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New guideline recommends when to use CT scans in emergency for seizures

8 November, 2007

A new guideline developed by the American Academy of Neurology recommends immediate brain computerised tomography (CT) scans to screen certain patients with seizures in a hospital accident and emergency department.

Evidence has shown that such scans can help doctors select the right treatment option.

Dr Cynthia Harden, the lead author of the guideline, said:

"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."

To develop the guideline, the authors analysed all available scientific studies on the topic. The author wrote that the strongest evidence shows that imaging in the emergency room with a head CT scan is particularly useful for seizure patients with a predisposing history, focal seizure onset, an abnormal neurologic examination, a history of AIDS, or who are younger than six months old.

Dr Harden added:

"Infants under six months old with seizures may have brain abnormalities on their CT scans 50 per cent of the time. In addition, evidence shows people with AIDS who are treated in the emergency room for their first seizure have high rates of brain abnormalities. Central nervous system toxoplasmosis, an infectious disease caused by a parasite, is also frequently found in AIDS patients."

The guideline suggests physicians consider an emergency CT scan in adults and children with a first seizure. This is because evidence shows the results will change how these people are treated in up to 17 per cent of adult cases and up to eight per cent of cases involving children. Abnormalities found on CT scans that would lead to a change in treatment include: tumours, traumatic brain injury with skull fracture, and stroke including bleeding in the brain.

Dr Harden says future research should address the use of brain MRI in the emergency room to screen people with seizures because there isn't sufficient data available to make recommendations regarding its use.

The guideline has been published in Neurology, the medical journal of the American Academy of Neurology.