First-episode seizures amongst adult patients presenting to an academic hospital emergency department – a preliminary report

Background: First-onset seizures are not a diagnosis per se but may be a harbinger of a potentially life-threatening underlying illness. The aim of this pilot study was to describe the pattern of presentation of adults presenting with a first-onset seizure to the emergency department (ED).Methods: Medical records of patients >18 years who presented over a 6-month period (November 2016 to May 2017) to the study centre with a first-episode seizure were retrospectively reviewed.Results: A total of 60 patients, with a median age of 37.4 years (IQR; 29.3–47.7 years) presented with first-onset seizures over the study period. The median time to ED presentation after a seizure episode was 120 min (IQR; 51–244 min). More than half the number of subjects (58.3%) were male, 28.3% were HIV positive, 84.2% had a generalized tonic-clonic seizure and 56.7% required admission. A decrease in the level of consciousness, foaming around the mouth, tongue biting and urinary incontinence were evident in 76.7%, 36.7%, 31.7% and 33.3% of subjects, respectively. Hypoglycaemia (26.7%), ring-enhancing space occupying lesion/s (16.7%) and cerebrovascular infarction (11.7%) accounted for approximately two-thirds of causes of first-episode seizures. Long-acting anticonvulsants were administered to 66.7% of subjects in the ED and prescribed to 53.3% of subjects upon hospital discharge.Conclusion: Hypoglycaemia and intracranial pathologies are common causes of first-episode seizures that must be considered in all patients. The late presentation of patients to the ED in this pilot study is a major concern. Due to the high prevalence of HIV in South Africa, there is a need to develop local guidelines on the management of first-presentation seizures in HIV-positive as well as HIV-negative patients.