Cross-sectional study of the hospital management of adult patients with a suspected seizure (EPIC2)

BMJ Open. 2017 Jul 13;7(7):e015696. doi: 10.1136/bmjopen-2016-015696.


Objective: To determine the clinical characteristics, management and outcomes of patients taken to hospital by emergency ambulance after a suspected seizure.

Design: Quantitative cross-sectional retrospective study of a consecutive series of patients.

Setting: An acute hospital trust in a large city in England.

Participants: In 2012-2013, the regions' ambulance service managed 605 481 emergency incidents, 74 141/605 481 originated from Sheffield (a large city in the region), 2121/74 141 (2.9%) were suspected seizures and 178/2121 occurred in May 2012. We undertook detailed analysis of the medical records of the 91/178 patients who were transported to the city's acute hospital. After undertaking a retrospective review of the medical records, the best available aetiological explanation for the seizures was determined.

Results: The best available aetiological explanation for 74.7% (68/91) of the incidents was an epileptic seizure, 11.0% (10/91) were psychogenic non-epileptic seizures and 9.9% (9/91) were cardiogenic events. The epileptic seizures fall into the following four categories: first epileptic seizure (13.2%, 12/91), epileptic seizure with a historical diagnosis of epilepsy (30.8%, 28/91), recurrent epileptic seizures without a historical diagnosis of epilepsy (20.9%, 19/91) and acute symptomatic seizures (9.9%, 9/91). Of those with seizures (excluding cardiogenic events), 2.4% (2/82) of patients were seizing on arrival in the Emergency Department (ED), 19.5% (16/82) were postictal and 69.5% (57/82) were alert. 63.4% (52/82) were discharged at the end of their ED attendance and 36.5% (19/52) of these had no referral or follow-up.

Conclusions: Most suspected seizures are epileptic seizures but this is a diagnostically heterogeneous group. Only a small minority of patients require emergency medical care but most are transported to hospital. Few patients receive expert review and many are discharged home without referral to a specialist leaving them at risk of further seizures and the associated morbidity, mortality and health services costs of poorly controlled epilepsy.

Keywords: Epilepsy; Neurology.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Ambulances*
  • Cross-Sectional Studies
  • Emergency Service, Hospital / statistics & numerical data*
  • England
  • Epilepsy / epidemiology
  • Epilepsy / physiopathology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Patient Discharge / statistics & numerical data
  • Recurrence
  • Referral and Consultation / statistics & numerical data
  • Retrospective Studies
  • Seizures / etiology*
  • Seizures / therapy*
  • Young Adult