Current management of urgent epileptic seizures in a tertiary referral hospital in the Community of Madrid: a descriptive study.

Abstract

Objective: Analyse the current status of the management of urgent epileptic seizures (ES) in a tertiary referral hospital in the Community of Madrid at each stage of the care process and by the different medical teams involved, including out-of-hospital emergency services, hospital emergency departments and neurology teams.

Method: Cross-sectional descriptive study with a subsequent 30-day prospective longitudinal follow-up of a consecutive sample of patients with urgent EC, recruited between October 2021 and March 2022.

Results: 53 patients were included. The mean age was 57.6 (21.2) years. 39.6% were women. 35.8% had a previous diagnosis of epilepsy. The most frequent cause of urgent ES was high-risk seizures (57%), followed by status epilepticus (24%) and cluster seizures (19%). A total of 90.5% of the seizures occurred in the out-of-hospital setting. The median time between ES and emergency services assessment was 40 (27-78) minutes, and between ES and neurology assessment 165 (97.5-290) minutes. 86.8% were treated with benzodiazepines and 81.1% with at least one anti-crisis medication. Urgent video-EEG monitoring was performed in 60.4%. The most frequent destination after emergency management was hospital discharge (47.2%), followed by hospitalisation (39.6%). At 30 days, 20.8% of patients had a new ES and 5.7% had died.

Conclusions: Analysis of the current state of emergency EC management shows significant delays at all levels, both in assessment and drug administration.