F176. Epilepsy, developmental delay and group homes: Role of the epilepsy monitoring unit to improve the management of seizures

Abstract

A significant proportion of the developmental delay (DD) population has epilepsy (26–70%) and lives in institutions. These patients’ communication skills are significantly limitated. They tend to have an atypical presentation of epileptic seizures, higher risk of misdiagnosis, greater number of seizures, and SUDEP. Also, this population often has drug resistant epilepsy requiring polypharmacy with increased risk of morbidity. On top of that, the support workers are not supervising the patients 24 h a day and frequently change making it difficult to have a complete medical history of the patients, increasing the risk of none identified the seizures.The aim of this study was to determine usefulness of Epilepsy Monitoring Unit (EMU) in diagnosis and management of these patients. This is a retrospective observational study at London Health Sciences center (LHSC) of epileptic patients with DD living in institutions that were admitted to the EMU, from January 2014 to December 2016. 1121 patients were admitted to the EMU and 2.05% (N = 23) fulfilled the inclusion criteria. The mean age was 38.8 (20–71), 52.2% (N = 12) were male and 78.3% (N = 18) had generalized epilepsy. Epilepsy onset was at age 6.4 (SD ± 6). 26.1% (N = 6) had a history of Status Epilepticus, 26.1(=6) of Lennox-Gastaut syndrome. The mean number of antiepileptic medications was 3(1–5). 17.4% (N = 4) were implanted with VNS. 39% (N = 9) had poor or none verbal language and 56.5% (N = 13) had moderate-severe developmental delay 52.2% (N = 12) had mood disorder and 30.4% (N = 7) were taking antipsychotic medication. The mean admission time was 7.14 days (2–18). 88.2% (N = 20) daily seizures and 67% (N = 14) had mores seizures than the caregivers were noticed. There was a good correlation between of the behavioral events and seizures in 82.6% (N = 19) of the patients, answering the reason of the admission in EMU. EMU admission can allows differentiating behavioral changes from seizures, quantify the real frequency of the seizures and severity of them. That information is helpful to improve seizure management and quality of life.