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From the Comprehensive Epilepsy Center, Department of Neurology (C.L.H.), and Department of Neurosurgery (T.H.S.), Weill Cornell Medical College, New York, NY; Department of Neuroradiology (R.D.Z.), Weill Cornell Medical College, New York; Emergency Medicine (J.S.H.), University of Virginia Health System, Charlottesville, VA; Department of Neurology (R.M.D.), University of Kansas, Kansas City, KS; Children’s Hospital (S.W.), Washington, DC; Pediatric Emergency and Transport Medicine (J.C.F.), Tisch Hospital, NYU Medical Center, New York; Departments of Pediatrics and Emergency Medicine (J.C.F.), NYU School of Medicine, New York; and Clinical Epilepsy Section (W.H.T.), National Institutes of Health, Washington, DC.
Address correspondence and reprint requests to the American Academy of Neurology, 1080 Montreal Avenue, St. Paul, MN 55116 guidelines{at}aan.com
Objective: To reassess the value of neuroimaging of the emergency patient presenting with seizure as a screening procedure for providing information that will change acute management, and to reassess clinical and historical features associated with an abnormal neuroimaging study in these patients.
Methods: A broad-based panel with topic expertise evaluated the available evidence based on a structured literature review using a Medline search from 1966 until November 2004.
Results: The 15 articles meeting criteria were Class II or III evidence since interpretation was not masked to the patient’s clinical presentation; most were series including 22 to 875 patients. There is evidence that for adults with first seizure, cranial CT will change acute management in 9 to 17% of patients. CT in the emergency department for children presenting with first seizure will change acute management in approximately 3 to 8%. There is no clear difference between rates of abnormal emergent CT for patients with chronic seizures vs first. Children <6 months presenting with seizures have clinically relevant abnormalities on CT scans 50% of the time. Persons with AIDS and first seizure have high rates of abnormalities, and CNS toxoplasmosis is frequently found. Abnormal neurologic examination, predisposing history, or focal seizure onset are probably predictive of an abnormal CT study in this context.
Conclusions: Immediate noncontrast CT is possibly useful for emergency patients presenting with seizure to guide appropriate acute management especially where there is an abnormal neurologic examination, predisposing history, or focal seizure onset.
Approved by the Therapeutics and Technology Assessment Subcommittee on December 9, 2006; by the Practice Committee on July 3, 2007; and by the AAN Board of Directors on July 19, 2007.
Disclosure: The authors report no conflicts of interest.
Received February 2, 2007. Accepted in final form June 7, 2007.
This article has been cited by other articles:
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  J. A. French and T. A. Pedley Initial Management of Epilepsy N. Engl. J. Med., July 10, 2008; 359(2): 166 - 176. [Full Text] [PDF]
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 Emergency CT for Seizures Journal Watch Neurology, January 8, 2008; 2008(108): 5 - 5. [Full Text]
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 Which Patients Presenting with Seizure Need Head CT in the ED? Journal Watch Emergency Medicine, December 14, 2007; 2007(1214): 2 - 2. [Full Text]
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