Etiology and Types of Seizures in Patients Presenting to a Tertiary Care Hospital in Karachi: A Cross-Sectional Study

Jawaid, Wajid; Nisa, Qamar Un; Umer, Sumera R; Barry, Sidra J; Qureshi, Amir; Shahbaz, Naila

doi:10.7759/cureus.9194

Cited by 8 publications

(9 citation statements)

References 9 publications

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“… 11 This is especially alarming as a recent study from our centre found CNS infections as among the most common causes of symptomatic epilepsy in both pediatric and adult age group patients in our set-up. 23 Among the four cases of super refractory SE in this study, three were secondary to CNS infections. The need of the hour is to prevent super-refractory status epilepticus by controlling the risk factors in the population, as mortality rate in these cases ranges from 30 to 50%.…”

Section: Discussionmentioning

confidence: 69%

Factors affecting prognosis of status epilepticus among patients presenting to a tertiary care hospital

Jawaid

Irfan²,

Shafee³

et al. 2021

Pak J Med Sci

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Objectives: This study aimed to evaluate the etiology, outcomes and prognostic factors associated with status epilepticus (SE) admissions in Neurology Department of a tertiary care hospital. Methods: A retrospective review was performed on all SE admissions at Dr. Ruth K.M. Pfau Civil Hospital Karachi over a five-year period from July 2015 to June 2020. Demographic, clinical, and etiological factors were investigated for prognostic value. Statistical tests were applied to determine significant prognostic factors. A five percent significance level was used. Results: A total of 176 patients were included in the study. Mortality was reported in 22 cases (12.5%) and morbidity at six months was observed in 44 cases (25.0%). Male gender, previous history of SE, prolonged seizure duration, and late presentation to hospital were significantly associated with mortality (p<0.05). De novo cases of SE tended to be older (p=0.048) and were associated with morbidity at follow-up (p=0.000). The most common causes of epilepsy in our patients with SE were CNS infections (n=54) and Idiopathic epilepsy (n=34). Non-compliance to medicines/under-dosing was the most common provocative factor (n=68). Acute symptomatic causes of SE were more likely to be associated with greater morbidity (p=0.000). Refractory and super-refractory SE were strongly associated with higher mortality (p=0.000). A longer duration of hospital stay was associated with higher morbidity (p=0.000). Conclusion: Male gender, poor control of seizures, CNS infections, prolonged seizures, delayed hospital arrival and refractory/super-refractory status epilepticus were key determinants of mortality in our setting. Previous history of status epilepticus, and acute and symptomatic etiologies were associated with higher morbidity. doi: https://doi.org/10.12669/pjms.38.1.5195 How to cite this:Jawaid W, Irfan M, Shafee SM, Barry SJ, Shah SMM, Shahbaz N. Factors affecting prognosis of status epilepticus among patients presenting to a tertiary care hospital. Pak J Med Sci. 2022;38(1):---------. doi: https://doi.org/10.12669/pjms.38.1.5195 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Section: Discussionmentioning

confidence: 69%

Factors affecting prognosis of status epilepticus among patients presenting to a tertiary care hospital

Jawaid

Irfan²,

Shafee³

et al. 2021

Pak J Med Sci

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“…This mean age is comparable to 20.0 ± 15.1 years reported by Mukuku et al 3 in Lubumbashi (in DRC). In a Pakistani study, Jawaid et al 11 found a mean age of 21.4 ±3.2 years. In studies in SSA and other developing countries, the mean age of epileptic patients ranges from 15 to 20 years, 12,13 unlike in developed countries where epilepsy has a bimodal distribution (i.e.…”

Section: Discussionmentioning

confidence: 98%

“…Studies in SSA have shown a strong representation of generalized tonic-clonic seizures 3,14 and elsewhere. 11 There is a good identification of generalized tonico-clonic seizures by the casework. Indeed, these seizures are the most dramatic.…”

