Characteristics of Patients with Epilepsy Applying to Pediatric Emergency Department

Year 2025, Volume: 10 Issue: 4, 147 - 155, 28.11.2025

Büşra Akça , Cansu Aydın Altuntaş , Halise Akça , Hande Yiğit , Funda Kurt , Ayşegül Neşe Kurt

https://doi.org/10.70852/tmj.1815800

Abstract

Objective: Epilepsy is one of the most common neurological diseases of childhood. Pediatric patients diagnosed with epilepsy may present to pediatric emergency departments for various reasons, in addition to follow-up in pediatric neurology/pediatrics outpatient clinics. This study aimed to examine the characteristics of patients diagnosed with epilepsy presenting to the pediatric emergency department, their reasons for admission, and the follow-up process in the pediatric emergency department.

Method: This is a retrospective study. 802 emergency visits from 492 patients diagnosed with epilepsy who presented to the Pediatric Emergency Department of Ankara Bilkent City Hospital between January 1, 2020, and December 31, 2021, were included.

Results: The mean age of the patients was 99.4 ± 64.3 months, 59.8% were male, and 40.2% were female. Thirty-four percent of the patients had a chronic disease accompanying their epilepsy, and those with comorbidities presented to the emergency department more frequently than those without (p<0.05). There was no statistically significant difference between the ages of patients with and without comorbidities (p>0.05). It was shown that the duration of follow-up for epilepsy did not affect the frequency of pediatric emergency department visits. The most common reason for patient visits to the pediatric emergency department was seizures (69.1%), followed by upper and lower respiratory tract infections (10.9%), acute gastroenteritis (6%), allergies (1%), and psychiatric conditions (1.5%). Irregular antiepileptic drug (AED) use was the most common cause of seizures. Of the 554 seizure visits, 161 received AED treatment in the emergency department. At the end of follow-up and treatment, 32.5% of the patients were admitted to pediatric inpatient wards, and 5.1% were admitted to the pediatric intensive care unit.

Conclusion: Establishing an emergency epilepsy clinic for patients diagnosed with epilepsy can reduce healthcare costs and prevent unnecessary workforce loss; the establishment of such clinics in our country is recommended.

Keywords

Epilepsy , Pediatric emergency department , Seizure

Çocuk Acile Başvuran Epilepsi Tanılı Hastaların Özellikleri

Abstract

Amaç: Epilepsi çocukluk çağının en sık rastlanan nörolojik hastalıklarından birisidir. Epilepsi tanılı çocuk hastaların çocuk nöroloji/çocuk sağlığı ve hastalıkları poliklinik izlemi dışında çocuk acil servislerine de farklı nedenlerle başvuruları olabilmektedir. Çalışmamızda; çocuk acil servise başvuran epilepsi tanılı hastaların özelliklerinin, başvuru nedenlerinin ve çocuk acil serviste izlem sürecinin incelenmesi amaçlanmıştır.

Yöntem: Çalışmamız retrospektif bir çalışma olup, çalışmaya 1 Ocak 2020– 31 Aralık 2021 tarihleri arasında Ankara Bilkent Şehir Hastanesi Çocuk Acil Servisine başvuran epilepsi tanılı 492 hastanın 802 acil başvurusu dahil edildi.

Bulgular: Hastaların yaş ortalaması 99,4 ± 64,3 ay, %59,8’i erkek, %40,2’si kızdı. Hastaların %34’ünde epilepsiye eşlik eden ek bir kronik hastalık vardı ve ek hastalığı olanlar olmayanlara göre acile daha sık başvuru yapmışlardı (p<0.05). Ek hastalığı olan ve olmayan hastaların yaşları arasında istatistiksel olarak anlamlı farklılık yoktu (p>0.05). Hastaların epilepsi takip süresinin çocuk acil servise başvuru sıklığını etkilemediği gösterildi. Hastaların çocuk acil servise başvuru nedenlerinden en sık olanı nöbet (%69,1), diğerleri üst ve alt solunum yolu enfeksiyonu (%10.9), akut gastroenterit (%6), alerji (%1) ve psikiyatrik (%1.5) nedenlerdi. Nöbet nedeni olarak en sık düzensiz antiepileptik ilaç (AEİ) kullanımı gösterildi. Nöbet nedeniyle yapılan 554 başvurunun 161’ine acil serviste AEİ tedavisi uygulanmıştı. Takip ve tedavi sonlanımında hastaların %32,5’u çocuk yataklı servislerine, %5,1’i çocuk yoğun bakım ünitesine yatırılmıştı.

Sonuç: Epilepsi tanılı hastalar için acil epilepsi kliniği oluşturulması sayesinde sağlık bakım hizmetleri için yapılan harcamalar azaltılıp ve gereksiz işgücü kaybının önüne geçilebilir; ülkemizde bu tarz kliniklerin oluşturulması önerilebilir.

