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Poster Sessions Epilepsia, 52(Suppl. 6):23–263, 2011 doi: 10.1111/j.1528-1167.2011.03207.x 29TH IEC PROCEEDINGS 29th International Epilepsy Congress, Rome, 28 August–1 September 2011 Poster Sessions Poster session: Adult epileptology I of risk of SUDEP hinging on the presence and absence of well recognized risk factors. Monday, 29 August 2011 We aim to present a clinical visual checklist to capture risks factors for SUDEP as evidenced by a detailed review of the current literature. p055 WHAT REALLY MATTERS TO PEOPLE WITH Method: We conducted a careful analysis of the current evidence base EPILEPSY IN 2011? A PAN-EUROPEAN PATIENT via a medline search using the search terms in various permutation and combinations: SUDEP, sudden death in epilepsy, death, epilepsy, risk SURVEY factors, checklist. Cramer JA1, Dupont S2, Goodwin M3, Trinka E4 1Yale Univexrsity School of Medicine, Houston, TX, U.S.A., Results: We divided the identified possible and probable risk factors 2PitiØ-SalpÞtrire Hospital, Paris, France, 3Northampton General into very low, low medium and high risk using the Australian risk map- 4 ping system for safety checklists AS4360. A simple tick box design facil- HospitalNHS Trust, Northampton, UnitedKingdom, Paracelsus itates at a glance profile of an individual’s risk and the overall severity of Medical University, Christian Doppler Klinik, Salzburg,Austria risk on a particular date. Purpose: To conduct a pan-European survey amongst people with epi- Conclusions: We have synthesized the available evidence into an easy lepsy to define issues of importance in their daily lives, correlated with reference checklist which can be quickly completed during a clinic. Once duration of epilepsy, age, as well as other characteristics. Questions gathered the checklist can be used to prioritise clinical activity based on allowed challenges to traditional assumptions of therapy goals. mortality risk. The checklist becomes a baseline from which to compare future progress or deterioration. One of the main uses of the checklist can Method: We collaborated with The International Bureau for Epilepsy be in discussing risk objectively on a sensitive rare event with patients, (IBE) to develop an easy-to-complete Web-based survey, distributed families and carers. through the IBE’s country chapter websites and by e-mail. The predomi- nantly multiple-choice questionnaire was available in 12 different languages. Questions primarily focused on personal experiences of the specific impact of epilepsy, individual management, and on which p057 aspects actually mattered most to them. Issues raised provided opportuni- CLINICAL PROFILES, PROGNOSIS, AND MANAGE- ties for patients to consider their personal needs and goals in contrast to MENT OUTCOMES OF PATIENTS WITH STATUS traditional assumptions of therapeutic goals (doctor’s point of view). EPILEPTICUS (SE) AND PREDICTIVE FACTORS FOR All survey responses were deidentified and collated on a central database for analysis. The scope of the survey allowed for multiple sub-analyses REFRACTORY CONVULSIVE SE: A 7-YEAR RETRO- including demographical stratifications. SPECTIVE STUDY Fernandez MLL, Fabiana NL, Pasco PMD, Casanova- Results: Preliminary results of the first round of the survey will be Gutierrez J presented. General Hospital, University of the Philippines-Manila, Manila, Conclusion: The survey findings will provide an insight to the real Philippines needs and challenges of people with epilepsy and may play a part in shap- ing future management strategies. Purpose: The study aims to characterize the demographics of status epi- Supported by Eisai Europe Limited. lepticus (SE) patients, determine prognostic factors for survival, and iden- tify predictive factors for developing refractory convulsive SE (RCSE). p056 Method: This is a retrospective study, involving 67 patients admitted SUDDEN UNEXPECTED DEATH IN EPILEPSY (SUDEP) for SE at our institution from January 2003 to September 2010. Clinical profiles, presentation and laboratory results were obtained from chart SAFETY CHECKLIST : A WAY OF QUANTIFYING AND reviews. Prognostic factors for survival were determined using logistic DESCRIBING A PATIENT’S RISK OF SUDEP USING A regression. Predictive factors for developing RCSE were identified using PRACTICAL CLINICAL CHECKLIST ON A SINGLE stepwise regression analysis. SHEET Results: About 52.2% of the patients had first-onset seizures progress- Cox DA, Shankar R ing into SE. Half of the events (50.7%, N = 34) were caused by primary Cornwall Partnership NHS Foundation Trust, Truro, United seizure disorder. Mortality rate of SE is 19.4%. About 16% (N = 11) of Kingdom the patients with SE were classified as RCSE. Six RCSE cases were diag- nosed with viral CNS infections. Two variables were associated with Purpose: It is estimated that SUDEP causes about 500 deaths each year RCSE (p < 0.05), first onset seizures (p = 0.017), and abnormal cranial in the UK (0.001% of those with epilepsy). The risk of dying due to epi- imaging (p = 0.006). Sensitivity of first