Choosing Wisely:

Do not routinely perform brain imaging after acute seizure in patients with established epilepsy.

Rationale and Comments: Unnecessary brain imaging increases radiation exposure and medical cost without benefit, yet is often done after habitual seizures when the patient is at baseline. Brain imaging should be considered in certain clinical situations, such as when there is seizure-related trauma or post-ictal deficits on exam.
Sponsoring Organizations:
  • American Epilepsy Society
  • Sources:
  • AAN and ACEP guidelines
  • Disciplines:
  • Emergency medicine
  • Neurologic
  • References: • Stiell IG, Clement CM, Rowe BH, Schull MJ, Brison R, Cass D, Eisenhauer MA, McKnight RD, Bandiera G, Holroyd B, Lee JS, Dreyer J, Worthington JR, Reardon M, Greenberg G, Lesiuk H, MacPhail I, Wells GA. Comparison of the Canadian CT Head Rule and the New Orleans Criteria in patients with minor head injury. JAMA. 2005;294(12):1511-8.
    • Kavalci C, Aksel G, Salt O, Yilmaz MS, Demir A, Kavalci G, Akbuga Ozel B, Altinbilek E, Durdu T, Yel C, Durukan P, Isik B Comparison of the Canadian CT head rule and the new orleans criteria in patients with minor head injury. World J Emerg Surg. 2014.
    • Harden CL, Huff JS, Schwartz TH, Dubinsky RM, Zimmerman RD, Weinstein S, Foltin JC, Theodore WH; Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Reassessment: neuroimaging in the emergency patient presenting with seizure (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2007;69(18):1772-80.
    • American College of Emergency Physicians, Best Practices for Seizure Management in the Emergency Department. http://www.acepnow.com/article/best-practicesseizure-management-emergency-department/.

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