As far as we know, there were no major hospital-based studies that evaluated new onset seizures in adults especially from Egypt.
Most epidemiologic studies of seizure disorders are studies of the prevalence of epilepsy and only a few prospective incidence studies of cases with a first ever seizure in adult population exist .
The importance of adult onset seizures stems from its frequent association with secondary causes. If proper analysis of etiology is made with history taking, clinical examination, and appropriate investigations, the presenting seizures can be treated accordingly, thus reducing associated morbidity and mortality .
In 2010, the International League Against Epilepsy (ILAE) Commission for Classification of Epilepsy divided epilepsies into three categories (genetic, structural/ metabolic, unknown cause) according to the etiologies of epilepsy .
We evaluated the data of 120 patients presented to ER and Neurology Clinic, who were ≥ 18 years of age at the time of first seizure. Of patients, 76 (63.33%) were males and 44 (36.67%) were females with a male to female ratio of 1.7:1.
Kaur and colleagues reported mild to moderate preponderance of males, with male to female ratio (1.85:1), and Chalasani and colleagues reported the same with a ratio of 1.9:1 [12, 13].
Yet, a study done by Derle and colleagues showed that females represented 50.8% of cases .
This can be explained by high incidence of head trauma in young adult males and CVDs in older adult males in comparison to corresponding age category in females, while Derle and colleagues reported increasing incidence of CVDs in females after menopausal hormonal changes with > 65 years of age female preponderance .
Faught and colleagues concluded that the average annual incidence of epilepsy in the elderly, aged 65 years and older, is up to 240 per 100,000 .
Ghosh and colleagues reported that nearly 25% of new onset epilepsy occur in the elderly .
Joshi and colleagues reported an increased number of patients with first seizure among older age group > 60 years .
The increasingly aging population in the last decades and the age itself being an independent risk factor for CVDs and the concomitant increase in the incidence and prevalence of post-stroke seizures can explain the higher prevalence of post-stroke epilepsy in our study among older age group (> 55 years) accounting for nearly 50% of our cases with new onset seizures.
On the contrary, other studies from India done by Kaur and colleagues, Chalasani and colleagues, and Muralidhar and colleagues revealed that the majority of cases were in the age group < 40 years [12, 13, 19].
Younger patients with epilepsy often show a genetic cause. However, new onset epilepsy in the elderly is mainly the consequence of accumulated injuries to the brain and other secondary factors .
New onset epilepsy in elderly people often has underlying etiology including CVDs, brain tumors, and traumatic head injury .
The present study highlighted the burden of new onset seizure with post-stroke epilepsy (41.67%). Therefore, better understanding of seizures’ characteristics, underlying etiological causes and drug interactions are necessary for effective patient management. As well as close follow-up of stroke patients for early detection of subtle fits which are hardly identified by patients themselves or their caregivers.
The second most common identified etiology of new onset seizures was idiopathic epilepsy syndromes (18.33), followed by SOL “Brain tumor” (9.17), acute symptomatic seizure “metabolic” (8.33%), post-traumatic epilepsy (6.67%), encephalitis (5.83%), and cryptogenic (5%).
Surprisingly, post-traumatic seizures were represented by fewer incidences than expected in Egypt.
The present study revealed that 25.83% of patients (n = 31) presented by cluster seizures and 14 (11.67%) of patients presented with status epilepticus (SE).
Chalasani and colleagues found that out of the 98 patients presented by new onset seizures above 20 years of age, 11% presented by SE .
The current study revealed that the most common underlying etiology, in patients presented with cluster seizures was SOL “Brain Tumors” (29.03%) followed by CVDs (25.8%).
We found that out of 11 patients with SOL (brain tumors) identified etiology of new onset seizure, 9 of them (81.8%) presented by cluster seizures with highly statistically significant value (P value < 0.001).
The current study revealed that the most common underlying etiology, in patients presented with status epilepticus, was cerebrovascular (35.71%) followed by brain tumors (21.34%).
In contrast to a study done by Kaur and colleagues who reported that out of 17 patients presented with status epilepticus, the most common cause was metabolic (35.3%) .