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Utility of hospitalization following a first unprovoked seizure

Authors

  • I. Goldberg,

    1. EEG and Epilepsy Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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  • M. Y. Neufeld,

    1. EEG and Epilepsy Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
    2. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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  • E. Auriel,

    1. EEG and Epilepsy Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
    2. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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  • R. Gandelman-Marton

    Corresponding author
    1. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
    2. EEG and Epilepsy Unit, Department of Neurology, Assaf Harofeh Medical Center, Zerifin, Israel
    • EEG and Epilepsy Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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R. Gandelman-Marton, The Neurology Department, Assaf-Harofeh Medical Center, Zerifin, 70300 Israel

Tel.: 972-8-9778134

Fax: 972-8-9779182

e-mail: revitalgm@hotmail.com

Abstract

Objectives

Hospital admission in otherwise healthy patients following a first unprovoked seizure is controversial. We aimed to evaluate the influence of admission in a neurology department on the identification of risk factors for seizure recurrence in patients with a first unprovoked seizure.

Materials and methods

We retrospectively reviewed the medical records of patients with a first unprovoked seizure, who were admitted to the neurology departments at two medical centers between 2007 and 2009. Risk factors for seizure recurrence included the following: abnormal neurological examination, abnormal brain CT scan, and epileptiform discharges on the EEG.

Results

The study group included 97 patients (52 men) aged 18–85 years (mean 42). Eighty-seven (90%) patients were admitted following a generalized tonic–clonic seizure. Risk factors were identified in the emergency room (ER) in 36 (37%) patients, mainly including abnormalities of the neurological examination and brain CT scan. Nineteen (20%) patients had a risk factor which was not apparent during ER evaluation, consisting of epileptiform activity on the EEG. Five (5%) patients had recurrent seizures during admission, three of them without risk factors during the ER evaluation.

Conclusions

Risk factors for seizure recurrence were detected during admission in nearly a quarter of the patients who presented to the emergency room with a first unprovoked seizure. Because the main advantage of admission is the EEG recording, we suggest that an early EEG should be obtained in these patients either during admission or through a special accelerated outpatient arrangement.

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