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Original Research

Open Access

Computed tomography for patients with drug- or substance-induced seizures: a retrospective analysis

  • Shao-Feng Liao1,†
  • Ming-Nan Huang2,†
  • Cheng-Hsien Hsieh2
  • Chun-Kuei Chen3
  • Po-Cheng Chen1
  • Chen-June Seak3,4,5
  • Hsien-Yi Chen3,4

1Department of Emergency Medicine, Chang Gung Memorial Hospital, 20401 Keelung, Taiwan

2Department of Emergency Medicine, En Chu Kong Hospital, 23702 New Taipei City, Taiwan

3Department of Emergency Medicine, Linkou Chang Gung Memorial Hospital, 333 Taoyuan, Taiwan

4School of Medicine, Chang Gung University, 333 Taoyuan, Taiwan

5Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, 236 New Taipei City, Taiwan

DOI: 10.22514/sv.2021.117 Vol.18,Issue 1,January 2022 pp.102-107

Submitted: 05 May 2021 Accepted: 01 June 2021

Published: 08 January 2022

*Corresponding Author(s): Hsien-Yi Chen E-mail: hshychen@gmail.com

† These authors contributed equally.

Abstract

Introduction: Seizure is a common poisoning-related neurological presentation in the emergency department (ED). Although brain computed tomography (CT) is recommended in patients presenting with first seizures, its role in patients with a suspected drug/substance-induced seizure (DSS) remains inconclusive. This study evaluated whether brain CT examination changes the management and outcome of DSS patients.

Methods: We retrospectively reviewed adult patients presenting to the ED with a DSS in Linkou and Taipei Chang Gung Memorial Hospital, Taiwan, from January 2008 to December 2015. We also analyzed whether the brain CT examinations found meaningful acute abnormalities and their impact on subsequent management. We compared the differences between DSS patients undergoing CT scans or not to identify factors that affect the decision to arrange brain CT.

Results: The study enrolled 97 patients (69 males). The most common cause of DSS was alcohol withdrawal (58.76%), followed by carbon monoxide (12.37%) and stimulants (8.25%). Eight (8.25%) patients developed status epilepticus, 15 (15.46%) were intubated, and 37 (37.76%) were admitted, including 12 (12.26%) to the intensive care unit. Brain CT was performed in 64 (66.0%) patients and four had abnormal reports that led to further imaging studies. The abnormal findings ultimately had no significant clinical impact. Patients who underwent CT scans had a worse Glasgow Coma Scale score (p = 0.024) and higher rate of status epilepticus (p = 0.031).

Conclusion: Brain CT does not provide substantial information for the care of DSS patients. Multi-center prospective studies are needed to obtain stronger evidence.


Keywords

Seizure; Poisoning; Computed tomography; Anticonvulsants; Alcohol withdrawal


Cite and Share

Shao-Feng Liao,Ming-Nan Huang,Cheng-Hsien Hsieh,Chun-Kuei Chen,Po-Cheng Chen,Chen-June Seak,Hsien-Yi Chen. Computed tomography for patients with drug- or substance-induced seizures: a retrospective analysis. Signa Vitae. 2022. 18(1);102-107.

References

[1] World Health Organization 2016. International Programme on Chemical Safety: Poisoning Prevention and Management. Available at: https: //www.who.int/ipcs/poisons/en/ (Accessed: 17 January 2021).

[2] Patel MM, Tsutaoka BT, Banerji S, Blanc PD, Olson KR. ED utilization of computed tomography in a poisoned population. American Journal of Emergency Medicine. 2002; 20: 212–217.

[3] Pesola GR, Avasarala J. Bupropion seizure proportion among new-onset generalized seizures and drug related seizures presenting to an emergency department. Journal of Emergency Medicine. 2002; 22: 235–239.

[4] Lowenstein DH, Alldredge BK. Status epilepticus at an urban public hospital in the 1980s. Neurology. 1993; 43: 483–483.

[5] Chen H, Albertson TE, Olson KR. Treatment of drug-induced seizures. British Journal of Clinical Pharmacology. 2016; 81: 412–419.

[6] Sanei Taheri M, Noori M, Nahvi V, Moharamzad Y. Features of Neurotoxicity on Brain CT of Acutely Intoxicated Unconscious Patients. Open Neuroimaging Journal. 2010; 4: 157–163.

