First seizure in adults: a prospective study from the emergency department

Abstract

A prospective study of 98 consecutive adults with a first seizure to determine the most important etiological factors and the optimum diagnostics. 27 were thought to have cryptogenic seizures. Main causes of symptomatic seizures were: cerebral infarction, alcohol-withdrawal, CNS infections, tumors, vascular malformations, traumatism and miscellanea. Eight were infected by human immunodeficiency virus (HIV-1) representing 8.2% of all the patients with a first seizure and 20% of the 15-45-year age group. CT disclosed structural lesions in 33 cases. MRI in those with normal CT and no other explanation of seizure revealed additional lesions in 22.2%, but did not change management in any. We conclude that CT is essential in evaluation of adults with first seizure. MRI may be useful in selected cases. The HIV-infected now represent an important group with a first seizure.

Practice Parameter: Evaluating an apparent unprovoked first seizure in adults (an evidence-based review): [RETIRED]

“…Also, some studies had many patients with other exclusion criteria (appendix 4) such as focal neurologic deficits, and it was not specified whether patients returned to their normal level of function after the seizure. [30][31][32][33] Despite these limitations and acknowledgment that yield is very low, 7 these four Class III studies were consistent in proposing some value to routine screening of blood glucose for hypoglycemia and serum electrolytes for hyponatremia because unanticipated and clinically relevant hypoglycemia and hyponatremia were found in about 1% of these patients. [30][31][32][33] The two Class II studies as well the four Class III we identified do not provide convincing evidence to support or refute significant value for blood glucose, blood count, and electrolytes as routine for adults at initial presentation with epileptic seizures.…”

“…18 There were four Class III studies that showed a higher incidence of significant laboratory abnormalities, particularly for serum sodium and glucose. [30][31][32][33] All these studies were based in emergency departments, and the patients were obviously ill with more comorbidities than those in our Class II studies. 18,23 A large proportion were patients with acute symptomatic or provoked rather than apparent unprovoked seizures, as required by our inclusion criteria (appendix 4).…”

“…There were no Class I or II studies, but of the two Class III studies considering the value of a lumbar puncture in patients with a first seizure, both were from emergency departments and reported significant lumbar puncture abnormalities in up to 8% of patients. 30,33 However, not all patients in these two studies had unprovoked seizures or returned to baseline function as our inclusion criteria require. A substantial number had acute symptomatic seizures and level of consciousness was not well specified.…”

“…Another major limitation of these studies is that lumbar punctures were performed selectively. They were performed in only 68% of the patients in one study 30 and 24% of the other, 33 and this depended on such presenting clinical features as fever or at the discretion of the staff. Consequently, lumbar punctures were not routinely performed, and the decision to perform a lumbar puncture was directed by the clinical history and physical findings.…”

Emergency centre investigation of first-onset seizures in adults in the Western Cape, South Africa

“…[5,6] Unless contraindicated, a lumbar puncture (LP) should be performed whenever an intracranial infection is suspected, in all immunocompromised patients, and in young patients where no obvious cause for a seizure is identified. [8][9][10] An EEG is considered a useful investigation to diagnose epilepsy and has an average abnormal yield of 29%. [3,11] While a normal EEG does not exclude epilepsy, it may predict seizure recurrence.…”