Determining Prevalence and Risk Factors of Seizure Recurrence in the Early Period in Patients Who Present to the Emergency Department with Epileptic Seizures

Abstract

Aim:Although the basic principles of acute epileptic seizure management in the emergency department (ED) are well known, there is no consensus on the optimal discharge time from the ED for patients who return to a normal-basal state of consciousness after an epileptic seizure. The main concern for physicians in terms of the optimal discharge time from the ED is the possibility of acute recurrent seizures (ARS) in the early postdischarge period. Such concerns can lead to extended monitoring of patients, resulting in overcrowding in the ED and higher hospital charges. The aim of this study was to determine the frequency of ARSs and risk factors for recurrence within the first 6 and 24 h after presentation to the ED with an acute seizure in patients with a confirmed diagnosis of epilepsy.Materials and Methods:This prospective observational study was conducted with patients aged older than 18 year old with a diagnosis of epilepsy who presented with convulsive seizures to the ED between October 2018 and October 2019. The primary outcome was the frequency of ARS within the early period (6 and 24 hours). The second outcome was the potential risk factor for ARS, which was seizure recurrence within the first 6 or 24 h after admission to the ED with the complaint of a seizure.Results:In to patients with epilepsy with seizure attacks were included during the study period. The prevalence of ARS within the first 6 and 24 h was found to be 21.8% and 27.4%, respectively. Risk factors for ARS within 6 h were found to be non-adherent to antiepileptic drug (AED) therapy, active seizures/postictal period on admission, and white blood cells, while risk factors for ARS within 24 h were found to be non-adherent to AED therapy, AED polytherapy, a history of weekly seizures, duration of the postictal period, and white blood cells.Conclusion:ARS are not rare in the early period after admission to the ED, with an incidence of 21.8% in the first 6 h and 27.4% in the first 24 h. Potential risk factors of ARS seem to be non-adherent to AED therapy, AED polytherapy, a history of weekly seizures, duration of the postictal period, and white blood cell.

Keywords

• acute recurrent seizure
• acute repetitive seizure
• seizure cluster
• epilepsy
• emergency department