Nonmotor seizures often undiagnosed in emergency departments

Key takeaways:

• The study analyzed 83 adolescents with focal epilepsy who presented to EDs.
• Nonmotor seizures were less likely than motor seizures to be identified during presentation to EDs.

Among adolescents with focal epilepsy, nonmotor seizures are more often missed or misdiagnosed compared with motor seizures, according to research presented in Neurology.

“Nonmotor seizures present as subtle seizures without noticeable movements and may not be outwardly apparent,” Nora Jandhyala, BS, a medical student in the department of neurology at NYU Langone Health, and colleagues wrote. “Thus, identification of these seizures can be difficult for both family and providers.”

Jandhyala and fellow researchers sought to investigate recognition of motor compared with nonmotor seizures in EDs and its effect on management and treatment of focal epilepsy in adolescents.

They engaged in a retrospective analysis of enrollment data from the Human Epilepsy Project (HEP), an international multi-institutional study that collected data from 34 sites between 2012 and 2017. A total of 83 neurotypical individuals aged 12 to 18 years who were within 4 months of treatment initiation for focal epilepsy were included. All participants were divided by the nature of their symptoms into motor and non-motor groups, then further subdivided by ED presentation by initial or recurrent seizure and semiology of the presenting seizure. Fifty-eight of the 83 young persons presented to an ED prior to epilepsy diagnosis.

Researchers utilized HEP enrollment medical records to review participants' initial diagnosis and management, while statistical analysis was performed with Chi-square, Mann-Whitney and student t-testing utilized for a number of physical, clinical and demographic comparisons.

Although 90% of ED presentations from the study cohort were for motor seizures, results showed that 38% of patients had a history of nonmotor seizures.

Adolescents with initial nonmotor seizures were less likely to present to EDs (59% vs. 82%), and nonmotor seizures were less likely to be correctly identified (33% vs. 81%). A history of initial nonmotor seizures was not recognized in any adolescent who presented for a first-lifetime motor seizure.

Researchers also found that initiation of treatment and admission from the ED was not more likely for this population compared with those with no seizure history. This lack of nonmotor seizure history recognition in the ED was greater than that observed an adult cohort (0% vs 23%) and occurred in both pediatric and adult ED settings.

“Improving seizure recognition in the [emergency department] may lead to increased appropriate neurology referrals, inpatient admissions and treatment initiation with the goal of improving outcomes for children living with epilepsy,” Jandhyala and colleagues wrote.