PracticeUpdate Conference Series - ANZAN 2018

Recurrent Untreated Seizures Often Exhibit Subtler Semiology and More Likely to Exhibit Normal MRI and EEG Results Than New-Onset Seizures Recurrent untreated seizures have been found to often exhibit subtler semiology and are more likely to exhibit normal MRI and EEG results than new-onset seizures, finds a retrospective chart review.

E mma J. Foster, MBBS (Hons) and Sarah J. Holper, MBBS (Hons), of the Royal Melbourne Hospital in Victoria, explained that diagnosis of a first seizure may be delayed due to financial, geographical, or social barriers to healthcare ser- vices, or to misdiagnosis with other disorders, such as syncope or stroke. Patrick Kwan, FRACP, PhD, also of the Royal Melbourne Hospital, participated in the chart review as well. “Seizures are a common neurological presentation in both community and hospital settings,” Dr. Foster told Elsevier’s PracticeUpdate . “It is likely that new-onset or newly diagnosed seizures occur- ring in the community and during hospitalization for other illnesses have different etiologies and prognoses, and thus require different investigation and treatment approaches.” She continued, “Previous studies have tended to investigate these cohorts separately, but direct com- parison of patient characteristics between these studies is difficult because of varying study settings.” “Within the same hospital,” she said, “we compared the clinical presentation and management of new-onset and newly diagnosed seizures in two cohorts: (1) patients who experienced a new-onset or newly diagnosed seizure in the community and presented to the emergency department, and (2) those admitted for an unrelated illness who expe- rienced a new-onset or newly diagnosed seizure in the hospital ward.” Medical charts were reviewed and information extracted on patient demographics and clinical characteristics. Inclusion criteria were age ≥18

years and attendance at a tertiary-level hospital in Melbourne between 2008 and 2016 with dis- charge codes ICD-10 G40 epilepsy, G41 status epilepticus, or R56.9 unspecified convulsions. A total of 367 episodes were identified, of which 151 met inclusion criteria (n=115 new-onset seizures; n=36 recurrent, untreated seizures). A total of 216 cases were excluded (n=186 preexist- ing epilepsy; n=30 nonseizure events). The cohort with recurrent, untreated seizes experienced a median of 2 seizures prior to receiving medical attention. Most of these were focal impaired-awareness seizures (50.00%). Focal seizures were more com- mon index seizures in the cohort with recurrent, untreated seizures (36.11% vs 24.35%). Primary generalized seizures predominated in the cohort with new-onset seizures (62.61% vs 50.00%). Compared with the cohort with new-onset seizures, the cohort with recurrent, untreated seizures was more likely to have suffered unprovoked seizures (72.22% vs 55.65%), to carry identifiable remote risk factors (41.67% vs 26.09%), to be younger (69 vs 76 years of age), to exhibit normal MRI and EEG, to be discharged with antiepileptic drugs (86.11% vs 73.91%), and to be followed by a neurologist (72.22% vs 39.99%). Follow-up was more timely than in the cohort with new-onset seizures. In fact, 30.56% vs 11.31% saw a neurologist within 1 month of discharge. “Our study revealed,” Dr. Foster said, “an older cohort than previously reported (median age 74 years),

Dr. Emma J. Foster

Dr. Sarah J. Holper

Dr. Patrick Kwan

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PRACTICEUPDATE CONFERENCE SERIES • ANZAN 2018