Abstracts

Rationale: Our hospital is a core hospital in Okayama district located in western Japan. Many patients who suffer from convulsive attack for the first time are transported to emergency department. Many of them are suspected as ""epilepsy"" by emergency physicians, and they are referred to neurologists. But true epilepsy cases are not so many. So we conducted this study to investigate the clinical aspects of first convulsive cases.Methods: We retrospectively selected patients who admitted to our hospital suspected as epilepsy because of convulsion from April 2012 to March 2015, and excluded those who have a history of epilepsy, showed only loss of consciousness, and without losing consciousness. After exclusion, we analyzed sex, age, witnessed laterality of convulsion, diagnosis at discharge, with or without abnormality in MRI brain scan, SPECT (mainly 99mTc-HMPAO), and electroencephalography (EEG), results of head up tilt test, and serum ammonia (NH3), creatine kinase (CK) levels at admission and peak CK levels during hospital course. Diagnosis at discharge was classified into epilepsy, provoked convulsion, neurally mediated syncope (NMS), cardiogenic syncope, and equivocal cases.Results: 86 cases were selected. 55 cases were male, 31 were female, mean age was 51.7 years. Diagnosis at discharge was epilepsy in 55 cases (64%), provoked convulsion in 11(13%), NMS in 7 (8%), cardiogenic syncope in 2 (2%), and equivocal cases in 11 (13%). Head-up tilt test was performed in 11 cases, and 7 were positive results. 29 cases showed convulsion with laterality and 21 cases (72%) were diagnosed as epilepsy in them. 57 cases were without laterality, and 34 cases (60%) diagnosed as epilepsy. Compared epilepsy cases with no-epilepsy cases, epilepsy cases had laterality in 38%, abnormality in MRI brain image in 54%, abnormality in EEG in 78%. On the other hand, no-epilepsy cases were 26%, 20% and 23% respectively.Conclusions: Majority of first convulsive cases were diagnosed as epilepsy. But no-epilepsy cases couldn't be ignored. Convulsion with laterality had tendency to be diagnosed as epilepsy.