ED visits for falls were 2.6 times as likely in the week before a first seizure

Design

Retrospective case-crossover study, US state databases

Population

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

Primary outcome

ED visit for a fall before first seizure vs control periods

Effect

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

This case-crossover study used emergency and inpatient databases from 11 US states, 2016 to 2021. Among 57,547 adults with a first-time seizure, it compared the odds of an emergency visit for a fall in periods before the seizure with the same periods a year earlier, each person serving as their own control.

A fall visit was 2.6 times as likely in the seven days before the first seizure (OR 2.6, 95% CI 2.2 to 3.2). Before first-time status epilepticus the odds were 4.5 (2.5 to 9.0). The association faded with time but remained detectable for about 22 weeks, held across age and sex, and persisted after excluding traumatic brain injury.

Some of these falls were likely unrecognised seizures. Administrative codes cannot show that directly, and some falls may simply share a cause, such as alcohol or acute illness. But the pattern suggests a fall without a clear mechanical cause is a missed opportunity to ask about seizures.

• Ask about loss of awareness, tongue biting or incontinence in an unexplained fall.
• Ask for a witness account; patients often cannot describe a seizure themselves.
• Consider seizure in a younger adult with a fall and no trip, slip or syncope prodrome.
• Arrange follow-up for a second unexplained fall rather than treating each as isolated.

Why it matters

Falls may be the first sign of epilepsy, and they are usually managed by clinicians not looking for it.

Don't overread it

This is an association in coded data; it cannot show how many of these falls were actually seizures.

The statistics, in plain English

An odds ratio of 2.6 means a fall visit was about two and a half times as likely in the week before the seizure as in the same week a year earlier. Because each patient is their own control, stable traits like age or chronic illness are accounted for.

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