Most frequent etiology of first-time seizure: a retrospective study realized in a public hospital?

LAGGER IGNACIO; BALLESTEROS DIEGO; GOMEZ MELE LUCAS; KURTZ, VERONICA; LOPEZ JUAN IGNACIO; PEREZ GARCIA JORGELINA; KNORRE FRANCISCO

Washington

Congreso; 71th American Epilepsy Society Annual Meeting,; 2017

American Epilepsy Society

Rationale Seizures are a common presentation of neurological emergency. Annually approximately 150,000 adults will present with a first seizure in the United States. According many studies, between 40-50% of patients with a first-time seizure (FTS) no cause is identified, less than 10% have a metabolic or toxicologic cause and 20% of patients diagnosed with epilepsy have pseudoseizures.According to the ILAE, seizures can be categorized depending on the etiology in acute symptomatic seizures, if it was caused by a recent acute CNS insult (toxic, structural, metabolic, infectious or due inflammation); or remote symptomatic seizures, if caused due to a preexisting brain injury or lesion such as a tumor or stroke; or unprovoked seizure (idiopathic seizure) when all studies were realized and no cause is identified.The aim of this study was to determine the incidence of FTS, cause of FTS and type of seizure in a public hospital in Argentina.MethodsA retrospective study was performed from patients with a FTS between June 2013 to April 2017 at the Hospital de Agudos Dr Teodoro Álvarez. To determinate the cause of FTS blood count, serum electrolytes, serum glucose and urinary sediment analyses were performed immediate after the FTS. Also, a brain imaging study using RMI or CT (depending on the patient condition or if they had any contraindications) were done.ResultsA total of 43 men and 40 women were studied, with a mean age of 52.68 years. The most frequent etiology was acute symptomatic seizure (36.14%), followed by remote symptomatic seizures (31.33%), unprovoked seizure (26.51%) and finally pseudoseizures (6.02%).The most frequent cause was infection disease (24 cases; 28.93%) followed by vascular disease (11 cases; 13.25%) and tumor (7 cases; 8.43%). Only 4 were provoked by hyponatremia and 2 by Hypocalcemia. Alcohol withdrawal and drugs were the cause in 5 patients.According to the blood tests, the CBC reported leukocytosis in 35 cases (42.16%). Serum electrolytes was useful in 6 cases (four seizures were due to hyponatremia and two to hypocalcemia). The urinary sediment analysis yielded pathological results in 10 cases (12.05%). Regarding imaging studies, 45 CT and 38 RMI were performed. 13 TC (29.54%) and 15 MRI (18.75%) were useful in diagnosing the etiology of FTS.Finally, in 22 patients (26.51%) all the studies (blood count, serum electrolytes, serum glucose, urinary sediment analysis and imaging study) were normal. We diagnose these cases as unprovoked seizures.Respect type of seizure, generalized onset seizures (tonic-clonic seizures) were the most frequent type (68.67%) follow by status epilepticus and focal to bilateral tonic-clonic seizures (9.64% and 8.43% respectively). Also 4 patients suffer focal impaired awareness seizure (4.82%), 2 suffer focal seizures (2.41%) and 6 patients had pseudoseizures (6.02%).ConclusionsOur study shows that acute symptomatic seizure is the most frequent etiology of FTS. Moreover, pseudoseizures were the less cause (6.02%), which go against the findings of LaFrance WC Jr and col, who determinate a pseudoseizure incidence of 20%.Also, it shows that the infectious etiology, the vascular etiology and tumors were the most frequent cause of FTS.Respect type of seizure, as many other studies show, generalized onset seizures (tonic-clonic seizures) were the most frequent type (68.67%). This could be because in many cases at the beginning of the seizure there were no witness or they didn?t know how to describe it.