more consistent follow-ups than Blacks. Because of the risks of polypharmacy and unnecessary use of ASM, it is crucial to understand the factors limiting healthcare accessibility in vulnerable populations.