Diagnostic Evaluation in New Onset Seizure Patients.
Abstract number :
2.209
Submission category :
Year :
2001
Submission ID :
1685
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
M.T. Acosta, MD, Neurology, Children[ssquote]s National Medical Center, Washington, DC; S.C. Reigle, BS, Neurology, Children[ssquote]s National Medical Center, Washington, DC; M.J. Kolodgie, CPNP, Neurology, Children[ssquote]s National Medical Center, Was
RATIONALE: The utility of diagnostic testing in newly recognized seizures in children is not firmly established
METHODS: We reviewed diagnostic evaluation results from a data base maintained prospectively in children with newly recognized seizures (excluding neonatal and febrile convulsions) using a critical care pathway implemented to achieve standardized care. Data were gathered over 6 months at a Children[ssquote]s hospital where all new onset seizure patients are evaluated by a child neurologist.
RESULTS: 73 patients were evaluated: 67.5% male, 32.5% female; and aged 2 months to 16 years. 57% had complex partial seizures, 33% generalized tonic-clonic, 2.5% infantile spasms. 7.5 % had status epilepticus. 24% had a history of prior neurologic injury; 25% had an abnormal neurologic exam at time of evaluation. EEG, performed in 98.8% within 36 hours of the presentation, was normal in 53%, showed focal abnormalities in 26% (spikes, 18.5%; slowing, 6.2%; PLEDS 1.3%) and generalized abnormalities in 14.8% (spikes, 2.5%; slow, 12.3%); 2 children (2.6%) had hypsarrhythmia. All children had brain CT: 81% were normal, 18% (13/73) CT revealed longstanding, static findings (old ischemic insult, dysplasia, intracranial calcification). Only one CT showed a subacute lesion requiring intervention (occipital tumor, normal exam, focal seizure). 22 patients (30%) had generalized seizures: Only 20% had focal CT scan or EEG. CSF was performed in 24.6%; 7/18 had lymphocytic pleocytosis with negative cultures, but 1 had presumed partially treated bacterial meningitis. CBCs were invariably unremarkable. Electrolytes (including Ca++), done in 91%, were unremarkable save for 2 with symptomatic hypocalcemia. All urine toxicology screens were normal (performed in 62%).
CONCLUSIONS: An expedited new onset seizure evaluation showed normal studies in the majority of patients; CT altered care in one child, and provided helpful etiology in 6 others (7.5%) with partial seizures. Other screening labs had low yield, but did, uncommonly, detect treatable abnormalities. The clinical utility of early abnormal EEG is being determined by follow-up studies.