IMPACT OF SEIZURE CLUSTERING ON ADULT EPILEPSY

This application is for a Mentored Patient-oriented RCDA (K23). The candidate is trained in clinical neurology and neurophysiology, and is currently on the faculty at the Albert Einstein College of Medicine (AECOM). The ma interests of the candidate are neurophysiologic, epidemiologic, and outcome issues in epilepsy, with a special f on seizure patterns and precipitants. The long term goals of the candidate are to develop the research sophistication and techniques to allow for high quality clinical research in the field of epilepsy or other neurologic disorders. career development proposal includes completion of a Masters of Science in the AECOM Clinical Research Training Program, followed by the design, implementation and analysis of the proposed research project on seizure clusting at Montefiore Medical Center/AECOM, which is a site of extensive, successful clinical research, and is ideally for the candidate's long term goals. Seizure clustering may affect treatment and outcome of epilepsy, but has not been widely studied. We aim recruit a cohort of 300 adult, predominantly inner-city patients with epilepsy, and follow them prospectively for months. We will define seizure clustering as three or more seizures occurring within 24 hours. We plan to examine the incidence, risk factors and precipitants for clustered seizures, as well as the impact of clustering on various epilepsy outcomes. We hypothesize that the incidence of clustering will be high ,that seizure clustering will be associated with localization-related factors and risk factors for status epilepticus (SE), and that patients with club will be at increased risk for SE. Identifying patients at risk for clustering may improve their treatment, especial they are at an increased risk of SE. Furthermore, we hypothesize that we will identify potentially modifiable precipitating factors for seizure clustering, and specifically, seizure clustering which requires emergency intervention. This may allow for a reduction in the incidence of clustering and a decrease in resultant morbidity. Finally, we examine outcome measures of epilepsy in our cohort,, including response to medical therapy, quality of life, an of care, and examine the impact of seizure clustering on these outcome measures. If outcome of epilepsy is demonstrated to be worse in patients with clustered seizures, development of a specialized epilepsy care program these patients, including more aggressive medical therapy and earlier psychosocial intervention, may be appropriate. We anticipate that this study will both define the role of seizure clustering in adult epilepsy, and increase o appreciation of the medical, social and financial impact of epilepsy in a large cohort of inner city adult patients.