New Guideline for CT Scan Use in ER for Seizures

Evidence shows such scans can help clinicians select the right treatment option. To develop the guideline, the investigators analyzed all available scientific studies on the topic.

The guideline was developed by the American Academy of Neurology (St. Paul, MN, USA). "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,” said the guideline's lead author Cynthia L. Harden, M.D., from Weill Cornell Medical College (New York, NY, USA) and member of the American Academy of Neurology.

The strongest evidence shows that imaging in the emergency room with a head CT scan is especially 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.

"Infants under six months old with seizure may have brain abnormalities on their CT scans 50% of the time,” said Dr. Harden. "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 because evidence shows the results will change how these people are treated in up to 17% of adult cases and up to 8% of cases involving children. Abnormalities found on CT scans that would lead to a change in treatment include: tumors, traumatic brain injury with skull fracture, and stroke including bleeding in the brain.

Dr. Harden reported that future research should also address the use of brain magnetic resonance imaging (MRI) in the emergency room to screen people with seizures because there is not sufficient data available to make recommendations regarding its use.

The guideline was published in the October 30, 2007, issue of the journal Neurology, the medical journal of the American Academy of Neurology.


Related Links:
American Academy of Neurology
Weill Cornell Medical College