Etiology of new-onset seizures in adult patients of different age groups presenting to the emergency department in North India and their outcomes

Abstract

A BSTRACT Introduction: Seizures are one of the most common neurological emergencies encountered in both urban and rural India. There is only limited research work on the etiology of new-onset seizures in adult patients of different age groups presenting to the emergency department, especially from the Indian sub-continent. A new-onset seizure can be the first presentation of stroke, or it may be a symptom of brain infections, metabolic abnormality, brain tumor, systemic disease, or an early phase of epilepsy, which needs scrutiny and appropriate management. A dedicated study of the underlying etiology of new-onset seizures among different age groups and their incidence and prevalence can help in the prognostication and clinical management of these patients. Materials and Methods: This was a prospective observational cross-sectional study conducted in the Emergency Medical Out-patient Department and emergency medical ward of the Post-graduate Institute of medical education and research, Chandigarh. Results: In our research, males out-numbered females. The most common seizure type recorded in our study was generalized tonic-clonic. In the younger age group between 13 and 35 years, infective etiologies were dominant. In the middle age group between 36 and 55 years, cerebrovascular accidents were the dominant etiology, followed by infective causes and metabolic causes. In the older age group above 55 years, the most dominating etiology found was cerebrovascular accident. Almost 72% had abnormal brain imaging. The most common abnormality found was ischemic infarcts. The second most common abnormality detected was a meningeal enhancement. A small percentage of patients had an intra-cranial bleed, and a very small percentage had a subarachnoid hemorrhage. Conclusions: In younger patients, infections such as tubercular and pyogenic meningitis and cerebral malaria are the most common causes of new-onset seizures, followed by malignancy and metabolic causes, in descending order. In the middle age group, stroke is the most common etiology, followed by central nervous system (CNS) infections and metabolic causes, in descending order. In elderly patients, stroke is the leading etiology for new-onset seizures. Physicians working in rural and remote areas routinely face challenges in managing patients with new-onset seizures. Knowledge of different etiologies in different age groups will equip them to make informed decisions regarding investigations and treatment of patients with new-onset seizures. It also encourages them to aggressively search for CNS infections, especially in younger patients.

Profile of adult -onset epilepsy in Zagazig university hospitals

“…These results are different from Bhatia and colleagues [14] who had reported that the most common seizure type of seizure was generalized tonic-clonic seizures, present in 98.9% of patients, whereas focal seizures were seen in 1.1%, and the percentage of patients having generalized tonic-clonic seizures was more than those in our study, probably because all patients in their study were enrolled from emergency departments where most of the active epilepsy patients brought to emergency room are those having the grand mal presentation (generalized tonic-clonic seizures), particularly when they take the serial or status form.…”

“…In our study 12.0% of the studied patients had normal computed tomography (CT) / magnetic resonance imaging (MRI) brain, and 88.0% had abnormal CT / MRI brain. Parallel to the results of our study, Bhatia and colleagues [14] showed that almost 72% had abnormal brain imaging and Sheikh and colleagues [17] stated that MRI showed abnormal findings in 59.7% of the patients.…”

“…In agreement with these results, Bhatia and colleagues [14] showed that male patients outnumbered female patients, 54.4% of the patients were males, and 45.6% were females, with an average age of 44.6 years, and the male to female proportion was 1.2 to 1. Similar results were reported by Kaur and colleagues [15] who stated that 65% were males, most of the patients (38%) were in the age group of 21 years-40 years and 41 years-60 years, only 9% were of < 20 years, and 15% were of more than 60 years.…”

“…Bhatia and colleagues [14] showed in their study that the majority of cases (81.1%) had no past history of medical diseases, whereas 7.7% had hypertension, 5.6% had diabetes. These figures are much lower than what is in our study, which may be attributed to differences in cultural and environmental factors, and in lifestyle and feeding habits, also it may be attributed to the much lower age range of their patients than ours, where two thirds of their patients aged from 13 to 55 years, while 74% of our patients aged from > 40 to > 65 years.…”

“…The majority of the studied patients (61%) had 1 to 4 seizures per month, 30% had 5 to 8 seizures per month, and 9% had 9 to 15 seizures per month. Bhatia and colleagues [14] reported that the majority of their patients (92.2%) had one to five episodes of seizure per month, whereas 5.6% of patients were found to have six to ten episodes, and 2.2% were found to have 10 -15 episodes of seizure.…”