Objective:

Analyze the emergency department (ED) management of alcohol-associated seizures (AAS).

Background:

Studying AAS in the ED is essential due to the significant disease burden they impose, helping healthcare providers better understand and manage these cases. 

Design/Methods:

A retrospective study was conducted from June 1, 2018 through December 31, 2018 on all adult ED visits at the Detroit Medical Center presenting with AAS or non-alcohol related seizures (SC). AAS was defined as seizures presenting in patients with acute withdrawal or acute intoxication. Data on demographics, diagnostic tests, epilepsy history and hospital disposition was collected. Non-seizure related encounters, refill visits, and syncope encounters were excluded.

Results:

Of 997 ED visits for seizures, there were 151 AAS and 833 SC encounters. Within the AAS group, 76 (50.3%) of the encounters were alcohol-induced and 73 (48.3%) were deemed secondary to alcohol withdrawal. Thirteen (8.6%) presented with status epilepticus. Patients with a previous diagnosis of epilepsy were 82.1% in the AAS group and 68.9% were prescribed anti-seizure medications (ASMs) at home. AAS encounters were more likely to receive a benzodiazepine compared to SC (p<0.05).  Compared to SC, the AAS cohort had more ICU admissions (p<0.05) and 33% of ICU admissions were diagnosed with status epilepticus. AAS encounters were also less likely to be discharged home with ASMs than the SC group (p< .00001). However, those with AAS were more likely to return to the ED for seizures in the following year (p<.01).

Conclusions:

Alcohol-associated seizures were more likely to require admission to the ICU. Although AAS presented more often to the ED with recurrent seizures, they were less likely to receive an ASM upon discharge. Larger studies are needed to determine risk factors for recurrent alcohol-associated seizures to reduce ED visits and determine appropriate treatments, educational resources, and social support.