Neurological Emergency Department Research Articles

Case report of ADEM in an adult patient with chikungunya

AbstractAcute Disseminated Encephalomyelitis (ADEM) is a demyelinating immune‐mediated disease characterized by bilateral and confluent lesions in white matter (WM), with an acute onset. This condition may arise due to a myriad of etiological factors, encompassing mainly vaccines and viral infections. This case report describes a 39‐y‐old patient who presented with a sudden onset of fever, confusion, and reduced level of consciousness, associated with paraparesis in the lower limbs and urinary retention, 2 d before admission to the neurological emergency department. The work‐up included analysis of the cerebrospinal fluid (CSF), which showed 1.6 cells/mm3 and elevated proteins (91 g/dL); in addition to magnetic resonance imaging (MRI) of the brain and the spinal cord, in which hyperintense ovoid lesions with asymmetrical and bilateral distribution in the WM and basal ganglia were observed in the T2 and FLAIR. Later, chikungunya virus was detected in a molecular viral panel in the CSF. The patient exhibited an improvement radiologically, and in his condition following pulse with methylprednisolone and intravenous immunoglobulin therapy, and 40 mg of prednisone was prescribed for management during outpatient follow‐up. This study highlights arbovirus infections as a possible cause of acute neurological conditions, involving both the brain and the spinal cord. Furthermore, the findings observed in the report were compared with those described in the literature, including other arboviruses. In conclusion, it was observed that the majority of patients responded to treatment with corticosteroids or immunoglobulins, with some neurological deficits eventually persisting. Therefore, more studies are needed to better investigate therapeutic options.

Characteristics of Adult Brain Tumors in Neurology Emergency Unit in Prof. Dr. I.G.N.G. Ngoerah Hospital Bali 2020-2022

Characteristics of Adult Brain Tumors in Neurology Emergency Unit in Prof. Dr. I.G.N.G. Ngoerah Hospital Bali 2020-2022

Endothelial receptor proteins in acute venous thrombosis and delayed thrombus resolution in cerebral sinus vein thrombosis

Background and purposeCerebral sinus venous thrombosis (CSVT) is a rare but life-threatening disease and its diagnosis remains challenging. Blood biomarkers, including D-Dimer are currently not recommended in guidelines. Soluble endothelial receptor proteins (sICAM-1, sPECAM-1 and sVCAM-1) have been shown to be promising diagnostic biomarkers in deep vein thrombosis (DVT) and pulmonary embolism (PE). Therefore, we examined endothelial receptor proteins as potential biomarkers for detecting CSVT.MethodsIn this bi-centre, prospective study, we quantified D-Dimer as well as sICAM-1, sPECAM-1 and sVCAM-1 in plasma of patients with clinically suspected CSVT managed in the neurological emergency department (ED) of a tertiary care hospital. All patients underwent cerebral magnetic resonance imaging (MRI) and were followed up after 3, 6 and 12 months to detect thrombus resolution.ResultsTwenty-four out of 75 (32%) patients with clinically suspected CSVT presenting with headache to the ED were diagnosed with acute CSVT. These patients had a mean age of 45 ± 16 years and 78% were female. In patients with CSVT, mean baseline D-dimer (p < 0.001) and sPECAM-1 (p < 0.001) were significantly higher compared to patients without CSVT. The combination of D-Dimer and sPECAM-1 yielded the best ROC-AUC (0.994; < 0.001) with a negative predictive value of 95.7% and a positive predictive value of 95.5%. In addition, higher baseline sPECAM-1 levels (> 198 ng/ml) on admission were associated with delayed venous thrombus resolution at 3 months (AUC = 0.83).ConclusionsPECAM-1 in combination with D-Dimer should be used to improve the diagnostic accuracy of acute CSVT and sPECAM-1 may predict long-term outcome of CSVT. Confirmatory results are needed in other settings in order to show their value in the management concept of CSVT patients.

Seizure or syncope: Is the history-based scale feasible to use in an emergency department setting?

