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Multicenter Study
. 2024 May;102(10):e209389.
doi: 10.1212/WNL.0000000000209389. Epub 2024 May 1.

Unrecognized Focal Nonmotor Seizures in Adolescents Presenting to Emergency Departments

Nora Jandhyala  1 , Monica Ferrer  1 , Jacob Pellinen  1 , Hadley T Greenwood  1 , Dennis J Dlugos  1 , Kristen L Park  1 , Liu Lin Thio  1 , Jacqueline French  1 ; for Human Epilepsy Project Investigators  1
Collaborators, Affiliations
Multicenter Study

Unrecognized Focal Nonmotor Seizures in Adolescents Presenting to Emergency Departments

Nora Jandhyala et al. Neurology. 2024 May.

Abstract

Background and objectives: Many adolescents with undiagnosed focal epilepsy seek evaluation in emergency departments (EDs). Accurate history-taking is essential to prompt diagnosis and treatment. In this study, we investigated ED recognition of motor vs nonmotor seizures and its effect on management and treatment of focal epilepsy in adolescents.

Methods: This was a retrospective analysis of enrollment data from the Human Epilepsy Project (HEP), an international multi-institutional study that collected data from 34 sites between 2012 and 2017. Participants were 12 years or older, neurotypical, and within 4 months of treatment initiation for focal epilepsy. We used HEP enrollment medical records to review participants' initial diagnosis and management.

Results: A total of 83 adolescents were enrolled between 12 and 18 years. Fifty-eight (70%) presented to an ED before diagnosis of epilepsy. Although most ED presentations were for motor seizures (n = 52; 90%), many patients had a history of nonmotor seizures (20/52 or 38%). Adolescents with initial nonmotor seizures were less likely to present to EDs (26/44 or 59% vs 32/39 or 82%, p = 0.02), and nonmotor seizures were less likely to be correctly identified (2/6 or 33% vs 42/52 or 81%, p = 0.008). A history of initial nonmotor seizures was not recognized in any adolescent who presented for a first-lifetime motor seizure. 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 = 0.03) and occurred in both pediatric and nonpediatric ED settings.

Discussion: Our study supports growing evidence that nonmotor seizures are often undiagnosed, with many individuals coming to attention only after conversion to motor seizures. We found this treatment gap is exacerbated in the adolescent population. Our study highlights a critical need for physicians to inquire about the symptoms of nonmotor seizures, even when the presenting seizure is motor. Future interventions should focus on improving nonmotor seizure recognition for this population in EDs.

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Conflict of interest statement

