Treatment outcomes after the introduction of a new seizure management protocol

The present study aims to determine qualitative outcomes of presentations with acute recurrent seizures or status epilepticus to the emergency department of our institution after the introduction of a new seizure management protocol.

We performed a retrospective analysis on two cohorts of patients for all presentations to the emergency department of our institution. Presentations were reviewed from January to July pre-protocol introduction and the same period post-protocol. Patients were included if they were treated for acute recurrent seizures or status epilepticus. The protocol applied a strict treatment regimen and used levetiracetam, valproate and phenobarbitone in place of phenytoin.

A total of 77 patients was included from the pre-protocol cohort and 72 from the post-protocol group. There was a significant reduction in intensive care unit (ICU) admission (seven patients in cohort 1 and 0 patients in cohort 2) and adverse drug reactions (18 patients in cohort 1 and four patients in cohort 2). There was a trend towards fewer deaths.

The introduction of the new seizure management protocol assessed in this study has resulted in fewer ICU admissions, adverse drug reactions and most importantly fewer patient deaths. This is likely attributable to a combination of improved efficacy of the newer antiepileptic agents and a clearly defined protocol directed therapy.