Emergency visits for falls cluster in the weeks before a first seizure

Design

Retrospective case-crossover study of administrative data

Population

57,547 adults with a first-time seizure in 11 US states, 2016–2021

Primary outcome

Emergency visits for falls before first seizure versus a year earlier

Effect

OR 2.6 (95% CI 2.2–3.2) in the prior 7 days; status epilepticus OR 4.5 (2.5–9.0)

Using emergency and inpatient databases from 11 US states, investigators identified 57,547 adults with an acute visit for a first-time seizure and compared each person's fall-related emergency visits before the seizure with the same periods a year earlier, so each patient acted as their own control.

A fall visit was 2.6 times more likely in the seven days before the first seizure. The association faded with time but persisted for about 22 weeks. It held across age and sex and after excluding traumatic brain injury, and was strongest before first-time status epilepticus (OR 4.5).

This design controls for fixed personal factors, but it relies on billing codes and cannot say whether a given fall was a seizure. Even so, the pattern suggests the emergency department sees many patients before their seizure disorder is recognised. For a neurologist, the practical step is to treat an unexplained fall, especially one without a trip or with a period of unresponsiveness, as a possible seizure that merits a proper history.

• Consider an unwitnessed seizure in any adult with an unexplained fall, particularly without a clear trip.
• Ask about lost awareness, tongue biting, incontinence and post-event confusion after a fall.
• Consider an EEG and neurology referral when the history of a fall is suggestive.
• Review previous emergency attendances in patients presenting with first seizure or status epilepticus.

Why it matters

It points to the emergency department fall as a missed chance to diagnose epilepsy earlier.

Don't overread it

Coded data show timing, not that the falls were seizures.

The statistics, in plain English

An odds ratio of 2.6 means fall-related visits were about two and a half times as likely in the week before a seizure as in the matching week a year before. A case-crossover design compares each person with themselves, removing fixed differences between people, but it cannot rule out changes in health over the year.

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