N. Jandhyala reports no disclosures relevant to the manuscript; M. Ferrer reports no disclosures relevant to the manuscript; J. Pellinen has received research support from the Department of Neurology at the University of Colorado School of Medicine, the Colorado Clinical and Translational Sciences Institute, NIH/NINDS, and the American Epilepsy Society. J. Pellinen serves as chair of the professional advisory board for the Epilepsy Foundation of Colorado and Wyoming (unpaid), serves as the Epilepsy Section Editor for Current Neurology and Neuroscience Reports, and has received salary support for advisory board work for SK Life Science; H.T. Greenwood reports no disclosures relevant to the manuscript; D.J. Dlugos receives salary support from the Epilepsy Study Consortium for consulting work and/or attending Scientific Advisory Boards for Beacon Biosignals, Inc., Biohaven Pharmaceuticals, Encoded Therapeutics, Grin Therapeutics, GW Pharma, Jazz Pharmaceuticals, Longboard Pharmaceuticals, Marinus, Neurelis, Neurocrine, Praxis, Rapport Therapeutics, Inc., SK Life Sciences, Stoke, Takeda, UCB Inc., Xenon, Zogenix. He has received travel/meal reimbursement related to research, advisory meetings, or presentation of results at scientific meetings from the Epilepsy Study Consortium, the Epilepsy Foundation, the Lennox Gastaut Foundation, the France Foundation, Thomas Jefferson University, and the Ministry of Health of the United Arab Emirates; K.L. Park reports no disclosures relevant to the manuscript; L.L. Thio serves on the Editorial Board for Neurology and is a consultant for the Epilepsy Study Consortium through which he is a consultant for Anavex Life Sciences Corp, Eisai Inc., GW Pharmaceuticals, the LouLou Foundation, Marinus Pharmaceuticals Inc., Ovid Therapeutics, SK Biopharmaceuticals, Stoke Therapeutics, Takeda Pharmaceuticals Inc, and Zogenix; J.A. French receives salary support from the Epilepsy Foundation and from Epilepsy Study Consortium for consulting work and/or attending Scientific Advisory Boards for Agrithera, Inc., Alterity Therapeutics Limited, Angelini Pharma S.p.A, Arvelle Therapeutics, Inc., Autifony Therapeutics Limited, Baergic Bio, Beacon Biosignals, Inc., Biogen, Biohaven Pharmaceuticals, Bloom Science Inc., BridgeBio Pharma Inc., Bright Minds Biosciences, Inc., Camp4 Therapeutics Corporation, Cerebral Therapeutics, Cerecin Inc., Cerevel, Coda Biotherapeutics, Cognizance Biomarkers, Crossject, Eisai, Eliem Therapeutics, Encoded Therapeutics, Engrail, Epalex, Epihunter, Epitel Inc, Equilibre BioPharmaceuticals, Genentech, Inc., Grin Therapeutics, GW Pharma, iQure Pharma Inc., Janssen Pharmaceutica, Jazz Pharmaceuticals, Knopp Biosciences, Korro Bio Inc., Leal Therapeutics Inc, Lipocine, LivaNova, Longboard Pharmaceuticals, Lundbeck, Marinus, Modulight.bio, Neumirna Therapeutics, Neurelis, Neurocrine, Neuroelectrics USA Corporation, Neuronetics Inc., NeuroPro Therapeutics, Ono Pharmaceutical Co., Otsuka Pharmaceutical Development, Ovid Therapeutics Inc., Paladin Labs Inc., Pfizer, Praxis, PureTech LTY Inc., Rafa Laboratories Ltd, Rapport Therapeutics, Inc., Receptor Holdings Inc., Sage Therapeutics, Inc., SK Life Sciences, Stoke, Supernus, Takeda, Third Rock Ventures LLC, UCB Inc., Ventus Therapeutics, Vida Ventures Management, Xenon, Zogenix. J. French has also received research support from the Epilepsy Study Consortium (Funded by Eisai and UCB) Epilepsy Study Consortium/Epilepsy Foundation (Funded by UCB), GW/FACES/One8Foundation and NINDS. She is on the editorial board of Lancet Neurology and Neurology Today. She is Chief Medical/Innovation Officer for the Epilepsy Foundation. She has received travel/meal reimbursement related to research, advisory meetings, or presentation of results at scientific meetings from the Epilepsy Study Consortium, the Epilepsy Foundation, Angelini Pharma S.p.A., Biohaven Pharmaceuticals, Cerebral Therapeutics, Neurelis, Neurocrine, Praxis, Rapport, SK Life Science, Stoke, Takeda, Xenon. Go to Neurology.org/N for full disclosures.

Figures

Figure 1
Figure 1. Flow Diagram Demonstrating the Selection of Participants in This Study
ED = emergency department; HEP = Human Epilepsy Project.
Figure 2
Figure 2. Groupings of Participants According to Seizure Onset Semiology and Presentation to the Emergency Department
ED = emergency department; HEP = Human Epilepsy Project.
Figure 3
Figure 3. Violin Plots of the Ages of Seizure Onset and Ages of Study Enrollment for the 58 Participants Who Presented to an ED for Seizures Before 18 Years of Age
The white circle represents the median age. The black box limits indicate the 25th and 75th percentiles; whiskers extend to 1.5× the interquartile range.
Figure 4
Figure 4. No Children Presenting With a Motor Seizure and a History of Nonmotor Seizures Were Recognized as Having a History of Nonmotor Seizures
See this image and copyright information in PMC

References

    1. Zack MM, Kobau R. National and state estimates of the numbers of adults and children with active epilepsy—United States, 2015. MMWR Morb Mortal Wkly Rep. 2017;66(31):821-825. doi:10.15585/mmwr.mm6631a1 - DOI - PMC - PubMed
    1. Russ SA, Larson K, Halfon N. A national profile of childhood epilepsy and seizure disorder. Pediatrics. 2012;129(2):256-264. doi:10.1542/peds.2010-1371 - DOI - PubMed
    1. Khan A, Lim H, Almubarak S. Importance of prompt diagnosis in pediatric epilepsy outcomes. Seizure. 2020;80:24-30. doi:10.1016/j.seizure.2020.03.011 - DOI - PubMed
    1. Berg AT, Loddenkemper T, Baca CB. Diagnostic delays in children with early onset epilepsy: impact, reasons, and opportunities to improve care. Epilepsia. 2014;55(1):123-132. doi:10.1111/epi.12479 - DOI - PMC - PubMed
    1. Pellinen J, Tafuro E, Yang A, et al. . Focal nonmotor versus motor seizures: the impact on diagnostic delay in focal epilepsy. Epilepsia. 2020;61(12):2643-2652. doi:10.1111/epi.16707 - DOI - PubMed

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