Section: Discussionmentioning

confidence: 99%

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2022

JNSK

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per 1,000 persons) for active epilepsy and 16 per 1,000 persons (95% CI: 12.3-19.7 per 1,000 persons) for lifetime epilepsy, but this estimate was a median figure generated from these studies. These authors found that prevalence was highest in Central Africa at 30.2 per 1,000 people (95% CI: 6.2 to 66.7 per 1,000 persons) and that the prevalence of active epilepsy in rural areas was twice as high as in urban areas. 7 . More than 800,000 people are thought to have epilepsy in the Democratic Republic of the Congo (DRC), where very few epidemiological studies on this condition have been conducted. 8 Etiologies of epilepsy are diverse; they can be infectious, vascular, neoplastic, metabolic, genetic, or degenerative. Head injuries can also cause epilepsy immediately or several years later. Stroke and neurodegenerative diseases may be etiological factors of epilepsy in the elderly. 9 The present study aims to describe socio-demographic characteristics, the type of epileptic seizures, and etiological factors of these seizures in a hospital cohort of epileptic patients followed at the Neuropsychiatric Hospital Center in Goma (in the DRC). Materials and methods Study framework and designThis cross-sectional descriptive study was conducted at the Neuropsychiatric Hospital Center in Goma, North-Kivu province, the eastern DRC (city with about 2 million inhabitants). This hospital is the only hospital in North-Kivu province to provide specialized services in neuropsychiatry and has a bed capacity of 100 patients. Epilepsy prevalence in the community is unknown. Study population and variablesThe present study includes all adults and children admitted for epilepsy. We reviewed the admissions registry from January 1st, 2017 to December 31st, 2021 for patients diagnosed with epilepsy and/or a history of use of anti-epileptic drugs. Following data were collected using a form with a variety of variables and was obtained

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“…A study done by Singh TD et al showed metabolic abnormalities causing 12% of the cases of new onset seizures, in whom hyponatremia was the most common cause. 25 Adults with secondary seizures were diagnosed most often with head injury (25.2%), brain tumors (19.9%) and stroke (18.4%) as causative factors in a study conducted by Wajid J et al 26 Among total number of cases, 8.6% have positive family history of epilepsy while a study conducted in Aziz H et al showed that family history was positive up to 32 %. 27 …”

Section: Discussionmentioning

confidence: 99%

Etiology and outcomes of new onset seizure in adult patients: A clinical experience from emergency department of a tertiary care center

Noman¹,

Dharamshi

Mustahsan³

et al. 2022

Pak J Med Sci

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Objectives: To identify the etiology and outcomes of new onset seizure in adult patients presenting to the Emergency Department (ED), to improve knowledge among healthcare providers regarding diagnosis and hence improve the outcomes. Methods: This was a descriptive retrospective study conducted at the Emergency Department of Aga Khan University Hospital, Karachi, Pakistan. Adult patients (18 years and above), presented to the ED from January 01, 2019 to June 30, 2020, with new onset seizure were included consecutively. Descriptive data on patient demographics, seizure types, investigations performed, final diagnosis and disposition were collected retrospectively from patient’s file and electronic record. Etiologies of seizure were classified as structural (metabolic, trauma, infection), genetic or idiopathic. The immediate outcomes were reported as hospitalization or discharge from the ED. Results: In total 198 patients with new onset seizure were included. Majority of the patients were found in middle age group i.e., 35 to 65 years (44.4%). Gender distribution showed slightly higher percentage of females (55.1%). Generalized tonic clonic seizures were found to be the most common type of seizures (74.2%), followed by generalized tonic (12.1%) and focal onset aware seizures (7.5%). Out of total patients no cause was identified in eight patients (4%), whereas in total confirmed causes of new onset seizures, structural lesions of brain were found to be the most common cause (89.6%%), including neurological (23.6%), infectious (4.2%), systemic (13%), metabolic (7%) and toxicological (4%) causes respectively. Conclusion: This study explores the various etiologies of new onset seizures in adult patients presenting to the ED. The study emphasizes the need for a local guideline for the investigation of new onset seizures in adult patients that would direct emergency physicians in respect of appropriate management, thus to ensure better quality of patient care and outcomes. doi: https://doi.org/10.12669/pjms.38.5.4411 How to cite this:Ali N, Dharamshi HA, Mustahsan S, Noorani S. Etiology and outcomes of new onset seizure in adult patients: A clinical experience from emergency department of a tertiary care center. Pak J Med Sci. 2022;38(5):---------. doi: https://doi.org/10.12669/pjms.38.5.4411 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Etiology and Types of Seizures in Patients Presenting to a Tertiary Care Hospital in Karachi: A Cross-Sectional Study

Cited by 8 publications

References 9 publications

Factors affecting prognosis of status epilepticus among patients presenting to a tertiary care hospital

Factors affecting prognosis of status epilepticus among patients presenting to a tertiary care hospital

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Etiology and outcomes of new onset seizure in adult patients: A clinical experience from emergency department of a tertiary care center

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