Acute symptomatic seizures (ASS) are seizures occurring in close temporal association with an acute central nervous system (CNS) insult such as stroke, traumatic brain injury, CNS infections, or metabolic disturbances. These seizures are considered provoked and differ significantly in etiology, management, and prognosis compared to unprovoked or epileptic seizures. ASS accounts for approximately 40–50% of all first-time seizure presentations in emergency departments, especially in developing countries where CNS infections and metabolic causes are prevalent. (1, 2)

The clinical and demographic characteristics of patients with ASS can vary depending on the underlying cause, age group, and geographic location. For instance, in low- and middle-income countries, neuroinfections such as neurocysticercosis and tuberculous meningitis are common contributors, whereas stroke and head trauma are more predominant in high-income settings (3). Several studies have attempted to characterize the etiology and outcomes of ASS, including those by Beleza (2012) and Kaur et al. (2018), who highlighted the role of metabolic abnormalities and CNS infections in Indian cohorts. However, the variability in presentation and lack of standardized outcome predictors pose a challenge to early prognostication and management (4, 5).

Despite the clinical importance, there is limited literature evaluating how demographic and clinical variables such as age, comorbidities, nature of the provoking factor, and seizure characteristics influence the short-term and long-term outcomes of ASS. Moreover, the differentiation between risk factors that impact recurrence and those that affect neurological recovery or mortality is still an area requiring further exploration (George et al., 2019). Previous research has often focused on specific etiologies or subpopulations, limiting the generalizability of their findings (6).

Given these gaps, this study aims to evaluate the clinical presentation and demographic profile of patients presenting with acute symptomatic seizures and to identify factors associated with adverse outcomes such as prolonged hospital stay, neurological deficits, or mortality. Understanding these factors is crucial for improving risk stratification, patient counseling, and tailoring acute management strategies.

This observational, prospective study was conducted in the Department of General Medicine, Shri Sathya Sai Medical College and Research Institute, Chennai, over a period of 12 months. The study aimed to evaluate the clinical and demographic characteristics of patients presenting with acute symptomatic seizures and to identify factors influencing their clinical outcomes.

Study Population: A total of 75 patients admitted with acute symptomatic seizures were enrolled in the study. Acute symptomatic seizures were defined as seizures occurring within 7 days of an identifiable acute neurological or systemic insult, such as stroke, CNS infections, metabolic disturbances, or head injury, in accordance with the International League Against Epilepsy (ILAE) guidelines (Beghi et al., 2010).

Inclusion Criteria:

• Patients aged ≥18 years
• First-time presentation with acute symptomatic seizures
• Seizures occurring in association with an acute medical or neurological illness, confirmed by clinical and/or radiological/laboratory findings
• Informed consent obtained from patient or guardian

Exclusion Criteria:

• Patients with a prior history of epilepsy or unprovoked seizures
• Seizures due to toxic or drug-related causes
  • Patients with pseudoseizures (psychogenic non-epileptic seizures)
  • Incomplete clinical or follow-up data

Data Collection: A detailed clinical history was obtained for each patient, including demographic details (age, gender), past medical history, comorbidities, seizure semiology, and duration of symptoms. General and neurological examinations were performed at the time of admission.

Relevant investigations were conducted based on the suspected etiology. These included:

• Hematological and biochemical parameters (electrolytes, renal and liver function tests, blood sugar)
• Neuroimaging (CT/MRI brain)
• Lumbar puncture and CSF analysis (where indicated)
• EEG (in selected patients)
• Outcome Measures:
• Patients were followed up during their hospital stay and assessed for:
• Duration of hospital stay
• Seizure recurrence during admission
• Neurological status at discharge (full recovery, persistent deficits, or mortality)

Statistical Analysis:

Data were entered and analyzed using Microsoft Excel and SPSS version XX. Descriptive statistics were used to summarize demographic and clinical data. Categorical variables were expressed as frequencies and percentages; continuous variables were presented as mean ± standard deviation. Associations between clinical/demographic variables and outcomes were analyzed using chi-square test or Fisher’s exact test for categorical variables, and Student’s t-test or Mann–Whitney U test for continuous variables, as appropriate. A p-value <0.05 was considered statistically significant.