BackgroundThis study aimed to assess the efficacy of a screening questionnaire, based on historical criteria, in distinguishing between seizures and syncope in patients experiencing their first episode of transient loss of consciousness (TLOC) in a neurology emergency department. MethodsA prospective cohort of 159 patients with initial TLOC episodes underwent clinical observation and answered a nine-question screening questionnaire. The questionnaire's predictive ability was compared to final diagnoses determined through detailed neurology, electrophysiology, and cardiology assessments during a minimum 12-month follow-up. Logistic regression (LR) analysis was performed with final diagnosis as the outcome variable. The calibration and discrimination of the models were assessed. Resultsrevealed that the screening score accurately classified 72.33% of patients. Among those with positive screening scores, 65 (67.71%) had seizures compared to 31 (32.29%) with syncope. Introducing a novel risk-scoring model incorporating age and gender, in addition to the screening score, significantly improved performance achieving an accurate classification rate of 81.48%. Among patients with a positive prediction, 63 (80.77%) had seizure, whereas 15 (19.23%) had syncope. ConclusionsEmploying a structured questionnaire based on common historical criteria is a valuable tool for distinguishing between seizure and syncope in the dynamic setting of the emergency department.

Healthcare utilization impacts of an eConsult program for headache at an academic medical center.

Interprofessional consultations ("eConsults") can reduce healthcare utilization. However, the impact of eConsults on healthcare utilization remains poorly characterized among patients with headache. We performed a retrospective, 1:1 matched cohort study comparing patients evaluated for headache via eConsult request or in-person referral at the Mount Sinai Health System in New York. Groups were matched on clinical and demographic characteristics. Our primary outcome was one or more outpatient headache-related encounters in 6 months following referral date. Secondary outcomes included one or more all-cause outpatient neurology and headache-related emergency department (ED) encounters during the same period. We used univariable and multivariable logistic regression to model associations between independent variables and outcomes. We identified 74 patients with headache eConsults who were matched to 74 patients with in-person referrals. Patients in the eConsult group were less likely to achieve the primary outcome (29.7% vs 62.2%, P < 0.0001) or have an all-cause outpatient neurology encounter (33.8% vs 79.7%, P < 0.0001) than patients in the comparison group. Both groups did not significantly differ by headache-related ED encounters. In multivariable analyses, patients in the eConsult group had significantly lower odds of having one or more headache-related or all-cause neurology encounters than patients in the comparison group (odds ratio (OR) 0.3, 95% confidence interval (CI) 0.1-0.6; OR 0.1, 95% CI 0.1-0.3, respectively). In comparison to in-person referrals, eConsult requests for headache were associated with reduced likelihood of outpatient neurology encounters in the short-term but not with differential use of headache-related ED encounters. Larger-scale, prospective studies should validate our findings and assess patient outcomes.

Frequency of delirium and associated factors in patients from a neurological emergency department

Frequency of delirium and associated factors in patients from a neurological emergency department

Epidemiology of headache in a neurological Emergency Department in Medellin, Colombia

IntroductionHeadache is a common reason for presentation to emergency departments (ED) around the world. In many countries, ED are not speciality-focussed, however, in Colombia and some other countries, specialist neurological hospitals have ED with a strong neurological focus. For patients presenting with headache, these ED may have different epidemiology, investigation strategies and treatment patterns from general ED. The objective of this study was to describe the epidemiology of headache presenting to the ED of Instituto Neurológico de Colombia in Medellin, Colombia – an ED which is a referral centre for neurological and neurosurgical diseases. MethodsThis was an observational study by chart review of adults (aged ≥18) with a main presenting compliant of headache. Demographic, clinical, imaging, diagnoses and outcome data were collected. The primary outcome of interest was the rate of serious secondary intracranial headache cause. Analysis was descriptive.ConclusionDiagnosis of headache in ED is challenging with a very wide range of possible causes. A small proportion of patients (approx. 9%) have a serious cause for their symptoms – a proportion similar to that reported in other international emergency department cohorts.