Keywords

Çocuk acil servis , Epilepsi , Nöbet

References

• Ackermann, S., Le Roux, S., & Wilmshurst, J. M. (2019). Epidemiology of children with epilepsy at a tertiary referral centre in South Africa. Seizure, 70, 82-89. https://doi.org/10.1016/j.seizure.2019.06.018
• Ashrafi, M. R., & Heidari, M. (2018). General principles of the medical management of epilepsy in children: A literature review. Rev Clin Med, 5(2), 49-53. https://rcm.mums.ac.ir/article_9001.html
• Ataş Berksoy, E., Yılmaz, Ü., İşgüder, R., Yazıcı, S., Çelik, T., & Ünalp, A. (2017). Characteristics of Children Admitted to the Emergency Department with Convulsive Epileptic Seizures: A Single-Center Study. Journal of Pediatric Emergency and Intensive Care Medicine, 4(2), 60-65. https://doi.org/10.4274/cayd.86548
• Bozali, G., Kose, A., Babus, S. B., Kaleağası, S. H., & Temel, G. O. (2021). Characteristics of the patients who admitted to the emergency department with seizures and the factors affecting the frequency of admission. Neurosciences (Riyadh), 26(2), 163-170. https://doi.org/10.17712/nsj.2021.2.20200092.
• Burrows, L., Lennard, S., Hudson, S., McLean, B., Jadav, M., Henley, W., … (2020). Exploring epilepsy attendance at the emergency department and interventions which may reduce unnecessary attendances: A scoping review. Seizure, 76, 39-46. https://doi.org/10.1016/j.seizure.2020.01.012.
• Fisher RS, Cross JH, French JA, et al. (2017). Operational classification of seizure types by the International League Against Epilepsy: Position Paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017 Apr;58(4):522-530.
• Girot, M., Hubert, H., Richard, F., Chochoi, M., Deplanque, D., Derambure, P., Girardie, P., Pauchet, N.,Leblanc, S., Lim, A., Wiel, E., Williate, P., Szurhaj, W., Lenne, X., & Tyvaert, L. (2015). Use of emergency departments by known epileptic patients: An underestimated problem?. Epilepsy research, 113, 1–4. https://doi.org/10.1016/j.eplepsyres.2015.02.017.
• Hauser, W. A., & Beghi, E. (2008). Epidemiology of epilepsy in children. In J. M. Pellock, B. F. D. Bourgeois, & W. E. Dodson (Eds.), Pediatric epilepsy (3rd ed., pp. 147-164). New York: Demos Medical Publishing.
• Hirtz, D., Berg, A., Bettis, D., Camfield, C., Camfield, P., Crumrine, P., Gaillard, W. D., Schneider, S., Shinnar, S., Quality Standards Subcommittee of the American Academy of Neurology, & Practice Committee of the Child Neurology Society (2003). Practice parameter: treatment of the child with a first unprovoked seizure: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology, 60(2), 166–175. https://doi.org/10.1212/01.wnl.0000033622.27961.b6
• Huff, J. S., Morris, D. L., Kothari, R. U., Gibbs, M. A., & Emergency Medicine Seizure Study Group (2001). Emergency department management of patients with seizures: a multicenter study. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 8(6), 622–628. https://doi.org/10.1111/j.1553-2712.2001.tb00175.x
• Kwan, P., & Brodie, M. J. (2006). Refractory epilepsy: Mechanisms and solutions. Expert Review of Neurotherapeutics, 6(3), 397-406.
• Lekoubou, A., Bishu, K. G., & Ovbiagele, B. (2018). Relationship between office-based provider visits and emergency department encounters among publicly-insured adults with epilepsy. Epilepsy & behavior: E&B, 80, 235–239. https://doi.org/10.1016/j.yebeh.2018.01.030.
• Mastrangelo, M., & Baglioni, V. (2021). Management of Neurological Emergencies in Children: An Updated Overview. Neuropediatrics, 52(4), 242–251. https://doi.org/10.1055/s-0041-1730936
• Mühlenfeld, N., Kowalski, R., & Schreiber, S. (2021). Frequent injury patterns, hospitalization and therapeutic implications in patients with epilepsy. Chinese Journal of Traumatology & Emergency Medicine, 9(4), 215 221. https://doi.org/10.1016/j.cjtee.2021.10.003.
• Noble, A. J., Goldstein, L. H., Seed, P., Glucksman, E., & Ridsdale, L. (2012). Characteristics of people with epilepsy who attend emergency departments: Prospective study of metropolitan hospital attendees. Epilepsia, 53(10), 1820-1828. https://doi.org/10.1111/j.1528-1167.2012.03586.x
• Öztürk, B., Nalbantoğlu, B., Çelik Güzel, E., Hatipoğlu, S., & Nalbantoğlu, A. (2011). Çocuk acil ünitesine febril konvülziyon tanısıyla başvuran beş ay-beş yaş arasındaki çocukların retrospektif olarak incelenmesi. Çocuk Dergisi, 11(3), 114-121. https://doi.org/10.5222/j.child.2011.114.
• Sapkota, S., Caruso, E., Kobau, R., Radhakrishnan, L., Jobst, B., DeVies, J., Tian, N., Hogan, R. E., Zack, M. M., & Pastula, D. M. (2022). Seizure- or Epilepsy-Related Emergency Department Visits Before and During the COVID-19 Pandemic - United States, 2019-2021. MMWR. Morbidity and mortality weekly report, 71(21), 703–708. https://doi.org/10.15585/mmwr.mm7121a2.
• Scheffer, I. E., Berkovic, S., Capovilla, G., Connolly, M. B., French, J., Guilhoto, L., et al. (2017). ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia, 58(4), 512–521. https://doi.org/10.1111/epi.13709
• Tang, X. H., Yu, P., Ding, D., Ge, Y., Shi, Y., Wang, P., Zhu, G., & Hong, Z. (2017). Risk factors for seizure reoccurrence after withdrawal from antiepileptic drugs in individuals who have been seizure-free for over 2 years. PLoS ONE, 12(8), e0181710. https://doi.org/10.1371/journal.pone.0181710
• Ünver, O., Keskin, S. P., Uysal, S., & Ünver, A. (2015). The epidemiology of epilepsy in children: A report from a Turkish pediatric neurology clinic. Journal of Child Neurology, 30(6), 698-702. https://doi.org/10.1177/0883073814539559