Evaluation of the role and utility of neuroimaging in new onset seizures presenting to the Emergency Department

  • Lalit Kumar gian sagar medical college and hospital, Rajpura
  • Vipin Kumar Dayanand Medical College and Hospital, Ludhiana
  • Hardeep Singh Gill gian sagar medical college and hospital, Rajpura
  • G Avasthi SPS Apollo Hospital, Ludhiana
  • Gagandeep Singh Dayanand Medical College and Hospital, Ludhiana
  • Rajesh Mahajan Dayanand Medical College and Hospital, Ludhiana
Keywords: CT scan, Electroencephalography, Epilepsy, MRI, Neuroimaging, Seizure.

Abstract

Epilepsy is defined as recurrent unprovoked seizures.  Initial clinical assessment seldom gives a specific diagnosis and this leads to uncertainty about prognosis and further management. Aim of this study was to evaluate the role and utility of Computerized Tomography Scan and Electroencephalography in the setting of new onset seizures presenting to the emergency department. In this study, all the emergency patients, above 12 years of age, presenting with onset of new seizures within 72 hours prior to presentation, were included for a period of 1½ year. Patients were investigated about any medications taken and EEG was carried out when possible. CSF analysis was done in those seizures patients who had persistently altered mental status, infectious symptoms, elevated WBC count or fever. Patients were subjected to CT scan head and other investigations were carried out based on clinical history and examination. It was concluded that seizures are one of the common presenting complaints in the emergency department. Imaging studies especially CT scan and MRI are an important part of evaluation of patients with new onset seizures and should be done routinely in these patients.

Author Biographies

Lalit Kumar, gian sagar medical college and hospital, Rajpura
Assistant Professor, Department of Medicine
Vipin Kumar, Dayanand Medical College and Hospital, Ludhiana
Assistant Professor, Department of Medicine
Hardeep Singh Gill, gian sagar medical college and hospital, Rajpura
associate Professor, Department of General Surgery
G Avasthi, SPS Apollo Hospital, Ludhiana
Senior consultant, Head of Department of Medicine
Gagandeep Singh, Dayanand Medical College and Hospital, Ludhiana
Professor and head Department of neurology
Rajesh Mahajan, Dayanand Medical College and Hospital, Ludhiana
 Professor , Dept . of  Medicine

References

1. Day SC, Cook EF, Funkenstein H, Goldman L. Evaluation and outcome of emergency room patients with transient loss of consciousness. Am J Med. 1982; 73:15-23
2. Sander JW, Hart YM, Johnson AL, Shorvon SD. National general practice study of epilepsy; newly diagnosed epileptic seizures in general population. Lancet. 1990; 336: 1267-1271.
3. Eisner RF, Turnbull TL, Howes DS, Gold IW. Efficacy of a “standard” seizure workup in the emergency department. Ann Emerg Med. 1986; 15(1): 33-9.
4. Kaplan PW. Nonconvulsive status epilepticus in the emergency room. Epilepsia. 1996; 37: 643-650.
5. Henneman PL, DeRoos F, Lewis RJ. Determining the need of admission in patients with new-onset seizures. Ann of Emerg Med. 1994 Dec; 24(6): 1108-14.
6. William RR, Franz JW, Kavita KE. Seizure patient selection for emergency computed tomography. Ann Emerg Med. 1993; 22-B: 1298-1303.
7. Prego-Lopez M, Devinsky O. Evaluation of a first seizure. Postgrad Med. 2002 Jan; 111(1); 34-6, 43-8.
8. Commission on Classification and Terminology of the International League against Epilepsy. Proposal for revised classification of epilepsies and epileptic syndromes. Epilepsia.1989; 30: 389–399.

9. Jagoda A, Richardson L. The evaluation and treatment of seizures in the emergency department. Mt Sinai J Medicine. 1997 Sep-Oct; 64(4-5): 249-57.
10. Gotman J, Herciani MG. Electroencephalographic spiking activity, drug levels and seizure occurrence in epileptic patients. Ann Neurol. 1985 Jun; 17(6): 597-603.
11. Hopkins A, Garmar A, Clarke C. First seizure in adult life. Lancet. 1988 April; i: 721-726.
12. Mark AK, Newton M, Jackson GD et al. Epileptology of the first-seizure presentation: a clinical, electroencephalographic and magnetic resonance imaging study of 300 consecutive patients. Lancet. 1998; 352: 1007-11.
13. Tardy B, Lafond P, Convers P et al. Adult first generalized seizures: etiology, biological tests, EEG, CT scan, in an ED. Am J Emerg Med.1995; 86: 13-15.
14. American College of Emergency Physicians, American academy of neurology, American Association of Neurological Surgeons, American Society of Neuroradiology. Practice parameter: Neuroimaging in the emergency patient presenting with seizure. Ann Emerg Med. 1996; 27: 114-118.
15. Luders et al. Semiological seizure classification. Epilepsia. 39(9): 1006-13; 1998.
16. Sempere et al. First seizures in adults: A prospective study for the Emergency department. Acta Neurol Scand.1992 Aug; 86(2): 134-8.
17. Earnest M, Feldmon H, Marx J et al. Intracranial lesions shown by CT in 259 cases of first alcohol related seizures. Neurology. 1988; 38: 1561-1565.
18. Shoenberger RA, Heim SM. Indications for computerized tomography of the brain in patients with first uncomplicated generalized seizures. BMJ. 1994; 309: 986-989.
19. Ramirez M– Lassepas, Cipolle RJ, Morilla LR, Gumnit RJ. Value of Computed Tomographic Scan in the evaluation of adult patient after their first seizure. Ann Neurol. 1984; 15: 536-543.
20. William RM, Michelle H, Biros, David AT et al. Selective tomographic imaging of patients with new-onset seizure disorder. Academic Emergency Med. 2002; 9: 143-147.
Published
2016-04-27
Section
Original Article