Prognosis and management of acute symptomatic seizures: a prospective, multicenter, observational study

Herzig-Nichtweiß, Julia; Salih, Farid; Berning, Sascha; Malter, Michael P.; Pelz, Johann O.; Lochner, Piergiorgio; Wittstock, Matthias; Günther, Albrecht; Alonso, Angelika; Fuhrer, Hannah; Schönenberger, Silvia; Petersen, Martina; Kohle, Felix; Müller, Annekatrin; Gawlitza, Alexander; Gubarev, Waldemar; Holtkamp, Martin; Vorderwülbecke, Bernd J.

doi:10.1186/s13613-023-01183-0

Annals of Intensive Care

Table 3 Variables associated with unprovoked seizure relapse after a first acute symptomatic seizure of structural etiology

From: Prognosis and management of acute symptomatic seizures: a prospective, multicenter, observational study

		No unprovoked seizure relapse, n = 111	Unprovoked seizure relapse, n = 11	p, bivariate, uncorrected	Odds ratio, multivariable*	p, multivariable*
Sex	Female	52 (47%)	2 (18%)	0.11
Sex	Male	59 (53%)	9 (82%)	0.11
Age [years]		64 (54–78)	58 (53–64)	0.20
Inpatient treatment	ICU	59 (53%)	5 (46%)	0.83
	IMC	15 (14%)	1 (9%)
	Stroke unit/telemetry unit	32 (29%)	4 (36%)
	General ward	5 (5%)	1 (9%)
Mechanical ventilation	Ventilation	39 (35%)	4 (36%)	1.0
Mechanical ventilation	No ventilation	72 (65%)	7 (64%)	1.0
Sepsis	Sepsis	5 (5%)	1 (9%)	0.44
Sepsis	No sepsis	106 (95%)	10 (91%)	0.44
Initial mRS		3 (1–5)	3 (1–5)	–
Etiology of acute symptomatic seizure	Structural only	101 (91%)	7 (64%)	0.023	1	0.010
Etiology of acute symptomatic seizure	Structural + infectious	10 (9%)	4 (36%)	0.023	11.1 (1.8–69.7)	0.010
Acute symptomatic seizure as initial symptom of underlying pathology	Initial symptom	61 (55%)	3 (27%)	0.11
	Not initial symptom	50 (45%)	8 (73%)	0.11
Delay between manifestation of underlying pathology and seizure	< 24 h	81 (73%)	4 (36%)	0.018	1	0.12
	> 24 h	30 (27%)	7 (64%)	0.018	3.0 (0.8–12.2)	0.12
Acute symptomatic seizure type	Tonic–clonic	79 (71%)	5 (45%)	0.095	1	0.068
Acute symptomatic seizure type	Other than tonic–clonic	32 (29%)	6 (55%)	0.095	4.9 (0.9–26.9)	0.068
Single vs. multiple acute symptomatic seizures	Single seizure	66 (59%)	8 (72%)	0.57
	Multiple, within 24 h after first seizure	25 (23%)	1 (9%)
	Multiple, beyond 24 h after first seizure	20 (18%)	2 (18%)
Inpatient medication	No medication	14 (13%)	0	0.28
	Sedatives only	9 (8%)	0
	Classical antiseizure medication only	35 (31%)	6 (55%)
	Sedatives + classical antiseizure medication	53 (48%)	5 (45%)
Inpatient EEG	Epileptiform activity	10 (9%)	2 (18%)	0.25
	No epileptiform activity	83 (75%)	9 (82%)
	EEG not performed	18 (16%)	0
Time to discontinuation of ASM [months]		4.0 (0.1–9.4); n = 95**	3.9 (0.4–9.9); n = 4***	0.98

Data are given as n (column percent) or median (interquartile range). p values < 0.05 are underlined. mRS, modified Rankin score; ASM, antiseizure medication
*Binary logistic regression; 122 cases included; Nagelkerke’s R² = 0.24
**Otherwise, unknown
***Otherwise, unprovoked seizure relapse at 3.3 months (0.2–5.4) while still on initial treatment

Back to article page