American Epilepsy Society

View all recommendations from this society

August 15, 2018

Do not routinely perform brain imaging after acute seizure in patients with established epilepsy.

Unnecessary brain imaging increases radiation exposure and medical cost without benefit, yet is often done after habitual seizures when the patient is at baseline. Brain imaging should be considered in certain clinical situations, such as when there is seizure-related trauma or post-ictal deficits on exam.


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American Epilepsy Society (AES) and the AES Practice Management Committee (PMC) worked together to prepare the five statements from 2016–2018. The PMC met in person in December 2016 to use the ABIM Foundation’s Operating Principles for Clinician Organizations’ Participation in the Choosing Wisely Campaign to discuss and propose topics for further development. The PMC ultimately proposed seven potential topics for further discussion and tasked a subgroup of seven committee members to draft seven Choosing Wisely statements. Once drafted, each item was voted upon by the PMC subgroup for further inclusion.

Voters were provided additional instructions to select the item for further inclusion if it had (1) clinical relevance, (2) clinical validity, and (3) clarity of concept. Voting occurred electronically. Two items were eliminated, and five items were selected for further and final development. The final five items were completed by individual PMC subgroup members. The entire PMC subgroup then reviewed each statement for final editing and final vote for submission to Choosing Wisely, based on the same criteria mentioned above. Items receiving at least six “yes” votes (among seven voters) were advanced and reformatted and edited by the Practice Committee Chair, Dr. Gabriel Martz, to adhere to the ABIM Foundation’s Choosing Wisely submission specifications. The PMC subgroup then re-evaluated items to ensure consistency of message after re-formatting, and again voted on each item individually for or against advancement for review and consideration of approval by the AES Council on Clinical Activities, AES Executive Committee, AES Board of Directors. The AES Board of Directors provided feedback and final approval of the five statements for submission to the ABIM Foundation for consideration of inclusion in the Choosing Wisely Campaign. The PMC will review the statements on an annual basis to ensure adherence to the Foundation’s Operating Principles and that the statements continue to be supported by generally accepted evidence and are applicable to current clinical practice.

Sources

Stiell IG, Clement CM, Rowe BH, Schull MJ, Brison R, Cass D, Eisenhauer MA, McKnight RD, Bandiera G, Holroyd B, Lee JS, Dreyer J, Worthington JR, Reardon M, Greenberg G, Lesiuk H, MacPhail I, Wells GA. Comparison of the Canadian CT Head Rule and the New Orleans Criteria in patients with minor head injury. JAMA. 2005 Sep 28;294 (12):1511-8.

Kavalci C, Aksel G, Salt O, Yilmaz MS, Demir A, Kavalci G, Akbuga Ozel B, Altinbilek E, Durdu T, Yel C, Durukan P, Isik B Comparison of the Canadian CT head rule and the new orleans criteria in patients with minor head injury. World J Emerg Surg. 2014.

Harden CL, Huff JS, Schwartz TH, Dubinsky RM, Zimmerman RD, Weinstein S, Foltin JC, Theodore WH; Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Reassessment: neuroimaging in the emergency patient presenting with seizure (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2007 Oct 30;69(18):1772-80.

American College of Emergency Physicians, Best Practices for Seizure Management in the Emergency Department. http://www.acepnow.com/article/best-practicesseizure-management-emergency-department/