Epilepsy
Definitions
Epilepsy is a disease of the brain defined by any of the following conditions
At least two unprovoked (or reflex) seizures occurring >24 h apart
One unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next 10 years
Diagnosis of an epilepsy syndrome.
Epilepsy is considered to be resolved for individuals who had an age-dependent epilepsy syndrome but are now past the applicable age or those who have remained seizure-free for the last 10 years, with no seizure medicines for the last 5 years
Intractable Epilepsy Definition
“Intractable Epilepsy” is defined as persistent seizures in an epileptic child, despite adequate trials with ≥ 2 Anti-Epileptic Drugs (AEDS). There are three main treatments used for medically intractable epilepsy: Ketogenic diet, Epilepsy surgery, and Vagus Nerve Stimulator.
Please note the following terms are considered equivalent to Intractable Epilepsy – Pharmacoresistant; Treatment resistant; Refractory; Drug resistant epilepsy; Poorly controlled. Intractable epilepsy, or an equivalent term, should be documented when present to accurately reflect severity of illness.
Poorly Controlled Epilepsy Definition
Children’s Health Neurologists define “Poorly Controlled Epilepsy” as the presence of “breakthrough seizures” in a know epileptic patient.
Tips For Documentation
Always specify the type of Epilepsy if known.
Document intractable epilepsy or an equivalent term when applicable (i.e. ≥ 2 AEDS, Vagus Nerve Stimulator, Ketogenic Diet, and/or Surgical candidate)
Equivalent terms include: pharmacoresistant; treatment resistant; refractory; drug resistant; poorly controlled.
Consider “poorly controlled epilepsy” for epileptic patients presenting with breakthrough seizures.
Document the type of Epilepsy (focal with altered consciousness, focal without altered consciousness, absence, tonic, clonic, myoclonic, atonic, etc.)
| Not Specific | More Specific | Most Specific |
|---|---|---|
| Patient admitted with Epilepsy. | Patient admitted for poorly controlled epilepsy. | Patient admitted for poorly controlled epilepsy with focal complex seizures. |
What Do Clinical Documentation Specialists Look For?
Type:
Epilepsy, without mention of intractable; Poorly Controlled Epilepsy; Intractable Epilepsy; Pharmacoresistant Epilepsy; Treatment-Resistant Epilepsy
Detail:
Further specificity of type of epilepsy (i.e. partial, focal, localized vs. generalized epilepsy)
Underlying Cause:
Structural, Metabolic, Genetic, Acquired, or Unknown problems.
Clinical Indicators:
Medications – Anti-epileptics
Patient admitted for initiation of the Ketogenic Diet or Surgical Evaluation
Patient has or is admitted for placement of Vagal Nerve Stimulator
Administration of Rescue Anti-epileptics for prolonged seizure episode
Patient admitted for “breakthrough seizures”