Seizure in the emergency department: Risk and predictors of early recurrency during observation

This study aimed to determine the risk of early seizure recurrence and identify potential predictive factors for focal or generalized seizures among patients presenting to the emergency department.

We conducted a two-year observational study involving all consecutive patients admitted to the emergency department for seizures. Early recurrent seizures were defined as those occurring within 24 h of admission. Clinical and neurological features, blood tests, brain computed tomography scans, and electroencephalographic testing were analyzed. Kaplan-Meier survival analysis was used to determine the median time median time to early recurrent seizures. Univariable and multivariable logistic and Cox proportional hazards models were used to investigate potential predictors of recurrence.

Among the 433 enrolled patients, 92 (21 %) experienced an early recurrent seizure within 24 h. Sixty-three patients had a recurrence within 6 h, while only 19 patients (4.4 %) experienced recurrence between 12 and 24 h after arrival. Abnormal EEG findings (epileptiform or non-epileptiform alterations) and alcohol withdrawal were significantly associated with early recurrent seizures in univariate and multivariate analyses.

Overall, about a fifth of patients presenting with seizures to the emergency department experienced early recurrence within 24 h, with most of these occurring within the first 6 h. Abnormal EEG findings and alcohol withdrawal were significantly associated with an increased risk of early recurrence.