Clinical characteristics of a first seizure evaluation clinic in an academic center

Introduction: Evaluation by an epileptologist can help distinguish epileptic seizures from seizure mimickers. Proper and timely diagnosis of a seizure or new onset epilepsy is of critical importance due to implications regarding treatment, prognosis, quality of life, morbidity, and mortality. The goal of our study is to describe the demographics and clinical characteristics of patients referred to a first seizure clinic at a tertiary academic center within Chicago, Illinois.

Methods: This is a retrospective cohort study of adult patients referred to our clinic. Patients were identified through the electronic medical record from March 2021 to March 2022. Charts were reviewed to assess pertinent clinical characteristics and patient demographic data.

Results: A total of 123 out of 138 (89.0 %) scheduled patients checked in to the visit between March 2021-March 2022, of which 87/123 (70.7 %) were diagnosed with a seizure. Other diagnoses included syncope (17/123, 13.8 %), undifferentiated event (16/123, 13.0 %), suspected psychogenic non-epileptic event (2/123, 1.6 %), and migraine (1, 0.8 %). Of those with a seizure, 73/87 (83.9 %) were unprovoked and 14/87 (16.1 %) were provoked. The average wait time to be seen as a new patient by an epileptologist was significantly shorter with the establishment of this clinic compared to the year prior (17 days versus 53 days, p value < 0.001). The majority of patients had an EEG prior to or after the visit (121/123, 98.4 %), of which 24/121 (19.8 %) had interictal epileptiform activity. Findings relevant to the patient's cause of epilepsy were found in 26/108 (24.1 %) of patients who underwent an MRI or CT scan of the head. There were 40/123 (32.5 %) patients prescribed an anti-seizure medication (ASM) prior to the first office visit and 65/123 (52.8 %) patients prescribed an ASM within the first three office visits.

Conclusion: A first seizure evaluation clinic in an urban setting is an achievable and efficient way to evaluate patients with paroxysmal events concerning for seizure in a timely manner. Most patients in this clinic were diagnosed with epileptic seizures. Timely ancillary testing with head imaging and EEG can help contribute to the diagnosis of epilepsy and guide treatment.