الفهرس 
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Abstract
Seizures are common in the general population and
about 1 in 10 people will experience a seizure in their
lifetime. Most of these seizures are provoked by acute
events and are not related to epilepsy.
The importance of adult onset seizures stems from its
frequent association with secondary causes. With history,
clinical examination, and appropriate investigations, if
proper analysis of etiology is made, the presenting seizures
can be treated accordingly, thus reducing associated
morbidity and mortality.
We aimed in our study to identify the etiological
profile of new onset seizures and define the clinical
semiology of new onset seizures among adult Egyptians
above 18 years old.
In current study, we concluded 120 adult patients
older than 18 years of age; presented by new onset seizures
at neurology outpatient clinics and emergency room (ER)
of Ain Shams University and Nasr city Health Insurance
Hospitals.
Type of seizure was classified according to ILAE
2017 classification of seizure, full personal and past
medical history was taken, neurological examination was
done, laboratory investigations and neuro-imagings were
done to all patients. DEEG was done to most of the
patients.
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In this study; the age specific incidence of acute new
onset seizures was found to be highest (60%) in the age
groups of > 55 years.
It was found that male predominance in most of
different etiologies specially; post traumatic epilepsy
(87.5%), encephalitis (85.7%), and idiopathic epilepsy
syndrome by (66.6%) and only female slight predominance
in brain tumors etiology of new onset seizures (54.5%) with
nearly equal prevalence in symptomatic (metabolic)
etiology.
Past medical illness may give a clue to the possible
etiology. As in the current study, out of 53 patients with
cerebrovascular identified etiology; 42 patients were with
positive past history of old CVA and of 11 patients with
SOL; 5 were with past illness of malignancy. Out of 5
patients with proven hypocalcaemia induced seizures; 3
patients were with past history of CKD. Eight patients
diagnosed as post traumatic epilepsy, were with past history
of head trauma and one patient with drug abuse (Tramadol)
positive past history.
According to the seizure semiology, it was observed
that generalized seizure was the most predominant type of
seizure 46.67% (n = 56) while focal seizure 38.33% as
focal seizures (n = 46), and 15% as unknown onset seizures
(n = 18).
Among metabolic profile, hypocalcemia and
hyponatremia were found to be most common (12, 8 cases
respectively). Hyperglycemia was the next common (7
cases).
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Electrophysiological data showed generalized
epileptiform activity (spike & wave) in only 8.33% of
patients (n=10), Focal epileptiform activity (sharp waves)
in 10.83% of patients (n=13), slow background activity in
11.67% (n=14), bilateral or generalized non-epileptic
activity (diffuse cerebral slowing) in 3.33% (n=4) and
normal EEG in 28.33% (n=34). No EEG recording was
available for 34.17% of patients (n=41).
Abnormal neuro-imaging results were found among
75% of the participants. In 45.83% stroke was detected, of
which 43.33% were ischemic infarcts and 2.5% were
hemorrhagic stroke. In 10% of the participants, space
occupying lesion was present.
The current study showed different etiologies of
adult onset seizures according to different age groups. In
participants <36 years of age, the most common etiology
was idiopathic epilepsy syndrome (55.56%), while
cerebrovascular was most common identified etiology in
participants aged >55 years (65.28%).
Metabolic causes (13.89%), Brain tumors (9.72%)
and encephalitis (6.94%) were more prevalent in elderly
participants, while cases of post-traumatic seizures were
seen mostly in young adults aged <55 years.
In the current study patients with focal onset
seizures; most common cause was cerebrovascular etiology
(54.35%) followed by brain tumors (15.22%).
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Among patients with generalized seizures; most
common underlying etiology after cerebrovascular was
idiopathic epilepsy syndrome (23.21%) followed by
metabolic (16.07%). and it was found to be statistically
significant.
In this study, 17 patients presented with cluster
seizures with most common cause as brain tumors
(29.03%) followed by cerebrovascular (25.81%), while 17
patients presented with status epilepticus with most
common cause as cerebrovascular (35.71%) followed by
brain tumors (21.34%) and equally prevalent metabolic
induced seizure and encephalitis by (14.29%).