Abstract
Introduction. Transient loss of consciousness (TLoC) encompasses symptoms caused by either syncope, seizures or psycogenic disorders which are all frequent in the emergency department (ED). The study aims to determine the prevalences of causes of TLoC in the ED, analyse the characteristics of patients with seizures or established epilepsy in particular and estimate the level of evaluation and management they receive in respect to available international guidelines. Materials and methods. The data was cross-sectional and was retrieved from the local database of Vilnius University Hospital Santaros Klinikos from January 1st to December 31st 2016. Adult patients with diagnoses (coded in the International Statistical Classification of Diseases and Related Health Problems, ICD-10-AM) of syncope (R55), epilepsy (G40) or other and unspecified convulsions (R56.8) assigned either by the emergency medical services or the ED staff were involved in the study (315 cases). The data was analysed with Microsoft Excel v16.0 and IBM SPSS Statistics v20, two-sided Fisher’s exact and Mann-Whitney U tests were employed (p<0.05). Results. As diagnoses provided by emergency services and the ED staff were conflicting, only the latter were used for the assortment. The majority of patients brought to the ED with TLoC (average age 53.5±20.8) had syncope or collapse (134, 42.5%), 54 (17.1%) had epilepsy, and 32 (10.2%) had other and unspecified convulsions, which encompass mostly new-onset seizures. The mean age of patients with established epilepsy was 47.6±15.7 and significantly (p=0.014) lower than due to other causes. Male gender predominated in all-cause seizures (odds ratio OR=1.7; 95% confidence interval CI=1.0-2.9, p=0.042). Laboratory blood tests were commonly used for all patients, but patients with epilepsy received computed tomography (CT) scans and were hospitalized more often than other patients (p<0.001, p=0.002, respectively). Both an electrocardiography (ECG) and troponin blood levels (both often received after syncope and collapse) were evaluated less frequently in these cases, however (p<0.001). Focal seizures (32, 59.3%) and alcohol-related metabolic seizures (8, 14.8%) were most common with epilepsy; unknown or unspecified (22, 68.8%) and generalized (6, 18.8%) – with new-onset seizures. For outpatients with epilepsy, alcohol abstinence (16, 44.4%) and everyday (lifestyle, work etc.) recommendations (13, 36.1%) were most common, treatment was often modified (14, 38.9%). Outpatients with seizures but no diagnosed epilepsy were most often advised to consult a neurologist, receive an electroencephalography (EEG) (19, 76.0% and 11, 44.0%, respectively), and abstain from alcohol ( 11, 44.0%), but treatment was almost never prescribed. Conclusions. Syncope and collapse caused most cases of TLoC, followed by established epilepsy and new-onset seizures. Patients with epilepsy were younger than in other cases and in assessing all presentations with seizures, male gender predominated. The evaluative practices and care complied with selected international guidelines in most cases, except for some approaches related to neuroimaging and information deliverance.
Highlights
MATERIALS AND METHODSEpilepsy, with a prevalence of 8.3 per 1000 inhabitants in 2016 in Lithuania, is a common and costly neurological disorder with epileptic seizures presumed to cause about 1–2% of all emergency department (ED) visits [1,2,3]
Male gender predominated in allcause seizures
Our study shows that syncope and collapse is more common among cases of transient loss of consciousness (TLoC) than seizures of any cause
Summary
The American Academy of Neurology and the American Epilepsy Society (AAN and AES) present recommendations for dealing with a first unprovoked seizure [11]. Such guidelines indicate in which circumstances patients with seizures should receive general advice, laboratory testing, have neuroimaging or an electroencephalography (EEG) performed, begin treatment with anti-epileptic drugs (AEDs) or be hospitalized. As the data from various studies is summarized in these guidelines and is graded by levels of scientific evidence by ACEP, SIGN, AAN and AES from A to C by ACEP, SIGN, AAN and AES (A being from class I–II studies, B from class II–III and C from low to middle strength class III studies) and according to classes I–III by NICE, the recommendations become a useful means to estimate the quality of evaluation and care that patients presenting seizures receive in a particular ED. Studies aiming to perform a similar task are not very frequent, especially when considering the fact that the National Audit of Seizure management in Hospitals (NASH) study of 2015 in the United Kingdom claims to probably be the first of its kind worldwide [3]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
