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American Journal of Public Health Research. 2015, 3(5A), 148-151
DOI: 10.12691/ajphr-3-5A-32
Open AccessResearch Article

Computed Tomography of the Brain in Adults with First Seizure

Subita Lalchan1, Manish Kiran Shrestha2, Bishnu Jwarchan3, Prakash Sharma1, Subash K.C.1, Merina Gyawali1 and P.K. Tiwari1

1Department of Radiodiagnosis and Imaging, Manipal Teaching Hospital, Pokhara, Nepal

2Department of Radiodiagnosis and Imaging, Gandaki Medical College, Pokhara, Nepal

3Department of Medicine, Manipal Teaching Hospital, Pokhara, Nepal

Pub. Date: October 28, 2015
(This article belongs to the Special Issue Health Scenario 2015; Millennium Development Goals)

Cite this paper:
Subita Lalchan, Manish Kiran Shrestha, Bishnu Jwarchan, Prakash Sharma, Subash K.C., Merina Gyawali and P.K. Tiwari. Computed Tomography of the Brain in Adults with First Seizure. American Journal of Public Health Research. 2015; 3(5A):148-151. doi: 10.12691/ajphr-3-5A-32


Seizure is frequently encountered in emergency department. Whether a neuroimaging should be done in every patient after a first seizure is controversial. Some study recommend imaging of brain usually with CT scan as a part of diagnostic investigation for every adult after a first seizure, while some prefer to reserve for patients with increased risk of intracranial pathology. This study has been undertaken to evaluate the role of routine CT scan of the brain in adult patients presenting with first episode of seizure in western development region of Nepal thus helping in management. This study also highlights the common CT abnormalities in patients presenting with seizure in western region of Nepal. This study was conducted in Radiology department of Manipal Teaching Hospital from August 2014 to June 2015. Patients of age > 16 years referred to our department for CT scan of head with history of first episode of seizure were included for study. Total 445 patients were included in study. Patients with history of previous seizure, head injury, electrolyte abnormalities, alcohol/drug intoxication were excluded from study. The mean age in our series was 33.75 years. There were 57.8 % males and 42.2 % were female. Focal seizure was seen in 54.8 % of patients whereas generalized seizure was seen in 45.2 % of patients. Abnormal CT scan was found in 60.7% of patients with first episode of seizure. CT scan was abnormal in 89.3 % of patients with focal seizure. Only 25.9 % of patients with generalized seizure had abnormal CT scan. Neurocysticercosis was the commonest abnormality detected on CT scan which was found in 36.85 % of patients. NCC was the commonest abnormality detected in younger population (46.1%) while infarct was common in older patients found in 21.3% of patients.

CT scan first seizure neurocysticercosis

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[1]  Commission on Epidemiology and Prognosis, International League Against Epilepsy. Guidelines for epidemiological studies on epilepsy. Epilepsia 1993; 34(4):592-6.
[2]  American College of Emergency Physicians (ACEP). Clinical Policy: Critical issues in the evaluation of adult patients presenting to an emergency department with seizures. Ann Emerg Med 2004; 43: 605-25.
[3]  Fisher RS, van Emde Boas W, Blume W, Elger C, Genton P, Lee P, Engel J Jr. Epileptic seizures and epilepsy: Definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). Epilepsia 2005;46: 470-2.
[4]  Russo LS, Goldstein KH. The diagnostic assessment of single seizures. Is cranial computed tomography necessary? Arch Neurol 1983;40:744-6.
[5]  Jallon P, Loiseau P, Loiseau J. Newly diagnosed unprovoked epileptic seizures: presentation at diagnosis in CAROLE study. Epilepsia 2001;42(4):464-75.
[6]  Sempere AP, Villaverde FJ, Martinez-Menendez B, Cabeza C, Pena P, Tejerina JA. First seizure in adults: a prospective study from the emergency department. Acta Neurol Scand 1992; 86(2): 134-8.
[7]  Hopkins A, Garman A, Clarke C. The first seizure in adult life. Value of clinical features, electroencephalography, and computerised tomographic scanning in prediction of seizure recurrence. Lancet 1988;1:721-6.
[8]  Ramirez-Lassepas M, Cipolle RJ, Morillo LR, Gumnit RJ. Value of computed tomographic scan in the evaluation of adult patients after their first seizure. Ann Neurol 1984;15(6):536-43.
[9]  Young AC, Costanzi JB, Mohr PD, Forbes WS. Is routine computerised axial tomography in epilepsy worthwhile? Lancet 1982;1446-7.
[10]  Rosenthal RH, Heim ML, Waeckerle JF. First time major motor seizures in an emergency department. Ann Emerg Med 1980; 9: 242-5.
[11]  Mc Fadyen MB. First seizures, the epilepsies and other paroxysmal disorders prospective audit of a first seizure clinic. Scott Med J 2004;49(4): 126-30.
[12]  Grunewald RA, Chroni E, Panayiotopoulos CP. Delayed diagnosis of juvenile myoclonic epilepsy. J Neurol Neurosurg Psychiatry 1992; 55: 497-9.
[13]  Krumholz A. Nonepileptic seizures: Diagnosis and management. Neurology 1999; S76-83.
[14]  Begley CE, Famulari M, Annegers JF, Lairson DR, Reynolds TF, Coan S, Dubinsky S, Newmark ME, Leibson C, So EL, Rocca WA. The cost of epilepsy in the United States: an estimate from population- based and survey data. Epilepsia 2000; 41: 342-52.
[15]  Rogel-Ortiz FJ. Epilepsy in the adult. A prospective study of 100 cases. Gac Med Mex 1999;135(4):363-8.
[16]  Oscar H. Del Brutto. CT findings in neurologically normal adults with a single generalized seizure .Journal of Epilepsy 1994; 7(1): 38-40.
[17]  Rajbhandari KC. Clinical profile of epilepsy in Nepal. In: Yagi K, ed. Epilepsy care in Asia. National Epilepsy Center, Shizuoka Medical Institute of Neurological Disorder, 2003:28-9.
[18]  Tardy B, Lafond P, Convers P, Page Y, Zeni F, Viallon A, Laurent B, Barral FG, Bertrand JC. Adult first generalized seizure: Etiology, Biological tests, EEG, CT scan, in an ED. Am J Emerg Med 1995; 13(1): 1-5.
[19]  Wood LP. Parisi M. Finch IJ. Value of contract enhanced CT scanning in the non-trauma emergency room patient. Neuroradiology 1990; 32: 261-4.