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The importance of time in the management of epileptic seizures
The importance of time in the management of epileptic seizures
Estevo Santamarina
Unidad de Epilepsia, Hospital Vall d’Hebron; Research Group on status epilepticus and emergent seizures, Vall d’Hebron Institut de Recerca (VIHR). Barcelona, España
*Correspondence: Estevo Santamarina. Email: estevo.santamarina@vallhebron.cat
Summary
Epileptic seizures account for approximately 1-1.3% of emergency department visits and represent a common cause of urgent neurological care. While many seizures resolve without complications, some evolve into prolonged or refractory forms, such as status epilepticus, which carry a more severe prognosis. This review addresses the main prognostic factors associated with epileptic seizures, including etiology, level of consciousness, seizure duration, and initial treatment response. Among these, duration emerges as the only modifiable factor from the onset and is closely linked to the development of refractoriness, neurological sequelae, and increased mortality. Moreover, delays in treatment administration are associated with poorer functional outcomes, higher recurrence rates, progression to epilepsy, and increased hospital costs. The pathophysiological mechanisms involved in the loss of benzodiazepine efficacy are examined, along with clinical evidence supporting early intervention. Available data underscore the importance of promptly recognizing and treating any epileptic seizure in the emergency setting. Timely and coordinated intervention not only improves immediate outcomes but may also have a positive impact on long-term clinical evolution.
Keywords: Epileptic seizures. Prognosis. Duration. Early treatment. Emergency care.