Stroke thrombolysis given by emergency physicians: The time is here

Emergency Medicine core clinical privileges include administration of thrombolytic therapy for myocardial infarction and stroke. However, emergency medicine providers have created their own paradigm to rely on neurology specialty consultation to treat acute stroke patients. A 2013 study supported by the American Academy of Neurology showed an 11% shortage of neurologists at that time and projected a 19% shortage by 2025. The lack of neurologists is a worldwide problem. To help ease the shortage, teleneurology and telestroke care has been implemented by neurologists, most notably for acute ischemic stroke (AIS) patients. We present a model in which an Emergency Medicine (EM) Stroke Champion (SC); an EM physician within our Neurologic Emergency Department, directs care for acute stroke patients at our comprehensive hub and primary stroke center spoke hospitals. The SCs independently treat patients with fibrinolytic therapy and provide teleneurology to fellow emergency physicians caring for acute stroke patients at spoke hospitals. Over nineteen months the SCs received 457 phone calls for patients meeting stroke alert criteria. Sixteen patients were deemed eligible for IV alteplase with one hemorrhagic conversion (6.25%). Sixty-four patients required transfer, and this was facilitated by the SCs. The concept of emergency physician SCs providing teleneurology consultation to other fellow emergency physicians was found to be feasible and safe. This model has the potential to be generalized not to just stroke champions, but to all emergency physicians to feel both confident and comfortable treating acute stroke patients.

Characterization of potentially avoidable neurological emergency department visits at a large urban public hospital

This study characterized potentially avoidable neurological emergency department (ED) visits at a large urban public hospital. This was a retrospective review of Parkland Health (Dallas, TX) data from May 15, 2021, to July 15, 2021. The study population included encounters discharged home from the ED with any of the following: a primary neurological ED diagnosis, a neurological consultation in the ED, or a neurology clinic referral placed during the ED encounter. Neurovascular, strokelike, acute trauma, and nonneurological cases were excluded. The primary outcome was the number of ED visits by diagnosis category. A total of 965 ED discharge encounters met study criteria as potentially avoidable neurological ED visits, far higher than total neurology-related admissions over the same 2-month period. Headache (66%) and seizure/epilepsy (18%) syndromes were the most common. Thirty-five percent of all cases had neurology involvement in either the ED or the outpatient setting. This was lowest for headache (19%). The revisit rate within 3 months of the index ED visit was 29%, and it was highest for seizures/epilepsy (48%). Potentially avoidable nonvascular neurological ED visits occur frequently, especially for headache and seizure disorders. This study highlights the need for quality improvement and delivery innovation initiatives to optimize the site of care for patients with chronic neurological conditions.

A prospective study on the application of HINTS in distinguishing the localization of acute vestibular syndrome

BackgroundAcute vestibular syndrome (AVS) is a common clinical syndrome in neurology clinics and emergency department. Canonical standard for AVS diagnosis requires the presence of persistent vertigo for more than 24 h. HINTS (head impulse-nystagmus-test of skew) is an emerging scheme in the diagnosis of AVS. In this prospective study, we evaluated the specificity and sensitivity of HINTS in distinguishing between central and peripheral AVS.MethodsA cohort of 239 cases with complete clinical record was recruited in the study. All patients completed emergency brain CT examination to exclude hemorrhagic stroke. HINTS examination was conducted to distinguish between central AVS and peripheral AVS, and all patients completed head MRI, BAEP and vestibular function examinations within one week. Patients diagnosed as central AVS were subject to angiography (CTA/MRA/DSA), and patients with peripheral AVS were considered for a 3-month follow-up to correct the initial diagnosis.ResultsPatients with central AVS were associated with an elder age, higher incidences of hypertension, atrial fibrillation, family history of stroke and previous history of stroke. Posterior circulation cerebral infarction, vestibular migraine and cerebellitis were the dominant diseases associated with central AVS. The sensitivities of HIT, GE, and TS in the diagnosis of central AVS were 73.5%, 61.2%, and 26.5%, and the specificities were 97.9%, 92.6%, and 93.2% respectively.ConclusionsThe sensitivity of HINTS for central AVS diagnosis is 89.8% and the specificity is 84.2%. HINTS is an easy-to-operate, low-cost, high-sensitivity and specific examination technique, which is practical in neurology outpatient clinics and emergency departments.

Nurses Knowledge and Practice Concerning Nursing Management for Patients with Stroke

Background: Stroke is the leading cause of mortality and disability worldwide; 87% of all deaths from stroke and 89% of all stroke-related disability-adjusted life-years occur in low- and middle-income countries. Objective: The goal of this study was to examine nurses' knowledge and practice for patient with stroke. Methodology: Design: A cross-sectional design was used to achieve the objective of the study. Setting: Data were collected from Neurological Wards and emergency department of Al-Sadder Medical City. Sample: A non-probability (purposive) sample consisted of (60) nurses. Results: The majority of the nurses in both groups are those with age’s group between (25-29) years old and the high percentages of participants in both groups (53.3%) are females for study and control groups. Overall assessment of nurses' knowledge regarding management of patients with stroke was moderate with (0.52) mean of score. Overall evaluation of nurses' practices regarding management of patients with stroke was poor with (0.522) mean of score. Conclusion: This study revealed the nurses' knowledge, regarding management of patients with stroke was moderate and nurses' practices regarding management of patients with stroke was poor. Recommendation: Development and application of periodic educational and training courses for nurses regarding the management of stroke.

