This is the current release of the guideline.

This guideline updates a previous version: Quality Standards Subcommittee of the American Academy of Neurology, American College of Emergency Physicians, American Association of Neurological Surgeons, and American Society of Neuroradiology. Practice parameter: neuroimaging in the emergency patient presenting with seizure: summary statement. Neurology 1996 Jul;47(1):288-91.

Definitions of the strength of the recommendations (A, B, C, U) and classification of the evidence (Class I through Class IV) are provided at the end of the "Major Recommendations" field.

Question 1: What is the likelihood that acute management, for the adult emergency patient presenting with a first seizure, is changed because of the results of a neuroimaging study?

Conclusion

An emergency computed tomography (CT) in adults with first seizure is possibly useful for acute management of the patient (Class III).

Recommendation

An emergency CT may be considered in adults with first seizure (Level C).

Question 2: What is the likelihood that acute management for the pediatric emergency patient presenting with a first seizure (not excluding complex febrile seizures) will change based on the results of a neuroimaging study?

Conclusion

An emergency CT in children with a first seizure is possibly useful for acute management of the patient (Class III).

Recommendation

An emergency CT may be considered in children with a first seizure (Level C).

Question 3: What is the likelihood that acute management for the emergency patient presenting with a chronic seizure will be changed by the results of a neuroimaging study?

Conclusion

The evidence is inadequate to support or refute the usefulness of emergency CT in persons with chronic seizures.

Recommendation

There is no recommendation regarding an emergency CT in persons with chronic seizures (Level U).

Question 4: What is the likelihood that the results of a neuroimaging study will lead to a change in acute management in special populations presenting with seizure (age <6 months, acquired immunodeficiency syndrome [AIDS], children with immediate posttraumatic seizures)?

Conclusion

An emergency CT in children less than 6 months of age and in patients with AIDS is possibly useful for acute management (Class III).

Recommendation

An emergency CT may be considered in children less than 6 months of age and in patients with AIDS (Level C).

Question 5: What factors are associated with an abnormal neuroimaging study for patients presenting with seizure in the emergency department?

Conclusion

The clinical and historical features of an abnormal neurologic examination, a predisposing history, or a focal seizure onset are probably predictive of an abnormal CT study for patients presenting with seizures in the emergency department (Class II).

Recommendation

An emergency CT should be considered in patients presenting with seizure in the emergency department who have an abnormal neurologic examination, predisposing history, or focal seizure onset (Level B).

Definitions:

AAN Classification of Evidence for Rating of Screening Articles

Class I: A statistical, population-based sample of patients studied at a uniform point in time (usually early) during the course of the condition. All patients undergo the intervention of interest. The outcome, if not objective, is determined in an evaluation that is masked to the patients' clinical presentation.

Class II: A statistical, non-referral-clinic-based sample of patients studied at a uniform point in time (usually early) during the course of the condition. Most patients undergo the intervention of interest. The outcome, if not objective, is determined in an evaluation that is masked to the patients' clinical presentations.

Class III: A sample of patients studied during the course of the condition. Some patients undergo the intervention of interest. The outcome, if not objective, is determined in an evaluation by someone other than the treating physician.

Class IV: Expert opinion, case reports, or any study not meeting criteria for Class I to III.

Classification of Recommendations

A = Established as effective, ineffective, or harmful (or established as useful/predictive or not useful/predictive) for the given condition in the specified population. (Level A rating requires at least two consistent Class I studies.*)

B = Probably effective, ineffective, or harmful (or probably useful/predictive or not useful/ predictive) for the given condition in the specified population. (Level B rating requires at least one Class I study or at least two consistent Class II studies.)

C = Possibly effective, ineffective, or harmful (or possibly useful/predictive or not useful/ predictive) for the given condition in the specified population. (Level C rating requires at least one Class II study or two consistent Class III studies.)

U = Data inadequate or conflicting; given current knowledge, treatment (test, predictor) is unproven. (Studies not meeting criteria for Class I–Class III).

*In exceptional cases, one convincing Class I study may suffice for an "A" recommendation if 1) all criteria are met, 2) the magnitude of effect is large (relative rate improved outcome >5 and the lower limit of the confidence interval is >2).

None provided

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations").

Not applicable: The guideline was not adapted from another source.

1996 (revised 2007 Oct)

American Academy of Neurology - Medical Specialty Society

American Academy of Neurology (AAN)

Therapeutics and Technology Assessment Subcommittee

Primary Authors: C.L. Harden, MD; J.S. Huff, MD, FACEP; T.H. Schwartz, MD; R.M. Dubinsky, MD, MPH; R.D. Zimmerman, MD; S. Weinstein, MD; J.C. Foltin, MD, FAAP; W.H. Theodore, MD

Therapeutics and Technology Assessment Subcommittee Members: Janis Miyasaki, MD, MEd, FAAN (Co-Chair); Yuen T. So, MD, PhD (Co-Chair); Carmel Armon, MD, MHS, FAAN (ex-officio); Vinay Chaudhry, MD, FAAN; Richard M. Dubinsky, MD, MPH, FAAN; Douglas S. Goodin, MD (ex-officio); Mark Hallett, MD, FAAN; Cynthia L. Harden, MD (facilitator); Kenneth J. Mack, MD, PhD; Fenwick T. Nichols III, MD; Paul W. O'Connor, MD; Michael A. Sloan, MD, MS, FAAN; James C. Stevens, MD, FAAN

This is the current release of the guideline.

This guideline updates a previous version: Quality Standards Subcommittee of the American Academy of Neurology, American College of Emergency Physicians, American Association of Neurological Surgeons, and American Society of Neuroradiology. Practice parameter: neuroimaging in the emergency patient presenting with seizure: summary statement. Neurology 1996 Jul;47(1):288-91.

None available

This NGC summary was completed by ECRI on December 1, 1998. The information was verified by the guideline developer as of February 12, 1999. This NGC summary was updated by ECRI Institute on December 22, 2008. The updated information was verified by the guideline developer on January 23, 2009.

This NGC summary is based on the original guideline, which is copyrighted by the American Academy of Neurology.