In a recent publication in the journal Neurology, researchers conducted a retrospective analysis to explore the identification of motor versus nonmotor seizures in emergency departments (EDs) and the impact on managing and treating focal epilepsy in the adolescent patient population.
The study included 83 preteens and teens. The researchers obtained and reviewed enrollment data from the Human Epilepsy Project (HEP), an international, multi-institutional study that collected data from 34 sites between 2012 and 2017. The participants were aged 12 years or older, neurotypical, and within 4 months of treatment initiation for focal epilepsy. The researchers reviewed participants’ initial diagnosis and management by utilizing HEP enrollment medical records.
The results revealed that there were 39 participants whose first seizure was a motor seizure and 44 whose first seizure was a nonmotor seizure. Additionally, before diagnosis, 58 went to the ED for seizures. After a review of the medical records, researchers established that for 32 patients the first seizure was a motor seizure and for 26 patients, it was a nonmotor seizure; however, when seeking care in the ED, 90% were seen for motor seizures, with 38% of that group having an unidentified history of nonmotor seizures.
The results also revealed that 17 participants who were seen in the ER for their first motor seizure had a history of nonmotor seizures, but none were recognized at the time as having had prior nonmotor seizures. As a result, they received comparable treatment as those experiencing their first seizure, even though their disease was more advanced. The researchers established that patients with initial nonmotor seizures were less likely to seek ED care, with only 59% seeking care compared with 82% of those with initial motor seizures. In ED care, the researchers also learned that just 33% of nonmotor seizures were correctly identified, compared with 81% of motor seizures.
The authors wrote, “As a result, initiation of treatment and admission from the ED was not more likely for these adolescents who met the definition of epilepsy compared with those with no seizure history. This lack of nonmotor seizure history recognition in the ED was greater than that observed in the adult group (0% vs. 23%, P = .03) and occurred in both pediatric and non-pediatric ED settings.”
The authors noted that a limitation of the study was that nonmotor seizures may have been underreported, principally in children who may have had trouble identifying and communicating the symptoms of those seizures.
The authors concluded that their findings support mounting evidence that nonmotor seizures are often undiagnosed, with many individuals not being recognized as having nonmotor seizures until conversion to symptoms consistent with motor seizures. They also noted that there was a treatment gap, especially in the adolescent patient population, and this study stresses an essential need for physicians to inquire about the symptoms of nonmotor seizures, even when the presenting seizure is motor, and future interventions should concentrate on improving identification of nonmotor seizure among adolescent patients presenting to the ED.
Study author Jacqueline French, MD, of New York University Grossman School of Medicine and a Fellow of the American Academy of Neurology, stated, “Early diagnosis of epilepsy is of the utmost importance because epileptic seizures can lead to injury and even death. Medications can reduce these risks, but our study found that a history of nonmotor seizures was being missed when children and teens were seen in emergency care.”
Lastly, Dr. French indicated, “Participants with nonmotor seizures described symptoms of hearing repeated phrases or jumbled noises, zoning out and episodes of dizziness, yet for many, this history was not collected until they had a tonic-clonic seizure and were referred to a neurologist. This highlights a critical need for doctors to ask about these symptoms when someone seeks care for a motor seizure to ensure they get the best care.”
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