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<< Current Guidelines For Management Of Seizures In The Emergency Department

Practice Parameter: Evaluating An Apparent Unprovoked First Seizure In Adults (An Evidence-Based Approach).

Neurology. 2007;69:1996-2007. Link to this: http://www.neurology.org/cgi/reprint/69/21/1996 

This document was developed by a group of neurologists organized by the American Academy of Neurology (AAN) in collaboration with the American Epilepsy Society; the methodology is adapted from the AAN Clinical Practice Guideline Process Manual.3 The group identified 5 questions based on a literature search from 1966 to 2004, and it was carried out according to explicit criteria. Article inclusion and exclusion criteria are specified and selected details around the review process are described. Evidence was evaluated for quality according to predefined, specified criteria and assigned to 1 of 4 classes (I, II, III, IV). Recommendations were graded at 4 levels: A, B, C, U, based primarily on the strength of evidence for each question. Level A: established as true; Level B: probably true; Level C: possibly true; Level U: data inadequate or conflicting. The target provider population is not defined.

The Practice Parameter applies to adults 18 years of age and older presenting with a first unprovoked seizure (ie, excluding patients with diagnosed seizure disorders and seizures resulting from an obvious cause such as trauma and stroke).

The Conflict of Interest statement notes “Drafts of the guidelines have been reviewed by at least 3 AAN committees, a network of neurologists, Neurology peer reviewers, and representatives from related fields,” and “The AAN forbids commercial participation in, or funding of, guideline projects.” The authors report no conflicts of interest. The following questions and recommendations are abstracted from the Practice Parameter. To view the original document in its entirety, click here: http://www.neurology.org/cgi/reprint/69/21/1996 

In an adult presenting with an apparently unprovoked first seizure, should an EEG be ordered routinely?

Recommendation 1 (Level B): For an adult with an apparent unprovoked first seizure, the EEG should be considered as part of the neurodiagnostic evaluation, because it has a substantial yield.

Recommendation 2 (Level B): For an adult with an apparent unprovoked first seizure, the EEG should be considered as part of the neurodiagnostic evaluation because it has value in determining risk of seizure recurrence.

For an adult presenting with an apparent unprovoked first seizure, should a brain imaging study (CT or MRI) be routinely ordered?

Recommendation 3 (Level B): For an adult presenting with an apparent unprovoked first seizure, brain imaging studies using CT or MRI should be considered as part of the neurodiagnostic evaluation.

For an adult presenting with an apparent unprovoked first seizure, should blood counts, blood glucose, and electrolyte panels be routinely ordered?

Recommendation 4 (Level U): There are insufficient data to support or refute routine recommendation of laboratory tests such as blood glucose, blood counts, and electrolyte panels (particularly sodium) for an adult presenting with an apparent unprovoked first seizure, though they may be helpful in specific clinical circumstances.

For an adult presenting with an apparent unprovoked first seizure, should lumbar puncture be routinely performed?

Recommendation 5 (Level B): There are insufficient data to support or refute recommending routine lumbar puncture in the adult initially presenting with an apparent unprovoked first seizure; however, in special clinical circumstances (ie, febrile patients), it may be helpful.

In an adult presenting with an apparent unprovoked first seizure, should toxicologic screening be routinely ordered?

Recommendation 6 (Level B): There are insufficient data to support or refute a routine recommendation for toxicology screening; however, it may be helpful in specific clinical circumstances.

Full Guideline: http://www.neurology.org/cgi/reprint/69/21/1996