Nonmotor seizures are often missed in the emergency department and are only realized after conversion to motor seizures, according to a study published online May 1 in Neurology.

Nora Jandhyala, from NYU Langone Health in New York City, and colleagues investigated recognition of motor versus nonmotor seizures in the emergency department among 83 individuals (ages 12 to 18 years) who where neurotypical and within four months of treatment initiation for focal epilepsy.

The researchers found that 70 percent of participants presented to an emergency department before diagnosis of epilepsy. While most presented for motor seizures (52 patients; 90 percent), many had a history of nonmotor seizures (20 of 52; 38 percent). Individuals with initial nonmotor seizures were less likely to present to the emergency department (26 of 44 [59 percent] versus 32 of 39 [82 percent]). Nonmotor seizures were less likely to be correctly identified (33 versus 81 percent). Among adolescents who presented for a first-lifetime motor seizure, a history of initial nonmotor seizures was not recognized in any; therefore, initiation of treatment and admission from the emergency department were not more likely for those who met the definition of epilepsy versus those with no seizure history. Compared with an adult group, this lack of nonmotor seizure history recognition in the emergency department was greater (0 percent for adolescents versus 23 percent for adults), with occurrence in both pediatric and nonpediatric settings.

“Our study highlights a critical need for physicians to inquire about the symptoms of nonmotor seizures, even when the presenting seizure is motor,” the authors write.

Several authors disclosed ties to the pharmaceutical and biotechnology industries.

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