Authors :
Presenting Author: Takato Akiba, MD – Juntendo University Urayasu Hospital
Shino Shimada, PhD,MD – Juntendo University Urayasu Hospital
Shinpei Matsuda, MD – Juntendo University Urayasu Hospital
Shinpei Abe, PhD,MD – Juntendo University Urayasu Hospital
Ken Takahashi, PhD,MD – Juntendo University Urayasu Hospital
Rationale: During travel, seizures are more likely to be provoked by factors, such as sleep deprivation and fatigue, due to changes in daily rhythm. Seizures are more likely to occur during travel in Idiopathic Generalized Epilepsy (IGE) and self-limited epilepsy with autonomic seizures (SeLEAS). Urayasu City is home to one of the largest amusement parks in Japan and is famous worldwide. Our hospital is the only tertiary emergency hospital in the neighborhood with a pediatric emergency room, and many travelers with seizures are transported there. We investigated the characteristics of the patients with travel-related seizures.
Methods: Participants were 142 pediatric patients who had seizures transported to our hospital between January 2017 and December 2023. Clinical information was collected retrospectively from the medical records.
Results: In age, 42 patients were involved in the 0
–4 age group(AG), 32 in the 5–9 AG, and 68 in the 10–15 AG. Regarding seizure types, only 38% of patients in the 0–4 AG and 25% of those in the 5–9 AG showed generalized tonic-clonic seizures (GTC) of 5 min or less. However, in the 10–15 AG, the rate was very high (69.1%). Sixty-five (45.7%) patients experienced their first unprovoked seizure, accounting for approximately half of the total. Epilepsy was diagnosed in 58 patients (40.8%), 45 of whom were taking antiseizure medications. Seven of these were provoked by neglecting medication, and three were provoked by fever. Epilepsy syndromes were classified in 17 patients, including six with IGE and three with SeLEAS. In 28 patients, seizures had a focal component, and in 13 patients, the epilepsy syndrome could not be classified. Forty-one patients (28.8%) had status epilepticus (SE), of whom nine had their first episode. Of the 41 patients, 27 had no underlying medical conditions, 24 were 10 years or younger. Eight patients with SE were under 10 years of age without underlying medical conditions, five had autonomic symptoms that preceded with suspected SeLEAS, and five of them had been transported from within the theme park during the day.
Conclusions: Among patients with SE, seizures that were suspected of SeLEAS were more frequent during the daytime in theme parks, suggesting an inducible factor due to the physical and mental load in unusual spaces. After comparing patients aged 10 years and older with other AGs, we found that the seizure type was more frequently GTC, with a smaller proportion of patients with SE. Therefore, we considered the possibility that this AG might have a high incidence of IGE. Our data suggest that neglecting medication or fever is not necessarily the most common seizure trigger in patients with epilepsy and that sleep deprivation or physical and mental strain may be more vital seizure triggers. The clinical characteristics of travel-related seizures were examined, and the involvement of age, presence of epilepsy syndromes, and underlying diseases were determined. It has been suggested that seizures are provoked by traveling in unusual spaces and fatigue in IGE and SeLEAS. Additional analyses and future studies are essential for disease education in patients and for understanding the pathogenesis of epilepsy.
Funding: Nothing to disclose