Daniel J. Pallin, MD, MPH reviewing Wyman AJ et al. Ann Emerg Med 2016 Oct 10.

A quarter of patients having electroencephalograms in the ED were diagnosed with epilepsy and started on anticonvulsants.

The current standard of care for first-time unprovoked seizure in patients presenting to the emergency department (ED) is to obtain a head computed tomography scan or arrange for one to be performed within a few days, obtain electrolyte levels, and discharge the patient without a prescription if no cause is found. The patient is referred to a neurologist, who typically will arrange an electroencephalogram (EEG) and possibly further imaging. For patients presenting with a non–first-time unprovoked seizure who have not yet had an EEG, the standard of care is not clear, and many emergency physicians would consider immediate neurological consultation or empiric treatment with an anticonvulsant.

These investigators report results from a prospective study in which both groups —patients with first-time unprovoked seizure and those with previous seizure who had not had an EEG — received an EEG in the ED, with immediate remote interpretation by a neurologist. EEGs were successfully obtained for 71 of 73 adult patients enrolled. Of these, 24% were diagnosed with epilepsy and started on anticonvulsants. The weighted kappa score for agreement between the interpreting neurologist and a second neurologist was 0.69, indicating substantial but not excellent agreement.

CITATION(S):

Wyman AJ et al. The first-time seizure emergency department electroencephalogram study. Ann Emerg Med 2016 Oct 10; [e-pub].

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