Emergency Brain Scans Rarely Help After Breakthrough Seizures

What was studied

This study looked at how useful emergent non-contrast head CT scans were for adults with known epilepsy who came to the emergency department because of breakthrough seizures. The researchers reviewed electronic medical records from 2019 to 2023. After applying inclusion and exclusion criteria, they included 121 emergency encounters involving adults with confirmed epilepsy, presenting with breakthrough seizures, who received an emergent head CT scan.

What they found

Most CT scans did not show anything new. Of the 121 scans, 92 were normal. Other findings included prior stroke, postoperative changes, small-vessel disease, remote trauma, and ambiguous findings. The study reports that none of the CT findings represented new pathology compared with prior imaging, and none altered acute clinical management. In this group, emergent CT had a low diagnostic yield.

Limits of the evidence

This was a retrospective chart review, so the researchers looked back at existing records rather than using a planned prospective study. The findings describe this study group and do not show that CT is never useful in breakthrough seizures. The study only included adults with known epilepsy who underwent emergent CT in the emergency department, so the results may not apply to children, people who were not imaged, or other clinical settings. The abstract also does not describe whether some subgroups might still benefit from imaging.

For families and caregivers

For families, this study suggests that an emergency head CT often did not add new information for adults with known epilepsy who came to the emergency department with a breakthrough seizure. The abstract also notes concerns about cost and radiation exposure. Still, this does not mean CT scans are unnecessary in every case, and the study calls for better evidence-based imaging guidelines.

What to watch next

Future studies could help develop evidence-based guidelines for when emergency CT imaging is most useful in adults with known epilepsy who present with breakthrough seizures.

Terms in this summary

breakthrough seizure

A seizure that happens in a person who already has epilepsy.

CT scan

A test that uses X-rays to make pictures of the inside of the body, including the brain.

non-contrast CT

A CT scan done without injected dye.

diagnostic yield

How often a test finds useful information.

acute clinical management

The immediate treatment and decisions made during an emergency visit.

retrospective review

A study that looks back at medical records from the past.