Ethical Consideration:

The study was approved by the Institutional Ethics Committee of Shri Sathya Sai Medical College and Research Institute. Written informed consent was obtained from all participants or their legal guardians.

Table 1: Demographic and Clinical Profile of Patients (n = 75)

In this study of 75 patients with acute symptomatic seizures, the mean age was 48.6 ± 16.4 years, with most patients aged between 46–60 years (33.3%). Males were more commonly affected (58.7%) than females (41.3%). A majority (62.7%) of patients were from rural areas, suggesting either greater exposure to risk factors or delayed access to care in these regions (Table 1).

Table 2: Clinical Comorbidities, Seizure Type, and Etiology (n = 75)

Table 2 shows, among the 75 patients studied, hypertension (42.7%) and diabetes mellitus (37.3%) were the most common comorbidities, followed by alcohol use (28%) and chronic kidney disease (12%). The majority of patients (80%) presented with generalized tonic-clonic seizures, while 20% had focal seizures. Stroke was the leading etiology (37.3%), followed by metabolic causes such as hyponatremia and uremia (24%), CNS infections (16%), head injury (12%), and other less defined causes (10.7%).

Table 3: Hematological and Biochemical Parameters in Study Participants (n = 75)

Among the 75 patients, the most common biochemical abnormality was hyponatremia, seen in 36% of cases, followed by hyperglycemia (29.3%) and elevated blood urea (26.7%). Anemia was observed in 24% of patients based on a mean hemoglobin level of 12.6 ± 1.8 g/dL. Other abnormalities included leukocytosis (16%), elevated creatinine (16%), and hypokalemia (12%). Liver enzyme elevations were less frequent, with SGOT and SGPT raised in 10.7% and 12% of cases respectively (Table 3).

Table 4: Neuroimaging Findings (CT/MRI Brain) in Study Participants (n = 75)

Neuroimaging (CT/MRI brain) revealed abnormalities in the majority of patients, with acute ischemic stroke being the most common finding (29.3%). Other structural lesions included intracerebral hemorrhage (8%), post-traumatic contusions (8%), neurocysticercosis (9.3%), and tuberculoma (5.3%). Cerebral atrophy was noted in 6.7%, and metabolic encephalopathy-related changes in 4%. Notably, 29.3% of patients had normal imaging, suggesting a metabolic or non-structural cause for the seizures (Table 4).

Table 5: Lumbar Puncture and CSF Analysis (n = 15 patients who underwent LP)

Table 5 shows lumbar puncture and CSF analysis were performed in 15 patients with suspected CNS infection. Among them, elevated protein was the most common abnormality (53.3%), followed by lymphocytic pleocytosis (46.7%). Low CSF glucose was noted in 20% of cases, and neutrophilic predominance in 13.3%, suggesting bacterial infection in some patients. Tuberculosis was confirmed in 13.3% of cases (positive AFB/CBNAAT), while viral etiology (HSV PCR positive) was identified in one patient (6.7%). Pyogenic meningitis was suggested in 20%. Overall, 26.7% of patients had normal CSF, indicating non-infective causes. These findings reinforce the relevance of CSF analysis in diagnosing CNS infections in seizure cases.

EEG was performed in 20 selected patients, primarily those with prolonged altered sensorium or uncertain seizure etiology. Normal EEG was observed in 40% of cases. Among the abnormalities, diffuse slowing was the most common (30%), often indicating metabolic or encephalopathic states. Focal slowing was seen in 15%, suggesting localized cortical dysfunction. Epileptiform discharges were noted in 10%, and periodic lateralized epileptiform discharges (PLEDS) were identified in one patient (5%). These findings are consistent with the expected EEG patterns in acute symptomatic seizures, where epileptiform activity is less frequent than in chronic epilepsy (Figure 1).

