Patients admitted to the emergency room with seizures of demographic data, evaluation of laboratory and treatment process, A prospective investigation of second seizure frequency during follow-up in the emergency department

Aim: This study describes the demographic characteristics of patients brought to emergency rooms with epileptic seizures. It identifies the type of seizures (epileptic, acute symptomatic, remote symptomatic), evaluates the laboratory and monitoring results, investigates the relationship between these parameters and the number of recurring seizure episodes under hospital care and determines whether any of these relationships contribute to managing these patients in emergency rooms. Method: Patients over 18 years of age with epileptic seizures admitted to the EUTF (Ege University Medicine Faculty) Hospital in İzmir between March 2014 and February 2016 were included in this research, which was designed as a prospective analytical study. Patients who had a first seizure after trauma or who arrested in the emergency department between these respective dates were not included in the study. Four hundred and fifty cases from the patients who were not excluded by those criteria and signed the volunteer form were included in the study. Those 450 cases included patients who were repeatedly admitted to the emergency department with seizure complaints. Repeated admissions were not included in the study if the time between the first and second admissions was less than 30 days; the case was included in the study if the time between admissions was more than 30 days. A standard case report form was used for data collection. For statistical evaluation, a database was built using an SPSS 20.0 software program to perform the necessary statistical analyses. Findings: Four hundred and thirty-nine patients were evaluated in the study. The average patient age was 46 ± 20 (18 to 94 years of age). The distribution of patients by age at seizure onset revealed that the 1 to 20 age group was the largest group with 28.4% (n=125), followed by the 31 to 40 age group with 13.7% (n=60). The median age at seizure onset for each sex was 37.5 ± 23.8 (1 to 94 years of age) for men and 39.0 ± 25.1 (1 to 93 years of age) for women. In total, 35.1% (n=154) of the patients were determined to have had their first seizure. Considering the seizure types, 48.5% (n=213) of the seizures were classified as epileptic seizures, whereas 51.5% (n=266) of the seizures were symptomatic seizures. Among the patients who were diagnosed with symptomatic seizures, 20.8% (n=47) were acute symptomatic, whereas 79.2% (n=179) were diagnosed with remote symptomatic seizures. According to the distribution of seizure type by age, the 18 to 35 age group predominantly suffered from epileptic seizures, and symptomatic seizure incidents increased with increasing age. The median age of the acute symptomatic seizure patients was 34.0 ± 15.8 and a further classification of the etiology revealed that, with a 24.5% prevalence (n=11), the most frequent cause was acute cerebral ischemia. The median age of the remote symptomatic seizure patients was 59.0 ± 19.8, and a further classification of the etiology revealed that the most frequent seizure triggers were, with a 49.7% prevalence (n=90), intracranial space-occupying mass, metastasis or other conditions that caused increased intracranial pressure (edema, hydrocephaly, etc.); the second most frequent cause was chronic ischemic/hemorrhagic stroke, with a 37.0% prevalence (n=67). In total, 31.9% (n=140) of the patients who were included in the study had at least one seizure under emergency room care. Considering the distribution of the time at which the first seizure occurred, the median value was determined to be 2.0 (1 to 40) and the quarterly interval was 1.0 to 4.0. Overall, 39.3% (n=55) of the patients who suffered seizures under emergency room care were observed to be in status epilepticus. An investigation of the relationship between seizures under emergency room care and age range revealed that seizure rates during hospital monitoring increased with increasing age (p=0.016). For patients whose ages at seizure onset were >80, seizure rates during emergency room care were the highest; these high rates were statistically significant (p=0.016). For patients who arrived at the emergency department via ambulance, seizure frequency, either under emergency room care or after discharge, was statistically higher; in addition, SE (status epilepticus) prevalence in these patients was also higher. Patients who have simple partial seizures as basal seizures had statistically higher seizure rates under emergency room care (p=0.047). Symptomatic seizures during emergency room care were statistically higher than epileptic seizures (p=0.025), whereas no statistically significant difference was found between acute and remote symptomatic seizures (p=0.230). Seizure rates under emergency room care were statistically higher in patients with an SE history (p=0.039). Statistically higher seizure rates under emergency room care were observed for patients who were diagnosed with epilepsy and used a higher number of drugs (p=0.004). When the first seizures are considered separately, compared with epileptic seizures, patients with symptomatic seizures were determined to have more frequent seizures (p=0.013) under emergency room care. For patients with first-seizure complaints, GCS (Glasgow Coma Scale) scores on admission were inversely proportional to seizure rates during emergency room care (p=0.001); the frequency of seizures under emergency room care was statistically higher in patients with focal neurological deficits (p=0.031). Regardless of the pathology, seizures were more frequent in first-seizure patients diagnosed with pathological findings on their brain revealed by computed tomography (CT) scans (p=0.012).