Prevalence and predictors of seizure cluster in emergency care: Insights from a tertiary hospital in Bogotá, Colombia

Introduction: Seizure clusters (SC) constitute a prevalent condition with high risk of progression to status epilepticus, whose management requires a methodical approach. This study aimed to determine the clinical and sociodemographic profile, course, and outcomes of patients with SC. Methods: An analysis was conducted of the subgroup of patients with SC and isolated epileptic seizures (IES) included in the institutional “seizure code” protocol. Baseline characteristics were described and analyses were conducted to identify potential predictors of the condition and compare hospital outcomes between groups. Results: A total of 485 patients were included in the “seizure code” protocol from 23 March to 20 August 2023, of whom 21.2% (n = 103) presented SC and 60.8% (n = 295) IES. A total of 75.7% of patients with SC had history of epilepsy. Younger patients (P = .028), patients with history of epilepsy (P = .0014), and those taking ≥3 antiseizure medications (P = .046) have an increased risk of presenting SC. Poor treatment adherence was the most common etiology. Patients with SC had longer hospital stays than those with IES (37.9 vs 26.8 h; P = .005). However, we did not find statistically significant differences in the prevalence of complications, admissions to the intensive care unit, or in-hospital seizure recurrence. Conclusions: SC are common in emergency departments, with a prevalence of 21.2% in this study. They most frequently affect younger patients, individuals with history of epilepsy, and those receiving ≥3 antiseizure medications. In this context, the main etiology was poor treatment adherence.