Impact of Treatment Delays in Epileptic Seizures: Time to Hospital Care and to EEG Increases Risk of Status Epilepticus and ICU Admission in Epileptic Seizures.
European journal of neurology · 2026-03-01 · Observational study
Abstract
BACKGROUND: Delays in the provision of care to patients experiencing seizures can result in evolution into status epilepticus (SE) and admission to the intensive care unit (ICU). However, data on specific response times and its implications remain sparse. Our aim is to report the time intervals of care delivery in patients with urgent seizures and evaluate its impact on the diagnosis of SE and the requirement for ICU admission. METHODS: A consecutive cohort analysis was conducted across two tertiary hospitals between December 2022 and March 2024. Of 1493 emergency episodes, 1139 cases were analyzed after excluding non-epilepsy diagnoses and incomplete data. Demographic data and time intervals (seizure onset, extra-hospital emergency activation, hospital admission, and EEG performance) were recorded. Associations between these intervals and SE diagnosis or ICU admission were evaluated. RESULTS: From our sample, 236 patients were diagnosed with SE, and 128 required ICU admission. Patients with SE had longer commute times (55 vs. 48 min, p = 0.040) and higher rates of prehospital anti-seizure drug administration (p < 0.001). Delays in EEG acquisition were associated with increased ICU admissions (22.1 vs. 16.5 h, p < 0.001). In multivariable analysis, prehospital treatment showed a strong association with SE (OR = 24.5, p < 0.001). Commute to hospital (OR = 4.95, p < 0.001) and seizure-to-EEG timelapse (OR = 5.05, p < 0.001) were associated with ICU admission. CONCLUSION: Pre-hospital treatment administration, commute home to hospital and delayed EEG acquisition are associated with SE diagnosis and ICU admission, underscoring the need to optimize urgent care protocols for epileptic seizures.