Abstracts

Authors debate about the duration of a seizure before acute treatment is appropriate. We wished to provide data on the duration of seizures observed in the epilepsy monitoring unit when the seizures subsided without acute therapy. This data will assist this debate. We logged the five longest epileptic seizures of each patient who was eighteen years or older and was in our epilepsy monitoring unit between 1/1/2000 and 12/31/2004. Most patients were in acute anticonvulsant withdrawal, but not those with a history of status epilepticus. We excluded patients with invasive electrodes and patients who were studied to determine if seizures continued. Seizure onset and end were determined by a single epileptologist (W.S.C.) who is experienced in intensive seizure monitoring evaluations. He chose seizure start as the initial EEG change or clinical change. Usually, the end of the seizure was chosen on EEG criteria. We observed seizures in 191 patients during this time. Most seizures (487) were of less than two minutes duration, 78 were 2-3 minutes, 21 were 3-4 minutes, 14 were 4-5 minutes, 9 were 5-6 minutes and 7 were more than 6 minutes long. Our longest seizure was 13 minutes in duration and was a partial simple seizure with only subjective symptoms. No primary generalized seizures were more than 3 minutes long. When seizures secondarily generalized, the generalized portion of the seizure was no more than 3 minutes long. However, the seizure could have a significant partial portion both before and after the generalized segment. None of our patients received medication to terminate a seizure, although several received medications shortly after a seizure when we judged that we had recorded enough events to answer the question posed for the admission. Our data demonstrates that most seizures last less than two minutes. However, some seizures can be quite lengthy, yet still be both self-limited and associated with mild symptoms. We did not observe [ldquo]lengthy[rdquo] primarily or secondarily generalized seizures in this cohort. This data supports the advice to physicians to observe a partial seizure before giving an acute anticonvulsant medication.