Hospital-onset seizures

Madeline C. Fields, Daniel L. Labovitz, Jacqueline A. French

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Objectives: To describe demographic and clinical characteristics of patients with hospital-onset seizure (HOS) and to explore current practices in their management. Design: Retrospective medical record review. Setting: Academic, tertiary care, private (New York University Langone Medical Center) and municipal (Bellevue Hospital Center) medical centers. Patients: Patients aged at least 18 years with HOS from January 1 through December 31, 2007. Patients admitted for evaluation of seizures or epilepsy were excluded. Main Outcome Measures: Hospital-onset seizure patterns, medication use, and outcomes. Results:Weidentified 218 patients with HOS; 139 (64%) had no history of seizure. Hospital-onset seizures were recurrent in 134 patients (61%) during the inpatient stay and were more likely to recur in those with new-onset seizure vs those with a history of seizure (43% vs 32%, P=.09). The most commonly described HOS in patients with a history of seizure and patients with new-onset seizure was a generalized tonic-clonic seizure (72 [33%]). Metabolic derangements were the most common identifiable cause of HOS (43 of 218 [20%]) and new-onset seizures (35 of 139 [25%]) and were more likely to recur. Phenytoin was the most common antiepileptic drug prescribed de novo (61%). Death during hospitalization or discharge to hospice was more common in patients with new-onset seizures compared with those with a history of seizure (19% vs 5%, P=.004). Among surviving patients discharged with a prescription of antiepileptic drugs, phenytoin and levetiracetam were prescribed most often. Conclusions: Hospital-onset seizures commonly occur as new-onset seizures, are typically recurrent, and are associated with a high mortality. Older antiepileptic drugs are often prescribed at seizure presentation and at discharge.

Original languageEnglish (US)
Pages (from-to)360-364
Number of pages5
JournalJAMA Neurology
Volume70
Issue number3
DOIs
StatePublished - 2013

Fingerprint

Seizures
Anticonvulsants
etiracetam
Phenytoin
Municipal Hospitals
Hospices
Prescription Drugs
Tertiary Healthcare
Medical Records
Inpatients
Epilepsy

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Hospital-onset seizures. / Fields, Madeline C.; Labovitz, Daniel L.; French, Jacqueline A.

In: JAMA Neurology, Vol. 70, No. 3, 2013, p. 360-364.

Research output: Contribution to journalArticle

Fields, MC, Labovitz, DL & French, JA 2013, 'Hospital-onset seizures', JAMA Neurology, vol. 70, no. 3, pp. 360-364. https://doi.org/10.1001/2013.jamaneurol.337
Fields, Madeline C. ; Labovitz, Daniel L. ; French, Jacqueline A. / Hospital-onset seizures. In: JAMA Neurology. 2013 ; Vol. 70, No. 3. pp. 360-364.
@article{8079fdb2aa2844969487acf4a71a9184,
title = "Hospital-onset seizures",
abstract = "Objectives: To describe demographic and clinical characteristics of patients with hospital-onset seizure (HOS) and to explore current practices in their management. Design: Retrospective medical record review. Setting: Academic, tertiary care, private (New York University Langone Medical Center) and municipal (Bellevue Hospital Center) medical centers. Patients: Patients aged at least 18 years with HOS from January 1 through December 31, 2007. Patients admitted for evaluation of seizures or epilepsy were excluded. Main Outcome Measures: Hospital-onset seizure patterns, medication use, and outcomes. Results:Weidentified 218 patients with HOS; 139 (64{\%}) had no history of seizure. Hospital-onset seizures were recurrent in 134 patients (61{\%}) during the inpatient stay and were more likely to recur in those with new-onset seizure vs those with a history of seizure (43{\%} vs 32{\%}, P=.09). The most commonly described HOS in patients with a history of seizure and patients with new-onset seizure was a generalized tonic-clonic seizure (72 [33{\%}]). Metabolic derangements were the most common identifiable cause of HOS (43 of 218 [20{\%}]) and new-onset seizures (35 of 139 [25{\%}]) and were more likely to recur. Phenytoin was the most common antiepileptic drug prescribed de novo (61{\%}). Death during hospitalization or discharge to hospice was more common in patients with new-onset seizures compared with those with a history of seizure (19{\%} vs 5{\%}, P=.004). Among surviving patients discharged with a prescription of antiepileptic drugs, phenytoin and levetiracetam were prescribed most often. Conclusions: Hospital-onset seizures commonly occur as new-onset seizures, are typically recurrent, and are associated with a high mortality. Older antiepileptic drugs are often prescribed at seizure presentation and at discharge.",
author = "Fields, {Madeline C.} and Labovitz, {Daniel L.} and French, {Jacqueline A.}",
year = "2013",
doi = "10.1001/2013.jamaneurol.337",
language = "English (US)",
volume = "70",
pages = "360--364",
journal = "JAMA Neurology",
issn = "2168-6149",
publisher = "American Medical Association",
number = "3",

}

TY - JOUR

T1 - Hospital-onset seizures

AU - Fields, Madeline C.

