Epidemiology and etiology of epileptic seizures in a tertiary emergency center: analysis of 734 admissions

Abstract

Background: Emergency department (ED) admissions for epileptic seizures are frequent. Early differentiation between acute symptomatic seizures (ASS) and unprovoked seizures (US) at the initial ED encounter is essential for guiding management and optimizing the use of diagnostic resources. Objective: To analyze the epidemiological and etiological profiles of patients treated for epileptic seizures in the ED. Among people with epilepsy (PWE), we evaluated the main causes of breakthrough seizures. Methods: This was a retrospective cohort study conducted in the ED of a tertiary hospital over a three-year period. Medical records of adult patients (≥18 years) with a confirmed diagnosis of epileptic seizure, coded as ICD-10 G40, G41, or R56.8, were reviewed. Records with incomplete information or final diagnoses of non-epileptic events were excluded. Patients were categorized according to demographic and clinical characteristics, including age, sex, seizure type (ASS vs. US), prior diagnosis of epilepsy, comorbidities, and previous use of antiseizure medications (ASM). The primary outcomes were hospital admission and readmission rates, while secondary outcomes included the etiological profile of ASS, causes of seizure decompensation in PWE, and the impact of the COVID-19 pandemic. Follow-up was conducted from the time of ED presentation until hospital discharge or death. Results: A total of 602 medical records were included; 543 (90.1%) were classified as US and 58 (9.6%) as ASS. Females accounted for 52.6% of cases, mean age of 53.5 years. Most patients (52.8%) had a prior diagnosis of epilepsy. The most frequent etiologies for ASS were vascular and central nervous system infections ( 19% each), followed by sepsis (17.2%). Among PWE, 36.9% of seizures were attributed to poor adherence to ASMs. No significant differences were observed in ED visits or readmissions rates during the COVID-19 pandemic. Conclusion: Approximately nine out of ten ED visits for seizures were due to US. In ASS, the most common etiologies were vascular and infectious. Poor adherence to ASMs was the leading cause of breakthrough seizures in PWE. The COVID-19 pandemic did not significantly affect ED visit or readmission rates.