Abstracts

Rationale: Acute seizures are a potential complication of neuroinfectious diseases and may lead to increased morbidity and mortality. Determining risk factors associated with seizure development and and their relation to outcomes can improve care provided to patients with neuroinfectious disease. We aimed to examine risk factors for seizures and outcomes, along with prevailing patterns of Anti-Seizure Medication (ASM) prescription in patients hospitalized with acute neuroinfectious diseases.

Methods: In a single-center retrospective study, we analyzed adults (age > 18 years) hospitalized with acute neuroinfectious diseases between 2002 and 2023. Clinical and imaging data were reviewed from electronic health records, documenting seizure frequency, electrographic epileptiform activity (periodic/rhythmic patterns), and anti-seizure medication (ASM) prescription. Outcomes were assessed using the Modified Rankin Scale (mRS) at discharge.

Results: Of the 243 eligible patients (median age 52 years (Q1 - Q3 35-63); 52% Male), clinical seizures occurred in 14% (33/243) as in-patients. A total of 86 patients underwent electroencephalography, of which 32 (37%) had electrographic seizures or other epileptiform activity. Risk factors for seizures included an encephalitic etiology (OR 5.43, p < 0.001), particularly Herpes Simplex Virus (HSV) Encephalitis (OR 4.5, p = 0.0005); cortical involvement (OR 3.92, p < 0.002) and Temporal Lobe involvement (OR 3.0, p = 0.01) on imaging, and a severe GCS score (≤ 8) on admission (OR 3.57, p < 0.03). Although only 33 patients had seizures, ASMs were prescribed to 72 (30%) patients, suggesting frequent use of ASM as primary prophylaxis. Among patients with seizures, Levetiracetam was the most commonly prescribed ASM (n=28, 85%). Clinical seizures were more frequently observed in patients with poor outcomes (25%) compared to those with better outcomes (7%), supported by multivariable analysis, which indicated that clinical seizures were significantly associated with poor discharge outcomes (modified Rankin Scale 4-6) [OR 4.10 (CI 1.496-11.269)].