Objective There is a lack of data with regard to the epidemiology of epilepsy in patients admitted to the NRH. Developing the knowledge base is likely to help inform prescribing practice, risk discussion, education of patients and staff thereby improve care and clarity of communication both to people with epilepsy and those involved in supporting them.
This study aimed to gather data on:
1. Epidemiology of seizures/epilepsy relating to in-patients at the
2. NRH, Anticonvulsant prescribing practice
Method A proforma was developed identifying key factors pertaining to epilepsy/seizures. This was piloted on 5 cases and amendments made. Discharge letters of all patients with ABI, discharged between 1/1/14–31/12/14 were analysed retrospectively using this proforma and data extracted.
Results A total of 279 discharge letters were examined (181M, 98F). 52 patients had a diagnosis of epilepsy at the time of admission. 42 patients (36M, 16F) had a diagnosis of secondary epilepsy and 10 a diagnosis of primary epilepsy. Of the 42 cases, 23 had had neurosurgical intervention post brain injury. Secondary epilepsy occurred with greater frequency in patients with traumatic brain injury (n=20), haemorrhagic stroke n=7), brain space occupying lesion (n=7) as compared to ischaemic stroke patients (n=3). 43%% (n=120) individuals were on anticonvulsants at admission for diverse reasons, mostly seizures 15.8% (n=44) and neuropathic pain 10% (n=28). In 33 patients out of 120, no clear indication was evident for their anticonvulsant prescription. Most frequently prescribed anticonvulsants were levetiracetam 21% (58), pregabalin 7.52% (21), sodium valproate 4.65% (13), and gabapentin 2.86% (8). Eleven patients had seizures during admission and in three, seizures occurred during weaning of anti-convulsants. Seizure rescue medication i.e. buccal midazolam was prescribed for 7 of 279 on discharge.
Conclusion Secondary epilepsy is common in this population examined. It was more prevalent in those who underwent neurosurgical intervention. Seizures and neuropathic pain were main reasons to be on anticonvulsants. Levetiracetam was the most commonly prescribed agent. Weaknesses of the study were the retrospective study design, the poverty of detail on seizure type, reasons for prescription of anticonvulsants and reliance on accuracy of discharge letters. Qualitative work is needed to look at experience of epilepsy in this group with long term follow up to help inform education, discussions and treatment.
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