The management of first seizures in adults in a district general hospital

Time interval providing highest yield for initial EEG in patients with new onset seizures

PURPOSE

Timing providing highest yield of initial electroencephalogram (EEG) after new onset unprovoked seizures, is an important and practical issue both in diagnosis and patient care. Current guidelines suggest routine EEG is the standard of care in work-up. However, yield of the initial EEG and exact timeframe in which to perform remain unclear and standardization in both adult and pediatric populations is still lacking. Our objective was to determine a concrete timeframe to perform initial EEG in patients with new onset unprovoked seizures and provide greater yield of EEG benefits in patient management.

METHOD

This is a retrospective chart review study of both pediatric and adult patients identified from EEG Database over 1999-2014 located at Kaleida Health at Buffalo using keyword "new onset seizure".

RESULTS

The percentage of EEGs revealing epileptiform discharges is much higher if EEGs are performed within 12hours after the seizure onset compared to studies done beyond this timeframe (53.1% versus 23.9%). There was no significant difference in the presence of epileptiform discharges if the study is done 12hours after the seizure onset. Odds ratio was 3.599 (the presence of epileptiform discharges) with a Confidence Interval of 1.691-7.660 (p=0.001) within first 12hours of initial event.

CONCLUSION

This study demonstrated statistical significance in yield of epileptiform discharges by performing EEG within the first 12hours of seizure onset, in both adult and pediatric populations, which should be considered for clinical practice and patient care.

Computed tomography abnormalities and epidemiology of adult patients presenting with first seizure to the emergency department in Qatar

OBJECTIVES

There is little information available from the Middle Eastern region on adult patients presenting with first seizure. The objectives of this study were to describe epidemiological characteristics of patients presenting to the emergency department (ED) in Doha, Qatar, with first seizure and to determine the incidence of computed tomographic (CT) scan abnormalities.

METHODS

A retrospective cohort study was conducted on all adult patients with first seizure presenting to Hamad General Hospital ED over a 1-year period (June 2012 through May 2013). Electronic patient records were reviewed for demographics, neuroimaging, electroencephalography, laboratory test results, and medications administered.

RESULTS

There were 439 patients who satisfied inclusion criteria. Patients were aged a mean of 35.3 years (95% confidence interval [CI] = 33.92 to 36.69 years) with a male-to-female ratio of five to one. CT abnormalities were detected in 154 patients (35.3%; 95% CI = 30.81% to 39.82%). Out of reported abnormal scans, 14.7% patients had significant abnormalities such as neurocysticercosis (9.2%); brain metastasis and neoplasm (3.4%); and subarachnoid and subdural hemorrhage, cavernous sinus thrombosis, acute stroke, and brain edema (2.0%). None of the patients had any electrolyte abnormalities, and three patients had hypoglycemia. Patients with initial abnormal CT brain results were more likely to have recurrent seizures (OR = 1.65; 95% CI = 1.11 to 2.45) within 6 months.

CONCLUSIONS

Adults who presented with first seizure to the ED in Qatar had a young male predominance, and a high proportion of brain CT scans were reported as abnormal. It is recommended that all such patients in this population should undergo prompt CT scanning in the ED, but the utility of routine electrolyte tests requires further investigation.

Epidemiology, clinical characteristics, and management of adults referred to a teaching hospital first seizure clinic

BACKGROUND

There are scarce data describing the epidemiology, clinical characteristics, and management of adults who suffer a suspected first seizure.

AIM

To describe the epidemiology, clinical characteristics, and management of adults with a suspected first seizure who are referred to a teaching hospital first seizure clinic over a one year period.

DESIGN

Prospective descriptive study.

METHODS

Data were collected on consecutive adults referred to the Royal Infirmary of Edinburgh between 4 February 2003 and 10 February 2004.

RESULTS

232 patients were referred to the first seizure clinic. Median age was 32 years; 53% of patients were male. Lower socioeconomic groups were more likely to present with a suspected first seizure. Nineteen per cent of patients were admitted to hospital after their suspected seizure episode. Appropriate driving advice was reported in 64% of cases. Seventy two per cent of patients were offered a first seizure clinic appointment within six weeks of referral. Nine per cent of patients had a subsequent seizure while awaiting review. Fifty two per cent of patients were confirmed as having a first seizure at the clinic, of which 56% were provoked by alcohol, recreational drugs, or sleep deprivation. Electroencephalography and computed tomography of the brain were the most common investigations ordered at the first seizure clinic (22% and 22% of patients respectively).

CONCLUSION

Adults who suffer a suspected first seizure, and who make a full neurological recovery, can be safely managed as an outpatient. Around half of these patients will have a specialist diagnosis of first seizure and alcohol will be a common precipitating factor.

Early management of adults with an uncomplicated first generalised seizure

A literature review of first seizures in adults was performed and a management algorithm was constructed. This review highlights the importance of a thorough history and examination, routine biochemistry and haematology, an electrocardiogram, selected neuroimaging, discharge planning with driving and lifestyle advice, and follow-up in a specialist clinic.

The management of alcohol-related seizures: an overview

Alcohol-withdrawal seizures are one of the common medical emergencies. The seizures are generalized and usually occur abruptly between 6-8 hours after cessation of alcohol use (peak 12-24 hours). These patients are often uncooperative and therefore need careful assessment. Lorazepam is the first-line drug for termination and prophylaxis of alcohol-withdrawal seizures.