Findings from the implementation of a novel needs assessment survey in children and youth with epilepsy; The impact of social determinants of health on utilization of medical services

ObjectiveThis study aimed to characterize the relationship between social determinants of health (SDOH) and epilepsy-specific outcomes. MethodsThis was an observational, cross-sectional, quality improvement study. We developed a novel screening survey (The Epilepsy Needs Assessment Survey), which was administered to patients with epilepsy at a large urban hospital. We assessed the prevalence of various SDOH and the association with independence in activities of daily living, verbal status, prevalence of intractable epilepsy, missed school/work days, missed neurology appointments and emergency department visits related to seizure. ResultsForty-nine percent of participants reported at least one insecurity. While disease burden did not appear to differ significantly between families with and without hardships, families who reported any hardship had almost twice the percentage of missed neurology appointments and were significantly more likely to have an ED visit related to seizure (RR = 5.44, CI 2.82–10.48). SignificanceSeveral studies have suggested that social determinants of health (SDOH) impact various patient health outcomes such as developmental concerns, functional limitations and higher healthcare utilization. The majority of studies have been performed in general pediatric clinics and the impact of SDOH on patients with complex medical conditions in subspecialty clinics has not been well documented. This is one of the first studies to assess the effects of SDOH on patient-centered, epilepsy specific outcomes using a low cost, novel standardized screening tool.

Effectiveness of an Interventional Program on Nurses' Practices Concerning Nursing Management for Patients with Stroke

Background: Stroke is the major cause of adult disability and mortality in the United Kingdom. A stroke can have a deleterious effect on patients, their families, and their caregivers. Objective: This study aimed to determine the effectiveness of the interventional program on nurses' practice concerning nursing management for patients with stroke. Methodology: A quasi-experimental research design was utilized. Data was gathered from Al-Sadder Medical City's neurological wards and emergency department in Al-Najaf Al-Ashraf City. All nurses (n = 60) were divided into two groups; thirty nurses in the study group were exposed to the nursing interventional program; thirty nurses were not exposed to the program. The researcher constructed an educational program and instruments to reach the aims of the present study. The program deals with 9 main domains related to nursing management for patients with stroke Two tools were used to measure the effectiveness of the education program the first tool: was a self-administered questionnaire sheet related to socio-demographic data; the second tool: Observational checklist to evaluate nurses' practice regarding the management of patients with stroke Results: The majority of the nurses in both groups are those with an age range of 25–29 years old, and the high percentages of participants in both groups (53.3%) are females in the study and control groups. Overall evaluation of study group practices regarding the management of patients with stroke at the pre-test was poor with a (0.522) mean score, and the post-test was good with a (1.762) mean score. Conclusion: The current study revealed the effectiveness of the interventional program where nurses' practice improved significantly as compared to before implementing the program. Recommendation: The study recommended generalizing implementation of the designed interventional program for nurses as routine hospital management for patients with stroke. Keywords: Practices, Nursing Management, Stroke.

Characterization of General Neurology Emergency Department Discharge Consultations: A Pilot Study into Potentially Avoidable Neurological ED Visits (P15-7.005)

Characterization of General Neurology Emergency Department Discharge Consultations: A Pilot Study into Potentially Avoidable Neurological ED Visits (P15-7.005)

Headache in the Neurological Emergency Department-High Degree of Inadequate Documentation Calls for Structured Assessments.

Headaches are a frequent reason for presentation to the emergency department (ED) and can pose a great challenge for the attending physicians. First and foremost, the distinction between a primary and secondary headache with potentially life-threatening implications can be difficult. Moreover, it often occurs that no specific headache diagnosis is made at discharge from the ED. Therefore, in this present retrospective cross-sectional study, all patients who presented to the emergency department of the Department of Neurology at Rostock University Medical Centre with the main symptom of headache between November 2013 and November 2016 underwent a neurological examination and the extent to which warning symptoms (“red flags”) for a secondary headache as well as symptoms necessary for a correct headache diagnosis according to the ICHD-3 classification were recorded and documented. We could show that documentation of red flags and clinical characteristics is inadequate and does not allow proper diagnostic categorization. To facilitate concise documentation and rapid decision making we suggest a structured and standardized form for documenting the headache history and red flags in the ED.

