Patients visiting the emergency room for seizures: insurance status and clinic follow-up.

PURPOSE: Epilepsy is a chronic condition that is best treated in the outpatient clinic setting. However, many epilepsy patients use the hospital emergency room (ER) as a primary resource for seizure management. We studied characteristics of these patients in comparison with patients attending an epilepsy clinic. METHODS: We reviewed ER data of patients seen in 2002 and 2003 for seizures, in Vanderbilt University Hospital (VUH) and Metro Nashville General Hospital (MNGH), seeking to identify patients who had visited the emergency room more than once. We collected demographic and insurance information on these patients and identified those who followed up in the epilepsy clinic. RESULTS: There were 1005 patients who visited the VUH ER and 205 the MNGH ER for seizures. Patients visiting the ER for seizures were less likely to be insured than epilepsy patients followed in the clinic, in both institutions. The proportion of patients visiting the ER more than once was 15.2% at VUH and 29.2% at MNGH. Among these patients, 3.2% at VUH and 26.7% at MNGH were uninsured. Clinic follow-up occurred in 68.6% of VUH and 13.3% of MNGH repeat ER visitors. Combining institutions, insured patients were much more likely to follow-up in the clinic. DISCUSSION: Repeated use of the ER for seizures was more common in the county hospital, where the proportion of uninsured patients was also higher. Patients visiting the county hospital ER repeatedly tend not to follow-up in the neurology clinic. This element of disparity of care requires further attention.

Diagnosis and treatment of patients with trigeminal neuralgia.

BACKGROUND: The authors review the literature regarding the etiology, diagnosis and treatment of trigeminal neuralgia, or TN. They also describe a patient with the disease. TYPES OF STUDIES REVIEWED: A MEDLINE search was conducted to identify articles published within the last 10 years regarding current thinking on the etiology, diagnosis and treatment of TN. The authors also reviewed historic articles to gather information about the initial discovery and descriptions of this condition. RESULTS: The authors identified more than 50 articles on the topic. Generally, there was concordance regarding the diagnosis of this condition; however, some questions and controversy exist regarding the pathogenesis and treatment modality of choice. The authors relied on the most representative and complete articles for this review article. CLINICAL IMPLICATIONS: TN is the most common form of neuralgia, and patients often visit several clinicians with complaints of pain. Clinicians must recognize this condition and diagnose it correctly for patients to receive proper referral and therapy for this relatively treatable condition.