Computed Tomography Abnormalities and Epidemiology of Adult Patients Presenting With First Seizure to the Emergency Department in Qatar

Objectives There is little information available from the Middle Eastern region on adult patients presenting with first seizure. The objectives of this study were to describe epidemiological characteristics of patients presenting to the emergency department (ED) in Doha, Qatar, with first seizure and to determine the incidence of computed tomographic (CT) scan abnormalities. Methods A retrospective cohort study was conducted on all adult patients with first seizure presenting to Hamad General Hospital ED over a 1-year period (June 2012 through May 2013). Electronic patient records were reviewed for demographics, neuroimaging, electroencephalography, laboratory test results, and medications administered. Results There were 439 patients who satisfied inclusion criteria. Patients were aged a mean of 35.3 years (95% confidence interval [CI] = 33.92 to 36.69 years) with a male-to-female ratio of five to one. CT abnormalities were detected in 154 patients (35.3%; 95% CI = 30.81% to 39.82%). Out of reported abnormal scans, 14.7% patients had significant abnormalities such as neurocysticercosis (9.2%); brain metastasis and neoplasm (3.4%); and subarachnoid and subdural hemorrhage, cavernous sinus thrombosis, acute stroke, and brain edema (2.0%). None of the patients had any electrolyte abnormalities, and three patients had hypoglycemia. Patients with initial abnormal CT brain results were more likely to have recurrent seizures (OR = 1.65; 95% CI = 1.11 to 2.45) within 6 months. Conclusions Adults who presented with first seizure to the ED in Qatar had a young male predominance, and a high proportion of brain CT scans were reported as abnormal. It is recommended that all such patients in this population should undergo prompt CT scanning in the ED, but the utility of routine electrolyte tests requires further investigation. Resumen Objetivos Existen poco datos de la region del Medio Este del mundo en pacientes atendidos con una primera crisis epileptica. Los objetivos de este estudio fueron describir las caracteristicas epidemiologicas de los pacientes atendidos en el servicio de urgencias (SU) en Doha, Qatar, con una primera crisis epileptica y determinar la incidencia de alteraciones en la tomografia computarizada (TC). Metodologia Estudio de cohorte retrospectivo que se llevo a cabo en todos los pacientes adultos atendidos por una primera crisis epileptica en el SU del Hamad General Hospital durante el periodo de un ano (junio 2012 a mayo 2013). Se revisaron las historias clinicas electronicas de los pacientes para los datos demograficos, la neuroimagen, la electroencefalografia, las pruebas de laboratorio y los farmacos administrados. Resultados Hubo 439 pacientes que cumplieron los criterios de inclusion. La edad media de los pacientes fue de 35,3 anos (IC 95% = 33,92 a 36,69 anos) con una proporcion varon/mujer de 5 a 1. Las alteraciones en la TC se detectaron en 154 pacientes (35,3%; IC 95% = 30,81% a 39,82%). Del total de los escaneres con alteraciones documentadas, un 14,7% de los pacientes tuvo una alteracion significativa como neurocisticercosis (9,2%), neoplasia o metastasis cerebral (3,4%), o hemorragia subaracnoidea y subdural, trombosis seno cavernoso, ictus agudo y edema cerebral (2,0%). Ninguno de los pacientes tuvo ninguna alteracion hidroelectrolitica y tres pacientes tuvieron hipoglucemia. Los pacientes con una TC alterada inicialmente resultaron tener mayor probabilidad de crisis epilepticas recurrentes (OR 1,65; IC 95% = 1,11 a 2,45) en los 6 primeros meses. Conclusiones Los adultos que se atendieron por una primera crisis epileptica en el SU de Qatar tuvieron una predominancia masculina y edad joven y una alta proporcion de escaneres cerebrales con anormalidades. Se recomienda que a todos los pacientes similares en esta poblacion se les lleve a cabo una TC de forma precoz en el SU, pero la utilidad de las pruebas diagnosticas de los electrolitos de forma rutinaria requiere de futuras investigaciones.