AU - Labovitz, Daniel L.

AU - French, Jacqueline A.

PY - 2013

Y1 - 2013

N2 - Objectives: To describe demographic and clinical characteristics of patients with hospital-onset seizure (HOS) and to explore current practices in their management. Design: Retrospective medical record review. Setting: Academic, tertiary care, private (New York University Langone Medical Center) and municipal (Bellevue Hospital Center) medical centers. Patients: Patients aged at least 18 years with HOS from January 1 through December 31, 2007. Patients admitted for evaluation of seizures or epilepsy were excluded. Main Outcome Measures: Hospital-onset seizure patterns, medication use, and outcomes. Results:Weidentified 218 patients with HOS; 139 (64%) had no history of seizure. Hospital-onset seizures were recurrent in 134 patients (61%) during the inpatient stay and were more likely to recur in those with new-onset seizure vs those with a history of seizure (43% vs 32%, P=.09). The most commonly described HOS in patients with a history of seizure and patients with new-onset seizure was a generalized tonic-clonic seizure (72 [33%]). Metabolic derangements were the most common identifiable cause of HOS (43 of 218 [20%]) and new-onset seizures (35 of 139 [25%]) and were more likely to recur. Phenytoin was the most common antiepileptic drug prescribed de novo (61%). Death during hospitalization or discharge to hospice was more common in patients with new-onset seizures compared with those with a history of seizure (19% vs 5%, P=.004). Among surviving patients discharged with a prescription of antiepileptic drugs, phenytoin and levetiracetam were prescribed most often. Conclusions: Hospital-onset seizures commonly occur as new-onset seizures, are typically recurrent, and are associated with a high mortality. Older antiepileptic drugs are often prescribed at seizure presentation and at discharge.

AB - Objectives: To describe demographic and clinical characteristics of patients with hospital-onset seizure (HOS) and to explore current practices in their management. Design: Retrospective medical record review. Setting: Academic, tertiary care, private (New York University Langone Medical Center) and municipal (Bellevue Hospital Center) medical centers. Patients: Patients aged at least 18 years with HOS from January 1 through December 31, 2007. Patients admitted for evaluation of seizures or epilepsy were excluded. Main Outcome Measures: Hospital-onset seizure patterns, medication use, and outcomes. Results:Weidentified 218 patients with HOS; 139 (64%) had no history of seizure. Hospital-onset seizures were recurrent in 134 patients (61%) during the inpatient stay and were more likely to recur in those with new-onset seizure vs those with a history of seizure (43% vs 32%, P=.09). The most commonly described HOS in patients with a history of seizure and patients with new-onset seizure was a generalized tonic-clonic seizure (72 [33%]). Metabolic derangements were the most common identifiable cause of HOS (43 of 218 [20%]) and new-onset seizures (35 of 139 [25%]) and were more likely to recur. Phenytoin was the most common antiepileptic drug prescribed de novo (61%). Death during hospitalization or discharge to hospice was more common in patients with new-onset seizures compared with those with a history of seizure (19% vs 5%, P=.004). Among surviving patients discharged with a prescription of antiepileptic drugs, phenytoin and levetiracetam were prescribed most often. Conclusions: Hospital-onset seizures commonly occur as new-onset seizures, are typically recurrent, and are associated with a high mortality. Older antiepileptic drugs are often prescribed at seizure presentation and at discharge.

UR - http://www.scopus.com/inward/record.url?scp=84874877681&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84874877681&partnerID=8YFLogxK

U2 - 10.1001/2013.jamaneurol.337

DO - 10.1001/2013.jamaneurol.337

M3 - Article

C2 - 23319087

AN - SCOPUS:84874877681

VL - 70

SP - 360

EP - 364

JO - JAMA Neurology

JF - JAMA Neurology

SN - 2168-6149

IS - 3

ER -