Practice parameter

Evaluating an apparent unprovoked first seizure in adults (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society

A. Krumholz, S. Wiebe, G. Gronseth, Shlomo Shinnar, P. Levisohn, T. Ting, J. Hopp, P. Shafer, H. Morris, L. Seiden, G. Barkley, J. French

Research output: Contribution to journalArticle

192 Citations (Scopus)

Abstract

OBJECTIVE: The Quality Standards Subcommittee of the American Academy of Neurology develops practice parameters as strategies for patient care based on analysis of evidence. For this practice parameter the authors reviewed available evidence relevant to evaluating adults presenting with an apparent unprovoked first seizure. METHODS: Relevant questions were defined and addressed by multiple searches of medical literature. Each article was then reviewed, abstracted, and classified using an established evidence scoring system. Conclusions and recommendations were based on a standard three-tiered scheme of evidence classification. RESULTS: For adults presenting with a first seizure, a routine EEG revealed epileptiform abnormalities in approximately 23% of patients, and these were predictive of seizure recurrence. A brain imaging study (CT or MRI) was significantly abnormal in 10% of patients, indicating a possible seizure etiology. Laboratory tests such as blood counts, blood glucose, and electrolyte panels were abnormal in up to 15% of individuals, but abnormalities were minor and did not cause the seizure. Overt clinical signs of infection such as fever typically predicted significant CSF abnormalities on lumbar puncture. Toxicology screening studies were limited, but report some positive tests. RECOMMENDATIONS: EEG should be considered as part of the routine neurodiagnostic evaluation of adults presenting with an apparent unprovoked first seizure (Level B). Brain imaging with CT or MRI should be considered as part of the routine neurodiagnostic evaluation of adults presenting with an apparent unprovoked first seizure (Level B). Laboratory tests, such as blood counts, blood glucose, and electrolyte panels (particularly sodium), lumbar puncture, and toxicology screening may be helpful as determined by the specific clinical circumstances based on the history, physical, and neurologic examination, but there are insufficient data to support or refute recommending any of these tests for the routine evaluation of adults presenting with an apparent first unprovoked seizure (Level U).

Original languageEnglish (US)
Pages (from-to)1996-2007
Number of pages12
JournalNeurology
Volume69
Issue number21
DOIs
StatePublished - Nov 2007

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Seizures
Spinal Puncture
Neuroimaging
Toxicology
Electrolytes
Blood Glucose
Electroencephalography
Neurologic Examination
Physical Examination
Patient Care
Fever
History
Sodium
Recurrence
Infection

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

Practice parameter : Evaluating an apparent unprovoked first seizure in adults (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. / Krumholz, A.; Wiebe, S.; Gronseth, G.; Shinnar, Shlomo; Levisohn, P.; Ting, T.; Hopp, J.; Shafer, P.; Morris, H.; Seiden, L.; Barkley, G.; French, J.

In: Neurology, Vol. 69, No. 21, 11.2007, p. 1996-2007.

Research output: Contribution to journalArticle

Krumholz, A. ; Wiebe, S. ; Gronseth, G. ; Shinnar, Shlomo ; Levisohn, P. ; Ting, T. ; Hopp, J. ; Shafer, P. ; Morris, H. ; Seiden, L. ; Barkley, G. ; French, J. / Practice parameter : Evaluating an apparent unprovoked first seizure in adults (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. In: Neurology. 2007 ; Vol. 69, No. 21. pp. 1996-2007.
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AU - Wiebe, S.

AU - Gronseth, G.

AU - Shinnar, Shlomo

AU - Levisohn, P.

AU - Ting, T.

AU - Hopp, J.

AU - Shafer, P.

AU - Morris, H.

AU - Seiden, L.

AU - Barkley, G.

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