AAN 2025 | First-line investigations when a patient presents with an acute symptomatic seizure
Clio Rubinos, MD, University of North Carolina at Chapel Hill, Chapel Hill, NC, discusses the first-line investigations that should be carried out when a patient presents with an acute symptomatic seizure. She notes that a comprehensive investigation is necessary to identify the underlying cause of seizures in patients, including laboratory tests, drug screens, neuroimaging, and lumbar puncture. This approach should also consider infections and other potential causes of seizures. This interview took place at the 77th American Academy of Neurology (AAN) Annual Meeting in San Diego, CA.
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Transcript
It’s important to define that acute symptomatic seizures are not the same as epilepsy. Everybody that has epilepsy will have a seizure but not everybody that had a seizure has epilepsy. So when you have a patient that comes with a first seizure, you have to look for a diagnosis or look for an etiology that is provoking the seizures. As a matter of fact, acute symptomatic seizures are synonymous with provoked or situationally related seizures...
It’s important to define that acute symptomatic seizures are not the same as epilepsy. Everybody that has epilepsy will have a seizure but not everybody that had a seizure has epilepsy. So when you have a patient that comes with a first seizure, you have to look for a diagnosis or look for an etiology that is provoking the seizures. As a matter of fact, acute symptomatic seizures are synonymous with provoked or situationally related seizures. So the line of investigation has to be very wide and comprehensive. You have to do laboratory tests looking for all types of electrolyte abnormalities and also medication-related. If there’s any reason to look for medication, as in drug screens, as well. Bear in mind that posterior reversible encephalopathy syndrome can be associated with cannabinoids or THC consumption. And posterior reversible encephalopathy syndrome, which is PRES, one of the presentations can be a seizure. The other line is neuroimaging. I do CT scans and MRIs and recommend doing also MRI with contrast. Also, in some cases, you have to do a lumbar puncture in order to make sure there’s not an inflammatory condition that is underlying the acute symptomatic seizure. Please do not forget also infections in general. Patients have to look for blood cultures for urinary tract infections as well. It has to be quite comprehensive in terms of looking for an etiology that is causing or provoking these seizures.
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Disclosures
Consulting for Azurity and Marinus Pharmaceuticals, Speaker honoraria for Marinus Pharmaceuticals.
