Neurology · Medical Literature
The burden of seizure emergencies in spain: a systematic literature review.
Abstract
Seizure emergencies pose significant clinical and healthcare challenges in Spain, impacting morbidity, mortality, and resource utilization. Comprehensive data on epidemiology, clinical outcomes, and economic impact remain limited. A systematic review was conducted following the Centre for Reviews and Dissemination (CRD), Cochrane, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Embase, PubMed, and CINAHL were searched (January 2010-April 2025) for observational studies on epileptic seizure emergencies in Spain. Study selection, data extraction, and risk of bias assessment (ROBINS-I) were performed independently by two reviewers. Given reporting heterogeneity, a descriptive narrative synthesis was undertaken. Forty-seven observational studies identified 16 population groups. The analysis focuses on two groups with the most comprehensive data: status epilepticus (SE), epileptic seizures at the emergency department; and in pediatric populations. SE patients experienced extended seizure duration (8-51 h), in-hospital mortality averaging 24.3%, intensive care unit (ICU) admissions between 17% and 48%, and hospital stays up to 24 days, indicating substantial resource utilization. Patients with epileptic seizures at the emergency department exhibited hospitalization rates between 6-32% and medical complications between 19.4% and 52.1%. Pre-hospital benzodiazepines use was between 11 and 38%. Pediatric likely underrepresented populations had lower mortality but frequent emergency visits. No studies assessed quality of life or indirect costs; one reported direct cost in SE. Reporting of seizure emergencies in Spain is heterogeneous and biased toward severe cases, likely overestimating per-patient burden while underestimating population impact. Broader data capture and improved early management could inform planning and reduce overall burden.
Clinical relevance
What is the epidemiological, clinical, and economic burden of seizure emergencies — including status epilepticus, emergency department seizures, and pediatric epileptic seizures — in Spain based on available observational evidence from 2010 to 2025? __SNAPSHOT__ {"studyDesign":"Systematic literature review with descriptive narrative synthesis (no meta-analysis performed due to reporting heterogeneity); conducted in accordance with CRD, Cochrane, and PRISMA 2020 guidelines","setting":"Spain; multiple institutional types inferred across 47 included observational studies; searches conducted in Embase, PubMed, and CINAHL","sampleSize":"47 observational studies included, identifying 16 distinct patient population groups; individual study-level sample sizes not reported in the abstract","population":"Patients presenting with epileptic seizure emergencies in Spain, including adults with status epilepticus (SE), patients with epileptic seizures at the emergency department (ED), and pediatric populations; 16 population subgroups identified across included studies","intervention":"Not applicable (observational burden-of-disease review; no therapeutic intervention was evaluated)","comparator":"Not applicable","primaryOutcome":"Epidemiology, clinical outcomes (seizure duration, in-hospital mortality, ICU admission rates, hospital length of stay), and economic impact of seizure emergencies in Spain; descriptive synthesis across three primary population groups (SE, ED seizures, pediatric seizures)","followUp":"Study search window: January 2010 – April 2025; individual study follow-up durations not reported in the abstract","fundingSource":"Not reported in the abstract; notable conflict of interest: lead author Manuel Toledo has received funding and honoraria from UCB Pharma, BIAL, EISAI Inc, Jazz, Angelini, Neumirna, and Neuraxpharm; two additional authors (Noem Sain and María Torrejón) are salaried employees of UCB Pharma"}
Key findings
Across the 47 included observational studies and 16 identified population groups, the review focused on three groups with the most comprehensive available data: SE, epileptic seizures presenting to the ED, and pediatric seizures. For SE specifically, the findings document a high clinical burden: seizure duration ranged from 8 to 51 hours across studies, in-hospital mortality averaged 24.3%, ICU admission rates ranged from 17% to 48%, and hospital stays extended up to 24 days (exact upper bound was truncated in the provided abstract). Confidence intervals, p-values, absolute risk differences, relative risk estimates, and NNT/NNH values were not reported in the abstract, as this is a descriptive narrative synthesis rather than a quantitative meta-analysis. Quality-of-life outcomes and indirect cost data were described as largely unreported across the included literature. Due to reporting heterogeneity among the 47 studies, no pooled effect estimates were calculable. All figures presented are derived from narrative ranges across heterogeneous observational studies and should be interpreted accordingly.
Practice implications
This systematic review establishes that seizure emergencies — particularly SE — carry a substantial clinical burden in Spain, with in-hospital mortality averaging 24.3% and ICU utilization rates approaching 50% in some study populations, figures consistent with international SE literature. The review did not establish causality, treatment efficacy, or comparative effectiveness of any intervention. The findings apply primarily to hospitalized patients with SE and ED-presenting seizures in the Spanish healthcare context; community-dwelling patients, those managed solely in out-of-hospital settings, and populations not captured in secondary or tertiary care are likely underrepresented. The available evidence base is skewed toward severe, institutionally managed cases, limiting generalizability to the full spectrum of seizure emergency severity. Economic impact, quality-of-life outcomes, and indirect costs remain largely unquantified, representing a major evidence gap. The review highlights that early out-of-hospital intervention may reduce overall burden, though this conclusion is inferential and not supported by a comparative effectiveness analysis within this review. IMPORTANT LIMITATION: Only the abstract was available for this summary; full-text data on individual study characteristics, risk of bias results (ROBINS-I assessments), and population-specific subgroup analyses were not accessible. Conclusions should be considered preliminary pending full-text review. __LIMITATIONS__ Descriptive narrative synthesis only — reporting heterogeneity across the 47 included studies precluded quantitative pooling, meaning all outcome figures represent ranges across non-comparable populations rather than precise estimates.,All included studies are observational, introducing inherent risks of selection bias, confounding, and ascertainment bias; ROBINS-I risk of bias assessments were performed but results are not detailed in the abstract.,Evidence base is hospital-centric and skewed toward severely affected patients, likely underestimating the true community burden of milder seizure emergencies.,Quality-of-life data and indirect economic costs (e.g., lost productivity, caregiver burden) were largely unreported across included studies, leaving the full societal impact uncharacterized.,Geographic restriction to Spain limits generalizability to other healthcare systems, even within Europe.,Sixteen population subgroups were identified but detailed data were available for only three, suggesting underpowered or heterogeneous data for the remaining 13 groups.,Industry conflict of interest is notable: the lead clinical author has financial relationships with multiple epilepsy pharmaceutical manufacturers, and two co-authors are employees of UCB Pharma, which markets antiseizure medications relevant to this disease area.,Abstract truncation prevented full assessment of hospital stay upper bounds and pediatric-specific outcome data.,Search window (2010–2025) may exclude relevant older Spanish epidemiological literature. __BOTTOM_LINE_CATEGORY__ low_certainty __BOTTOM_LINE__ Seizure emergencies in Spain impose a high clinical burden, with status epilepticus carrying an average in-hospital mortality of 24.3% and ICU admission rates of 17–48% across included studies; however, these figures derive from heterogeneous observational data with hospital-based ascertainment bias and should not be treated as precise population-level estimates. Comprehensive data on quality of life and economic impact remain lacking, and the evidence base is insufficient to guide specific management changes. Clinicians should be aware of the gaps in out-of-hospital and community seizure emergency data, and advocacy for standardized prospective registries in Spain is warranted.