Imaging Evaluation of the Adult Presenting With New-Onset Seizure

Background New-onset seizure (NOS) is defined as the first seizure within a 24-h period ever experienced by the patient. A first-ever seizure can be the first manifestation of epilepsy. Or it may be a symptom of a brain tumor, a systemic disorder, an infection, or a syndrome that deserves special attention and treatment. This study aims to identify the etiology of NOS among different age and sex groups of adult Egyptian patients. A hundred and twenty adult Egyptian patients (> 18 years) presented with acute NOS were enrolled in a hospital-based cross-sectional observational study from the emergency room and neurology outpatient clinics of our hospitals within a time period of 6 months from March till September 2018. All patients were subjected to neurological examination, laboratory, neuroimaging, and electroencephalogram investigations. Results Among 120 adult patients presented with NOS, males were prevalent (63%). Older adults (age group > 55 years) were the most prevalent cohort (60%). Cerebrovascular diseases (CVDs) were the most common identified etiology of NOS (44.17%), followed by idiopathic epilepsy syndrome (18.33%), symptomatic mainly “metabolic” (11%), brain tumors (9.17%), post-traumatic epilepsy (6.67 %), encephalitis (5.83%), and cryptogenic (5%). Idiopathic epilepsy syndrome was the most common etiology (55.56%) of new-onset seizures among the young adult age group (< 36 years), while CVDs were the most common etiology (65.28%) among older adults (> 55 years). Also, CVDs were the most common etiology among males (43.4%) as well as females (45.4%). However, male predominance was the highest among post-traumatic seizures (87.5%). And female predominance was the highest among brain tumors identified etiology of NOS (54.5%). Conclusion NOS among adults are prevalent in elder males. CVDs are the most commonly identified etiology of adult NOS across males and females. Idiopathic epilepsy syndromes are the predominant etiology among younger adults.

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“…Two studies revealed that CT failed to detect the abnormality in MRI-positive cases 26% and 57% of the time [17].…”

Section: Discussionmentioning

confidence: 99%

“…In the current study, neuroimaging abnormal findings were detected among (75%) of the participants. A recent study recruited 416 adult patients with NOS, detected neuroimaging abnormalities among 53% of its cohort [17].…”

Section: Discussionmentioning

confidence: 99%

Etiological profile of new-onset seizures among adult Egyptians

Mahmoud

Awad

Mohamed³

et al. 2021

Egypt J Neurol Psychiatry Neurosurg

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“…Not surprisingly, the neuroimaging yield is higher in the presence of a focal neurological deficit on physical examination [25][26][27]. However, significant intracranial abnormalities are found in 10-22% of patients with a first seizure and normal neurological examination [27]. Recommendations vary on whether neuroimaging should be performed in the ED.…”

Section: Reliability Of Testimonymentioning

confidence: 99%

“…When head CT is non-contributory, MRI is indicated. The sensitivity of MRI is much higher than that of CT for a variety of pathologies causing epilepsy, including infarcts, tumours, mesial temporal sclerosis, and cortical malformations, and is the modality of choice in the outpatient setting, where it is fundamental for the diagnostic assessment of a patient with a first epileptic seizure [15,27,31]. In one study, 23% of patients who underwent MRI at the time or soon after a first epileptic seizure had a potentially epileptogenic lesion [62].…”

Section: Immediately In the Edmentioning

confidence: 99%

“…In the acute setting, unenhanced head CT is an appropriate initial neuroimaging study [15, 25, 28]. Some guidelines recommend immediate head CT in all adult patients presenting with a first seizure [27], based on data suggesting that emergency head CT leads to an acute change in management in 9‐17% of patients [25, 26]. Other recommendations allow deferred neuroimaging [26], particularly in patients who have returned to normal baseline when reliable follow‐up is available [24].…”

Section: If the Tne Was An Epileptic Seizure Was It An Acute Symptomatic Seizure (Ass) Or An Unprovoked Epileptic Seizure?mentioning

confidence: 99%

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Management of a first unprovoked epileptic seizure in adolescence and adulthood

Franco

Parreira²,

Bentes

et al. 2021

Epileptic Disorders

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An epileptic seizure is one of the causes of so-called "transient neurological events" (TNEs). The differential diagnosis of a TNE relies mainly on history and physical examination. Laboratory markers are less frequently useful. After diagnosing an epileptic seizure, a distinction must be made between an acute symptomatic and an unprovoked seizure, since they have different treatments and prognosis. History, physical examination and other examinations (laboratory and imaging) are paramount in this distinction. After the diagnosis of a first unprovoked seizure, an EEG should be requested which may aid in establishing the diagnosis, evaluating the recurrence risk or ascertaining the self-limited nature of the seizure. 3T-MRI with an epilepsy protocol can be considered when CT has not clarified the aetiology. The decision to treat should be discussed with the patient/relatives, taking into account the risk of recurrence, the clinical characteristics (aetiology, seizure type, age, job, epileptic seizure schedule, comorbidities and polymedication), probability of AED side effects, and stigmatization. Nowadays, the chosen regimen is usually monotherapy with a second-generation AED that better suits the patient's characteristics, comorbidities and concurrent medication. Counselling should include first aid, precipitating factors, sport and physical exercise in order to avoid possible driving restrictions, the need for therapy compliance, and risk of recurrence and SUDEP.

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Expertise and Competence

Chrysikopoulos

2019

Errors in Imaging

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Imaging Evaluation of the Adult Presenting With New-Onset Seizure

Cited by 18 publications

References 74 publications

Etiological profile of new-onset seizures among adult Egyptians

Etiological profile of new-onset seizures among adult Egyptians

Management of a first unprovoked epileptic seizure in adolescence and adulthood

Expertise and Competence

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