New guideline recommends immediate brain CT scan for patients with seizures

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A guideline developed by the American Academy of Neurology recommends immediate brain CT scans to screen certain emergency room (ER) patients with seizures — evidence shown in scans can help doctors select the right treatment option, according to today’s issue of Neurology.

“Our analysis found immediate CT scans are a useful screening procedure because the results can help doctors decide how to care for the patient, especially after the first seizure, and for very young children and people with AIDS,” according to the guideline’s lead author Cynthia Harden, MD, of Weill Cornell Medical College in New York City and member of the American Academy of Neurology.

Evidence shows that imaging in the ER with a head CT scan is particularly useful for seizure patients with a predisposing history, focal seizure onset, an abnormal neurologic exam, a history of AIDS or who are younger than six months old, the authors said.

The guideline suggests physicians consider an ER CT scan in adults and children with a first seizure because evidence shows the results will change how the patients are treated in up to 17 percent of adult cases and up to eight percent of cases involving children.

Abnormalities found on CT scans that would lead to a treatment change include: tumors, traumatic brain injury with skull fracture and stroke including bleeding in the brain.

Future research should address the use of brain MRI in the ER to screen patients with seizures because not enough data is available to make usage recommendations, Harden said.