onset seizures and abnormal lepsy and especially due to SUDEP is low but when it happens it is trau- cranial imaging, as predictive factors for developing RCSE is 81.82%, matic for all involved. Each individual with epilepsy has their own level and specificity of both variables is 52.7 and 63.4% respectively. An 23 24 Abstracts 88.91% probability of RCSE occurrence was noted if first-onset seizures was attributed to a secondary cause and the remaining 31% to prior epi- and abnormal cranial imaging are both present. lepsy. Forteen patients had focal EEG pattern and two generalized. Ninety-four percent of those with crisis were in treatment with an an- Conclusion: This study identified two predictive factors for developing tiepileptic drug. Factors significantly associated with crisis were: CNS RCSE, abnormal cranial imaging and first-onset seizures. Presence of malformations p = 0.005 OR = 7.77.95% CI (1.87–32.36), p = 0.012 both variables can predict occurrence of RCSE with a relatively high prior epilepsy. OR = 9.55, 95% CI = (1.63–55.98), prior CNS infection sensitivity rate. It is important to identify patients who are at risk for p = 0.001 and CNS surgery p = 0.001 The same factors were associated developing SE to reduce the probability of progression into RSE, and pre- with SENC. vent long-term deleterious complications. Conclusion: Given these findings we believe EEG should be incorpo- p058 rated in all patients with this factors who enter to critical care units. THE MANAGEMENT OF REFRACTORY STATUS EPILEPTICUS IN ADULTS IN THE UK: THE CALL FOR p060 A STANDARDIZED CARE PROTOCOL COST OF EPILEPSY CARE AMONG ADULT NIGERI- 1 2 2 Patel M , Bagary M , Mccorry D ANS MANAGED IN A UNIVERSITY HOSPITAL 1 University of Birmingham, Birmingham, United Kingdom, Sanya EO, Adekeye K, Wahab KW, Ajayi K, Ademiluyi BA 2 Queen Elizabeth Hospital, Birmingham, United Kingdom University of Ilorin Teaching Hospital, Ilorin, Nigeria Introduction: Status epilepticus (SE) is a life-threatening neurological Purpose: Epilepsy is a major public health disorder that causes enor- emergency with patients presenting in a protracted epileptic crisis. mous burden on individual and family. Nearly 80% of people with Suboptimal management is associated with high morbidity and mortality. epilepsy (PWE) reside in developing countries where there is a wide Continuous EEG monitoring is regarded as essential by NICE in the man- treatment gap, widespread poverty, illiteracy, inefficient and unevenly agement of refractory status epilepticus (RSE). distributed health care system and social stigma. The aim of this study is to estimate direct and indirect cost of outpatient care of epilepsy in Purpose and Methods: We conducted a national audit to determine Nigeria. current clinical practice in the management of RSE amongst adults in Intensive Care Units (ICU) in 55 randomly selected UK NHS Trusts and Method: A cross-sectional observational study of PWE managed at neu- a literature review of the management of RSE. rology clinic of University of Ilorin Teaching Hospital in Ilorin middle belt Nigeria between January 2010 and December 2010. Patients Results: While 29 (56%of responders) had a protocol available in ICU included were those who had attended clinic more than twice. for early stages of SE just eight trusts had specific guidelines if RSE occurred. Only 14 trusts involve neurologists at any stage of management Results: A total of 69 patients were enrolled into the study with mean and just 11 (20%) have access to continuous EEG monitoring. age of 35 € 18 years and 52% were female. Close to 23% were students, of which 32% had only secondary education and 43% are gainfully Conclusion and Discussion: This study identifies considerable variabil- employed. About 13% had a comorbid condition and 12% had a least one ity in the management of SE in ICU’s across the UK. A minority of ICU family member living with epilepsy. Patients average clinic attendance units have a protocol for RSE or access to continuous EEG monitoring was 6 per year with 51% came accompanied by a relative. The average despite it being considered essential for management. The evidence base distance travelled to clinic was 20 km and average waiting for consulta- for interventions in RSE is extremely limited. However, we propose that tion was 4 h. Majority (80%) were on single antiepileptic drug (AED). all ICU’s should develop a standard protocol, in consultation with local Direct medical cost per year was #2,090,100.00 ($13,934.00), of which neurologists, incorporating the management of refractory SE. Alongside highest contributor was AED #1,429,389.48 ($9529.26). AED accounted both early neurological referral and universal patient access to continu- for 68% of total cost burden. Cost of transportation was #433,920.00 ous EEG monitoring, this achievable strategy would be a major step ($2892.80) and that for routine investigations was #226,800 ($1512.10). towards optimizing care the management of SE. It was difficult to estimate indirect cost in monetary terms.
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