Hospital-Onset Seizures An Inpatient Study

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: We identified 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. JAMA Neurol. 2013;70(3):360-364. Published online January 14, 2013. doi: 10.1001/2013.jamaneurol.337