In the adult patient with new-onset seizure, it can be reasonable to pursue emergency neuroimaging in many cases. However, the vast majority of presentations to the Emergency Department for seizure are for those with known seizure disorders. In this population, the calculus is different.
This is a retrospective review of 822 presentations for non-index seizures from two hospitals, examining the rate of neuroimaging and incidence of clinically important new findings. Of these, neuroimaging was obtained in about half. Of these 381, only 8 had true positive, clinically important findings on imaging. All of these cases had persistent altered level of consciousness, head trauma, or a focal finding on examination. Absent these factors, there were no cases of true positive imaging findings related to the acute presentation. If imaging were deferred in those cases absent any of those three factors, approximately half of scans could have been obviated.
This is a small sample at two academic institutions and a retrospective evaluation, so it is hardly definitive. However, the authors’ conclusion is reasonable there is certainly an opportunity to further reduce unnecessary imaging in non-index seizures.
“Emergency department neuroimaging for epileptic seizures”