Abstracts

Acute repetitive seizures (ARS), multiple seizures within 24 hours with recovery between seizures, are common. It has been thought that ARS requires urgent treatment in the Emergency Department (ED), but the management of ARS is not as well-defined as other acute seizure presentations such as status epilepticus or alcohol withdrawal seizures. ARS is commonly treated with benzodiazepines (BZD) sometimes with a longer-acting antiepileptic drug (AED), such as intravenous phenytoin (PHT), valproic acid (VPA), or leviteracitam (LEV). A better understanding of the characteristics of ARS and its response to therapy may help to optimize treatment of ARS in an ED setting., Patients who presented to the UMMC ED (Baltimore, MD) with ARS between 11/01/05 through 2/1/06 were identified. Initial search criteria included all patients at least 18 years of age with discharge diagnosis code(s) for seizure(s). ARS characteristics, ED treatment course including length of stay, and outcome were extracted. Patients who presented with status epilepticus or alcohol withdrawal seizures were excluded from this analysis., Over a 3-month period, 88 patients presented to the ED with seizures. Of these, 20 (23%) met criteria for ARS (median 3 seizures). Eight patients received either no treatments or only a single dose of BZD. Nine patients received some combination of BZD with a longer acting AED (PHT or VPA). Three patients received only a longer acting AED (PHT or LEV). No patients had recurrent seizures after treatment (or lack of treatment). Patients who received a combination of BZD and longer acting AED or a longer acting AED alone had an average length of stay greater than 10 hours and were more likely to be admitted, while patients who received no treatment or BZD only stayed in the ED for less than 10 hours on average and were less likely to be admitted., The majority of patients with ARS do well, even when not treated or given only a single dose of BZD. While all patients in this study had an excellent outcome, patients who were treated with a longer acting AED or a combination of longer acting AED and BZD tended to have longer ED stays and were more likely to be admitted. Based on these findings, perhaps the urgent use of longer acting AEDs to treat ARS in the ED setting should be reconsidered.,