This decision requires reasonable certainty of an epilepsy diagnosis the use of medication for a trial period in patients in whom the diagnosis is uncertain should be avoided. The initiation of long-term use of antiseizure medication is a major decision that is made by the patient and clinician. Morning Report Questions Q: Is antiseizure medication usually prescribed after a first seizure?Ī: Antiseizure medication is primarily indicated when the risk of further spontaneous seizures is judged to exceed 60% over the next 10 years. EEG is most informative in patients younger than 25 years of age because these patients are most likely to have subclinical interictal generalized activity that may confirm a generalized seizure tendency and that strongly predicts further seizures (70% positive predictive value). Interictal EEG that is performed in a patient who has had a first seizure is unlikely to capture another seizure, although the procedure may provoke psychogenic nonepileptic seizures. However, in most adults with a first seizure (especially a focal-onset seizure) or early epilepsy, detailed magnetic resonance imaging (MRI ideally 3-T MRI with <3-mm slice thickness on T2-weighted imaging and fluid-attenuated inversion recovery) is warranted to identify more subtle underlying causes such as hippocampal sclerosis, focal cortical dysplasia, or tumor that may be treated surgically. Computed tomography is useful and widely available. Q: What is the role of brain imaging and EEG after a first seizure?Ī: Urgent brain imaging is warranted in patients who present with a first epileptic seizure. These three factors allow clinicians to stratify low, medium, and high risks and help in guiding decisions about the initiation of antiseizure medication. Abnormal findings on electroencephalography (EEG), an abnormal neurologic status, and a second seizure all increase the probability of seizure recurrence. A: Epilepsy is diagnosed after two unprovoked seizures that occur more than 24 hours apart or after a single event that occurs in a person who is considered to have a high risk of recurrence (>60% risk in a 10-year period).
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |