The American Academy of Neurology has released guidelines addressing the best method of evaluating an apparent unprovoked first seizure in adults. EEG and brain imaging are recommended as routine diagnostic tests.

"Since even one seizure is a frightening, traumatic event with serious potential consequences, such as loss of driving privileges, limitations for employment and bodily injury, information about optimal, evidence-based approaches for treating people with a seizure is important," guideline author Dr. Allan Krumholz, from the University of Maryland Medical Center in Baltimore, said in a statement.

The guidelines were generated by analyzing data from relevant studies identified through a search of MEDLINE, CINAHL, and other sources.

According to the guidelines, which appear in the November 20th issue of Neurology, EEG and brain imaging with either CT or MRI should be ordered for all adults with an apparent unprovoked first seizure.

"Evidence shows an EEG revealed abnormalities indicating epilepsy in about one in four patients and was predictive of seizure recurrence," Dr. Krumholz said.

Roughly one in ten patients with an unprovoked first seizure have an abnormal imaging test, which may point to a seizure etiology. "A CT scan or MRI may lead to the diagnosis of disorders, such as a brain tumor, stroke, an infection, or other structural lesions and may help determine a person's risk for a second seizure," Dr. Krumholz noted.

As for laboratory tests, such as blood counts, blood glucose, and electrolyte panels, the results may be abnormal in up to 15 per cent of individuals, yet they are usually not the cause of the seizure. As such, the decision to order such tests should be made on the specific clinical circumstances, the report indicates. The same holds true for toxicology screening studies.

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