TY - JOUR
T1 - Hospital-onset seizures
AU - Fields, Madeline C.
AU - Labovitz, Daniel L.
AU - French, Jacqueline A.
PY - 2013/3
Y1 - 2013/3
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.
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U2 - 10.1001/2013.jamaneurol.337
DO - 10.1001/2013.jamaneurol.337
M3 - Article
C2 - 23319087
AN - SCOPUS:84874877681
SN - 2168-6149
VL - 70
SP - 360
EP - 364
JO - JAMA Neurology
JF - JAMA Neurology
IS - 3
ER -