Presentation of first onset seizures in Adults at a tertiary hospital in South Africa

Abstract

Background: First-onset seizure is not a diagnosis per se but may be an indication of a potentially life-threatening underlying illness. The symptoms and presentation may indicate certain types of seizures. The aim of this study was to describe adults presenting with firstonset seizures to an Emergency Department in Johannesburg. Method: A prospective review was performed on the medical records of patients >18-years who presented over a 6-month period to the study centre with first-onset seizures. Patients with post traumatic seizures and epilepsy were excluded. Results: A total of 60 patients, with a median age of 37.4 years (IQR; 29.3-47.7 years) presented over the study period. More than half the number of subjects (58.3%) were male, 43.6% were HIV positive, 84.2% had a generalised tonic-clonic seizure, 57.6% presented to hospital more than 2 hours after the seizure, 41.1% returned to baseline neurological function within 30 minutes of the seizure and 56.7% required admission. A decrease in the level of consciousness (77%), foaming around the mouth (37%), urinary incontinence (33%) and tongue biting (32%) were the most common symptoms. A full blood count (97%), urea & electrolytes (88%), blood glucose level (72%), CT scan of the brain (75%) and lumbar puncture (68%) were the most common diagnostic procedures performed. Hypoglycemia (26.7%), ring enhancing space occupying lesion/s (16.7%) and cerebrovascular infarction (11.7%) accounted for approximately two-thirds of abnormalities found on CT in our study subjects. Conclusion: Patients presented with multiple symptoms and multiple different possible causes of first onset seizures. Although most studies showed low yield for glucose and CTB, our study showed that in resource limited settings, glucose and CTB are key diagnostic investigations among patients presenting with first onset seizures.