[7] Taheri MS, Noori M, Shakiba M, Jalali AH. Brain CT-Scan Findings in Unconscious Patients after Poisoning. International Journal of Biomedical Science. 2011; 7: 1–5.

[8] Tay EM, Preisz P, Day RO. Role and impact of brain computed tomography in the management of drug overdoses and guideline recommendations. Emergency Medicine Australasia. 2019; 31: 1053–1058.

[9] Krumholz A, Wiebe S, Gronseth G, Shinnar S, Levisohn P, Ting T, et al. Practice Parameter: evaluating an apparent unprovoked first seizure in adults (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2007; 69: 1996–2007.

[10] Fountain NB, Van Ness PC, Swain-Eng R, Tonn S, Bever CT. Quality improvement in neurology: AAN epilepsy quality measures: Report of the Quality Measurement and Reporting Subcommittee of the American Academy of Neurology. Neurology. 2011; 76: 94–99.

[11] ACEP Clinical Policies Committee; Clinical Policies Subcommittee on Seizures. Clinical policy: Critical issues in the evaluation and management of adult patients presenting to the emergency department with seizures. Annals of Emergency Medicine. 2004; 43: 605–625.

[12] Practice parameter: neuroimaging in the emergency patient presenting with seizure—summary statement. Quality Standards Subcommittee of the American Academy of Neurology in cooperation with American College of Emergency Physicians, American Association of Neurological Surgeons, and American Society of Neuroradiology. Neurology. 1996; 47: 288–291.

[13] Persson HE, Sjöberg GK, Haines JA, Pronczuk de Garbino J. Poisoning severity score. Grading of acute poisoning. Journal of Toxicology Clinical Toxicology. 1998; 36: 205–213.

[14] Mower WR, Biros MH, Talan DA, Moran GJ, Ong S. Selective tomographic imaging of patients with new-onset seizure disorders. Academic Emergency Medicine. 2002; 9: 43–47.

[15] Schoenenberger RA, Heim SM. Indication for computed tomography of the brain in patients with first uncomplicated generalised seizure. British Medical Journal. 1994; 309: 986–989.

[16] Pathan SA, Abosalah S, Nadeem S, Ali A, Hameed AA, Marathe M,

et al. Computed tomography abnormalities and epidemiology of adult patients presenting with first seizure to the emergency department in Qatar. Academic Emergency Medicine. 2014; 21: 1264–1268.

[17] Sempere AP, Villaverde FJ, Martinez-Menéndez B, Cabeza C, Peña P, Tejerina JA. First seizure in adults: a prospective study from the emergency department. Acta Neurologica Scandinavica. 1992; 86: 134–138.

[18] Tardy B, Lafond P, Convers P, Page Y, Zeni F, Viallon A, et al. Adult first generalized seizure: etiology, biological tests, EEG, CT scan, in an ED. American Journal of Emergency Medicine. 1995; 13: 1–5.

[19] Kotisaari K, Virtanen P, Forss N, Strbian D, Scheperjans F. Emergency computed tomography in patients with first seizure. Seizure. 2017; 48: 89–93.

[20] Earnest MP, Feldman H, Marx JA, Harris JA, Biletch M, Sullivan LP. Intracranial lesions shown by CT scans in 259 cases of first alcohol-related seizures. Neurology. 1988; 38: 1561–1565.

[21] Feussner JR, Linfors EW, Blessing CL, Starmer CF. Computed tomography brain scanning in alcohol withdrawal seizures. Value of the neurologic examination. Annals of Internal Medicine. 1981; 94: 519–522.

[22] Freedland ES, McMicken DB. Alcohol-related seizures, Part i: Patho-physiology, differential diagnosis, and evaluation. Journal of Emergency Medicine. 1993; 11: 463–473.

[23] Prasad M, Krishnan PR, Sequeira R, Al-Roomi K. Anticonvulsant therapy for status epilepticus. Cochrane Database of Systematic Reviews. 2014; 2014: CD003723.

[24] Schmidt KJ, Doshi MR, Holzhausen JM, Natavio A, Cadiz M, Winegardner JE. Treatment of Severe Alcohol Withdrawal. Annals of Pharmacotherapy. 2016; 50: 389–401.

[25] Amato L, Minozzi S, Vecchi S, Davoli M. Benzodiazepines for alcohol withdrawal. Cochrane Database of Systematic Reviews. 2010; CD005063.


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