UMEM Educational Pearls

Category: Neurology

Title: What is the role of EEG for first-time seizures in the ED?

Keywords: seizure, electroencephalogram, EEG, epilepsy, antiepileptic (PubMed Search)

Posted: 6/14/2017 by WanTsu Wendy Chang, MD
Click here to contact WanTsu Wendy Chang, MD

Question

What is the role of EEG for first-time seizures in the ED?

Wyman and colleagues performed a prospective trial on the use of 30-minute routine electroencephalogram (EEG) in the ED after a first-time seizure or recurrent seizure without performance of a previous EEG to guide decision making in the initiation of antiepileptic medication.
A diagnosis of epilepsy based on EEG findings was made for 21% of patients (n=15/71).
Antiepileptic medication was initiated in 24% of patients (n=17/71), including 2 patients with abnormal but not epileptic EEG findings.

Take Home Point: A 30-minute routine EEG in the ED in adults with an uncomplicated first-time seizure revealed a substantial number of epilepsy diagnosis and can change ED management with immediate initiation of antiepileptic medication.

Answer

Background:

Seizures account for 1.2% of all ED visits with 24% representing first-time seizures.
The 2014 ACEP Clinical Policy on the evaluation and management of patients presenting to the ED with seizures recommend that antiepileptic medication not be initiated for uncomplicated first-time seizure.
Literature suggests that epileptiform activity on EEG predicts seizure recurrence while earlier EEG performance has a higher rate of finding epilepsy than delayed EEG performance.

References

Wyman AJ, Mayes BN, Hernandez-Nino J, Rozario N, Beverly SK, Asimos AW. The first-time seizure emergency department electroencephalogram study. Ann Emerg Med 2017;69(2):184-191.
Huff JS, Melnick ER, Tomaszewski CA, et al. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with seizures. Ann Emerg Med 2014;63(4):437-447.
Krumholz A, Wiebe S, Gronseth G, et al. 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. Neurology 2007;69(21):1996-2007.

Follow me on Twitter @EM_NCC