Immediate CT for Patients Presenting with Seizure Recommended
The American Academy of Neurology recently updated their guidelines for the assessment of patients who present to the emergency room after seizure. Those patients should undergo CT scans of the brain immediately upon presentation, though the guidelines apply to a select subgroup of patients.
Findings from CT scans can influence treatment plans for those patients, particularly among those patients who present with their first seizure, according to the report published in Neurology by the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.
The team conducted an extensive Medline search to examine all available evidence, considering publications since 1966 through November 2004. Those included had either Class II or III evidence, of which there were 15 publications.
The patients for whom the CT scans are indicated include those with focal seizure onset, a predisposing history, history of AIDS, abnormal neurologic exam, and those patients under six months old. Among those patients who had their first seizure episode, both children and adults, the evidence indicates that this can modify treatment decision making in the acute setting. Abnormalities found on CT which may modify treatment include traumatic brain injury with skull fracture, stroke, any bleeding to the brain, and tumors.
The team recommends future research investigating the use of MRI to screen patients who present with seizure. At this point, there is limited data to determine if assessment with that modality would be more beneficial.
November 6, 2007 Related topics: Imaging, Diagnostic, Psychiatry & Neurology, Emergency