Abstracts

Seizure is one of the most common serious neurological conditions encountered in the emergency departments. There is limited information about current use of emergent Brain CT in the evaluation of breakthrough seizure and its yield., Retrospective review, over a period of two years, of medical records of 250 emergency room admissions of adult patients (ages 18-59) with known history of epilepsy and breakthrough seizure(s) while on antiepileptic medications.The patients with diagnosis of status epilepticus have been excluded., Of the 250 patients with epilepsy, emergent brain CT was performed in 130(52%) cases. The indication for emergent brain CT in addition to epilepsy were fall in 56 (43.1%), altered mental status in 24 (18.5%), lethargy in 19(14.6%), prolonged seizure in 18 (13.8%) , recurrent seizures in 11 (8.5%), and headaches in 2 patients (1.5%). Type of seizures included 87 (66.9%) patients with generalized tonic clonic, 33 (25.4%) complex partial with secondary generalization, 2 (1.5%) myoclonic, and 8 (6.1%) had different types of seizures. 98 (75.4%) patients had previous emergent brain CT(s) in our institution.
Of the 130 patients scanned 86 (66%) had a normal CT brain, evidence of an old stroke was evident in 8 (6%), small vessel disease in 9 (6.9%), post operative changes in 11 (8.4%), remote trauma in 5 (3.8%), previously diagnosed primary brain tumor in 4 (3%), and nonspecific findings in 7 (5.3%) patients. Emergent brain CT had minor or no impact on the therapy decision-making in any of the 130 patients., The cost of multiple brain CTs in patients with established diagnosis of epilepsy is not trivial, and the benefits have not been determined. The potential cost savings of a more rational approach, multiplied by the large number of patients present to ED with breakthrough seizure, could be huge. Development of criteria or evidence-based guidelines is needed to justify necessity and value of emergent brain CT in this patient group.,