Guidelines on assessing seizure patients unveiled

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WASHINGTON, Nov 20 (Reuters) Doctors should perform brain wave tests and brain scans when evaluating adults who suffer a first seizure to try to detect brain abnormalities and predict likely recurrences, experts said.

The American Academy of Neurology and American Epilepsy Society unveiled their first guidelines on how doctors should assess an adult after an apparent first seizure.

The guidelines, published in the journal Neurology, endorsed two important tools for routine use in such cases -- an electroencephalogram, or EEG, and CT or MRI brain scans. The experts who crafted the recommendations reviewed existing research on various tools currently used by doctors.

The guidelindes did not endorse other commonly used tools, such as blood tests, for routine use but said they could be employed on a case-by-case basis.

A seizure is caused by excessive electrical activity in the brain. Many seizures involve loss of consciousness, with the body twitching or shaking. People who have more than one seizure are considered to have epilepsy.

The issue was highlighted in July when US Chief Justice John Roberts suffered a seizure at his summer home in Maine, his second known seizure. The previous one was in 1993, US officials said at the time.

Each year, about 150,000 US adults experience a first seizure, and 40 to 50 per cent of them go on to experience another seizure.

''It's a common problem and it's a frightening problem,'' Dr Allan Krumholz, a neurologist at the University of Maryland Medical Center who led the effort, said in a phone interview.

''After a seizure, there are a lot of limitations on you. You may not be able to work. You may not be able to drive. It's a psychologically traumatic thing, particularly since one never knows when or if another seizure will happen,'' Krumholz added.

An EEG is a brain wave test that looks for abnormal electrical activity in the brain. Krumholz said it finds abnormalities in about a quarter of these patients and is also valuable in predicting seizure recurrence.

The guidelines also recommend adult first-time seizure patients get a brain scan looking at brain structure. In about 10 percent of such cases, the scans detect significant abnormalities. Scans can help pinpoint underlying causes such as brain tumors, strokes or infection.

Previously released guidelines on evaluating children who have seizures stressed the routine use of EEGs, Krumholz said.

Epilepsy is incurable. Medicines can control seizures in most patients, although they sometimes cause severe side effects. The guidelines did not address the use of medication.


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