Reliability of prehospital diagnosis of acute cerebrovascular accident.

Early and correct suspicion of an acute cerebrovascular accident (CVA) is necessary to minimise the time to reperfusion treatment. Our aim was to evaluate the reliability of a prehospital diagnosis of stroke or transient ischaemic attack made by healthcare professionals referring patients directly to a neurological Emergency Department (ED). This retrospective analysis included all consecutive patients referred between 1 January and 31 December 2014 by ambulance physicians, paramedics or outpatient physicians to the neurological ED providing care for the 300-350,000 inhabitants of a highly urbanised area. We calculated sensitivity and positive predictive value (PPV) with 95% confidence intervals (95% CI) for each group of healthcare professionals, and compared the proportions of undetected CVAs. Of 802 patients referred with a prehospital diagnosis of CVA, 544 were confirmed. Additional 95 CVA cases were referred with a diagnosis other than CVA. The highest sensitivity for detection of any CVA was among ambulance physicians (96%; 95% CI 92-98%), followed by paramedics (85%; 95% CI 80-90%; p < 0.001) and outpatient physicians (74%; 95% CI 70-79%; p < 0.001). PPV for stroke was 83% (95% CI 77-87%) among ambulance physicians, 73% (95% CI 65-80%) among paramedics, and 56% (95% CI 47-64%) among outpatient physicians. Ambulance physicians are highly sensitive in diagnosing any CVA, and are correct in 8 out of 10 cases. The inferior performance of paramedics and outpatient physicians indicates the need for regular stroke training for paramedics and the implementation of two-way communication with the stroke team to identify potential candidates for reperfusion therapy before arrival at the ED.

Comparing the frequency tramadol abuse in seizure and non-seizure complaint patients referred to neurology emergency department of a university affiliated hospital

Aim: Due to its similar opioid effects, tramadol is commonly abused worldwide. One of the notable side effects of tramadol is seizure. The present study compares the frequency of tramadol abuse among seizure and non-seizure (other reasons) patients referring to the Neurology Emergency Ward of Ali Ibn Abi Talib Hospital, a referral center affiliated to Rafsanjan University of Medical Sciences, Iran. Methods: This cross-sectional study reviewed 141 patients referring to the emergency ward of a referral hospital. The data were collected by clinical examination, face-to-face interviews, and a structured self-questionnaire for each client. The data were analyzed using descriptive statistics, non-parametric chi-square, and independent T-test. Results: In this cross-sectional study, 82 male (58.2%) and 59 female subjects (41.8%) were included. The results revealed the average age of patients being 30.16 ± 9.12. The incidence of tramadol abuse was approximately 36.8% in the total population study. Twenty-five and half percent of the subjects were referred to the neurology emergency ward for seizure while 16.3% of the subjects were referred to other wards for non-seizure complaints. In this study, we no relationship was found between the duration of consumption and the concurrent use of other medications; however, there was a statistically significant correlation between the dose of tramadol and the incidence of seizure. Conclusion: The result of the present study illustrated a significant incidence of seizure in men with tramadol abuse and a direct correlation with medication dose.

Abstract TMP36: Improve Patient Outcomes In A Specialized Neurological Emergency Department

