Objective:

A quantitative study of the characteristics and management of patients presenting with presumed acute seizures at a tertiary care emergency department (ED) during defined pre versus peak COVID-19 pandemic periods. We aim to uncover determinants for initiating anti-seizure medications (ASM) as well as the effects of the pandemic.

Background:

As continuous EEG is unavailable due to resource scarcity, spot EEGs became the only electro-diagnostic method to evaluate suspected seizures. We observed a heavy reliance on spot EEGs to make clinical decisions regardless of seizure types, and wondered what variables in combination influence a decision to start ASM.

Design/Methods:

This is a retrospective review of 115 adult patients with a spot EEG in the ED. The independent variables are sex, age, motor semiology, EEG requisition indication, EEG results, and acute symptomatic seizure (ASyS) status. The dependent variable is ASM initiation. We applied Chi-squared, univariate and multivariate logistic regression models to find statistically significant determinants of ASM initiation. 

Results:

There were 63 pre-pandemic and 52 peak-pandemic patients. Demographics of patients selected for EEG did not change between pre and peak-pandemic periods, which allow combining both populations for logistic regressions. The univariate logistic regression models reveal motor semiology (p=0.002), EEG results (p<0.001), and ASyS (p=0.003) were statistically significant determinants of ASM initiation. In a multivariate model, ASyS is no longer statistically significant (p=0.199), whereas EEG results (p<0.001) and motor semiology (p=0.002) remain significant.

Conclusions:

While our study demonstrates motor symptoms and increasing EEG result severity were significant determinants of ASM initiation, we emphasize that an approach heavily relying on spot EEG results to initiate ASM is problematic, as spot EEGs are known for low sensitivities, and during the period immediately after a presumed seizure event, they do not generally predict or rule out an enduring predisposition to have recurrent seizures.