The epilepsy patient at emergency department: When and why?

Epilepsy has a relevant burden on health care systems worldwide. Studies about its weight have shown that the costs are high at the individual, family, health services, and society level in Europe. We focused on potential unnecessary resources of our health care service related to Emergency Department access by patients with already known diagnosis of drug-resistant epilepsy after a new seizure episode. All consecutive adult patients (>14 years), followed at our epilepsy center, with a definite diagnosis of drug-resistant epilepsy (according to the ILAE Task Force consensus definition), who had a new seizure episode from previous control, were included. We evaluated all patients who came to our Emergency Department (ED) after one or more seizures during the year 2011. A control group consisted of epileptic patients followed at our epilepsy center who consecutively underwent periodic visits without access to ED, despite the occurrence of seizures. Comparative analysis of the two groups showed the following main determinants of access to ED after the occurrence of seizures: foreign nationality, actual psychiatric therapy, actual AED therapy and actual AED polytherapy, more than one co-morbidity, one epileptic seizure versus more than one episode in the same day, seizures with similar description compared to previous events. Logistic regression analysis confirmed the potential role in predicting ED visit of these variables. Analysis of potential amendable factors related to epileptic patients ED access after a seizure can contribute to decrease unnecessary costs for our health care service.