Improved Patient Outcomes In A Specialized Neurological Emergency Department Introduction: Stroke is now the fifth leading cause of death in the U.S., but remains the leading cause of long term disability. Target: Stroke helps hospitals achieve improved stroke outcomes through reduced door-to-needle times for eligible stroke patients. Phase III of the American Heart Association/American Stroke Association initiative set more aggressive targets for timely treatment with IV alteplase. To achieve rapid treatment times and better patient outcomes, we created a neurologic emergency department (Neuro ED). Neuro ED hours are staffed by emergency physicians with specialized neuroscience training and administer IV alteplase independently, compared to the traditional ED (TED) where emergency providers consult neurology. Methods: This is a retrospective observational study from 2019-2021 comparing outcomes of acute ischemic stroke patients who received IV alteplase following implementation of the Neuro ED compared to a TED. The following metrics were calculated for each patient: Door to Needle times (DTN), door to CT times (DTCT), and pre and post National Institute of Health Stroke Scale (NIHSS) Results: 74 patients were treated in the Neuro ED and 45 patients were treated in the TED. Average DTN times in the Neuro ED were 27 minutes compared to 65 minutes in the TED. Patients treated in the Neuro ED achieved DTN times of 45 min or less 87% of cases, while only 24% of the time in the TED. Patients treated in the Neuro ED achieved DTN times of 30 min or less 65% of cases, with only 4% of cases in the TED. Average DTCT times in the Neuro ED were 8 minutes faster than the TED. No differences in admission NIHSS were found with an average of 8.75, but a significant improvement was found in discharge NIHSS. Average discharge NIHSS was 3.8 for Neuro ED stroke patients compared with 5.6 for TED patients (p&lt;0.001). Conclusion: Implementation of a Neuro ED led to swift management and improved symptoms for stroke patients. A dedicated Neuro ED is highly effective in improving DTN times, DTCT times, and overall stroke outcomes.

Diagnostic value of whole-brain computed tomographic perfusion imaging for suspected large artery occlusion stroke patients in emergency department.

To evaluate the diagnostic value of whole-brain computed tomographic perfusion (WB-CTP) in emergency department for suspected large artery occlusion stroke. Suspected large artery occlusion (LAO) stroke patients had initial WB-CTP in the neurological emergency department from August 2016 to August 2018 were retrospectively reviewed for analysis. The sensitivity and specificity of non-contrast computed tomographic scan (NCCT) or WB-CTP for diagnosis of cerebral infarction was compared between the anterior circulation and posterior circulation. The imaging characteristics of WB-CTP in patients with stroke-mimics were described. Among the 300 included patients, 259 patients (86.3%) were finally diagnosed as cerebral infarction, 16 (5.3%) were transient ischemic attack, 10 (3.3%) were epileptic seizure and 3 (1%) were cerebral venous sinus thrombosis (CVST). For patients with final diagnosis of cerebral infarction, WB-CTP found abnormality in 206 cases (79.5%). NCCT had poor sensitivity (4.6%) but high specificity (100%) for cerebral infarction. The CTP imaging had a sensitivity of 81.2% in anterior circulation and 59.6% in posterior circulation stroke, both with good specificity (57.1% and 92.6%, respectively). 60% (6/10) of epileptic patients showed abnormal perfusion in CTP maps, which was inconsistent with cerebral arterial supply territories. Hypoperfusion manifestations were discovered in areas adjacent to occlusion sinus of all 3 CVST cases. This retrospective study indicates WB-CTP can be useful in identifying acute ischemic stroke in emergency department, especially for patients with acute LAO stroke. Moreover, WB-CTP may have a value in differentiating stroke mimics such as epilepsy and CVST.

Seizures in the Emergency Department: clinical and diagnostic data from a series of 153 patients

IntroductionSeizures are a frequent reason for admission to emergency departments and require early, precise diagnosis and treatment. The objective of this study was to describe the clinical and prognostic characteristics of a series of patients with seizures attended at our hospital’s emergency department. MethodsWe performed a retrospective, observational study of all patients with seizures who were admitted to our hospital’s emergency department and attended by the on-call neurology service between February and August 2017. ResultsWe included 153 patients, representing 9.9% of all neurological emergency department admissions. The median age was 58 years, 52.3% of patients were women, and 51% had history of epilepsy. Onset was focal in 82.4% of cases, and the most frequent aetiology was cerebrovascular disease (24.2%). Twelve patients (7.8%) developed status epilepticus, which was associated with higher scores on the ADAN scale (P < .001) and with history of refractory epilepsy (P = .002). The in-hospital mortality rate was 3.7%, and in-hospital mortality was associated with older age (P = .049) and status epilepticus (P = .018). Eighty percent of patients with no history of epilepsy were diagnosed with epilepsy at the emergency department; all started treatment. The kappa coefficient for epilepsy diagnosis in the emergency department compared to diagnosis after one year of follow-up by the epilepsy unit was 0.45 (diagnosis was modified in 20% of patients). ConclusionsSeizures are a frequent neurological emergency with potential complications and considerable morbidity and mortality rates. In patients with no known history of epilepsy, the condition may be diagnosed in the emergency department, but follow-up at specialised epilepsy units is recommended.