Table 6: Clinical Outcomes during Hospital Stay (n = 75)

During the hospital stay, 50.7% of patients remained admitted for 4–7 days, while 26.7% were discharged within 3 days and 22.6% stayed longer than a week. Seizure recurrence during admission occurred in 14.7% of cases. At discharge, the majority of patients (77.3%) achieved full recovery, while 16% had persistent neurological deficits, and the in-hospital mortality rate was 6.7%. These outcomes suggest that most patients with acute symptomatic seizures recover well with timely intervention, though structural causes like stroke and CNS infections may contribute to poorer prognoses (Table 6).

This study aimed to assess the clinical and demographic characteristics of patients with acute symptomatic seizures (ASS) and identify factors associated with outcomes during hospital stay. Acute symptomatic seizures, unlike unprovoked epileptic seizures, occur in close temporal association with an acute brain insult or systemic disturbance, and have diverse etiologies including stroke, infections, metabolic derangements, and trauma (7).

In our cohort of 75 patients, the mean age was 48.6 ± 16.4 years, with the majority being between 31–60 years, and males (58.7%) slightly outnumbering females. This demographic distribution is comparable to findings from Ali et al., (8), who reported a mean age of 45.2 years and a male predominance in their cohort of adult patients with symptomatic seizures. Similarly, Jose et al. (9) reported that acute symptomatic seizures are more common in middle-aged and elderly populations due to higher prevalence of vascular and metabolic comorbidities.

Regarding etiology, stroke was the most common cause (37.3%) in our study, followed by metabolic disturbances (24%) and CNS infections (16%). This mirrors results from several Indian studies, where ischemic stroke consistently ranks as the leading cause (10). Neuroinfections like tuberculomas and neurocysticercosis also remain relevant in the Indian context, although the incidence appears lower than earlier reports, likely due to improved public health measures.

Neuroimaging revealed abnormalities in 70.7% of cases, with ischemic stroke being the most frequent lesion (29.3%). Around 29.3% had normal imaging, suggesting metabolic or functional causes. These findings are supported by Abdalkader et al. (2023), who noted imaging abnormalities in about 68% of cases, emphasizing the utility of CT/MRI in identifying structural etiologies (11).

Electrolyte abnormalities, especially hyponatremia (36%), and hyperglycemia (29.3%), were frequently observed. These results are consistent with findings from Sivaraju et al., (12), who emphasized the role of electrolyte imbalance as an important trigger in acute seizures. Such abnormalities are often reversible and associated with favorable outcomes if corrected promptly.

EEG was abnormal in 60% of the selected cases, mostly showing diffuse or focal slowing rather than epileptiform discharges, in line with expectations for ASS. Similar findings were reported by Ruiz et al. (13), who observed non-specific EEG changes in the majority of symptomatic seizure cases.

With respect to outcomes, 77.3% of patients recovered fully, 16% had persistent neurological deficits, and mortality was 6.7%. Poor outcomes were mostly seen in patients with stroke or severe CNS infections. This is similar to Zhou et al. (14), who reported a 20% rate of persistent deficits and 8% in-hospital mortality. The presence of comorbidities, prolonged seizures, and underlying structural brain lesions were commonly linked to adverse outcomes across studies (15).

Our study supports the view that acute symptomatic seizures, though alarming, often have a good prognosis when the underlying cause is promptly addressed. However, certain subgroups—particularly elderly patients, those with stroke, or severe metabolic abnormalities—require closer monitoring due to higher risk of complications or recurrence.

This study highlights that acute symptomatic seizures are common neurological presentations, predominantly affecting middle-aged adults with a slight male preponderance. Stroke remains the leading cause, followed by metabolic abnormalities and CNS infections. Most patients recover fully with timely diagnosis and treatment, but a significant minority experience neurological deficits or mortality, particularly those with structural lesions or severe systemic illness.

Identifying clinical and biochemical predictors of poor outcomes can aid in early risk stratification and optimize patient care. Routine neuroimaging and basic metabolic workup are essential for evaluating all new-onset seizures in adults.

Further multi-center and longitudinal studies are warranted to better understand long-term recurrence risks and refine management guidelines for acute symptomatic seizures in resource-limited settings.

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