Abstracts

Rationale: Epileptic seizures are one of the most common neurological entities encountered in the emergency room (ER). Seizures are either unprovoked, predominantly manifesting in patients with established epilepsy, or acute symptomatic, usually occurring in patients without a history of epilepsy. The latter are defined to manifest within close temporal relation to acute brain injuries such as stroke, traumatic brain injury or intracranial infections, or to systemic disturbances such as de- or intoxications or metabolic derangements. Acute symptomatic seizures (ASS) may indicate an imminent and potentially life-threatening underlying neurological condition and thus need to be rapidly discerned from unprovoked seizures (US). The aim of this retrospective study was to identify independent clinical variables associated with ASS. Methods: We searched the database of the Charit頿" Universit䴳medizin Berlin for all patients aged 18 years or older who presented in the year 2014 in the ER with a diagnosis coded by ICD10 as G40.x, G41.x or R56.8 (n=1,519). We excluded all ER presentations which primarily were not due a seizure but due to some other complaints (n=397) and in which we couldn't confirm the diagnosis of an epileptic seizure after having reviewed all available information from the charts (n=291). In patients with multiple ER presentations due to seizures in that year, we considered only the first one eventually resulting in 779 patients included. Demographic, semiological and treatment variables were derived from documentation in the ER charts and were assessed for significant associations with ASS as compared to US using multivariate analyses. Results: In the current sub-analysis, we focused on patients with epileptic seizures (n=695; median age 47.8 years, 1st quartile 32.0, 3rd 62.9 years; 65% males) and skipped 84 cases with status epilepticus. ASS were seen in 170 patients (82.4% males), median age was 48.2 years (1st quartile 39.5, 3rd 58.4 years). In 138 patients with ASS (81.2%), etiology was metabolic-toxic including 126 patients with alcohol withdrawal syndrome. The remaining 32 patients with ASS suffered from acute brain lesions including 17 cases with intracerebral hemorrhage. Clinical variables independently associated with ASS as compared to US were male sex (OR 3.245, 95%CI 2.093-5.030, p < 0.001), generalized tonic clonic as compared to partial seizures (OR 3.497, 95%CI 1.462-8.362, p=0.005), and first manifestation of an epileptic seizure (OR 2.305, 95%CI 1.398-2.961, p < 0.001). Pre-hospital mechanical ventilation was significantly more often performed in ASS (7.1%) compared to US (1,7%; p < 0.001). In the ER, ASS were treated significantly more often (55.9%) than US (30.3%) with anticonvulsants (p < 0.001). Conclusions: In the ER setting, generalized tonic clonic seizures, first manifestation of an epileptic seizure, and male sex may independently point to ASS. These characteristics should prompt the treating physician to early initiate thorough diagnostic tests including neuroimaging as well as blood and cerebrospinal fluid examinations to detect or exclude cerebrovascular accidents, infections, metabolic disturbances, or intoxications. Funding: None.