Posttraumatic Epilepsy Workup

  • Author: Ewa Posner, MD, MRCP; Chief Editor: Selim R Benbadis, MD   more...
 
Updated: Jun 7, 2011
 

Approach Considerations

In a patient who is still hospitalized after a recent head injury, investigation of a seizure should focus on determining whether an intracranial bleed or a change in clinical condition (eg, hyponatremia) has caused the seizure. If the patient is otherwise in stable condition, the serum electrolytes are within the normal range, and the neurologic findings are the same as those before the seizure, further laboratory studies are not needed.

In a patient presenting some time after the injury, the usual investigations that are applicable for the first epileptic seizure should be performed. See First Pediatric Seizure and First Adult Seizure for more discussion of these topics.

Serum prolactin measurement can be measured after the seizure to help differentiate pseudoseizures from seizures. However, this is still more of a research point rather than a well-recognized standard test.

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Neuroimaging

Brain magnetic resonance imaging (MRI) is the study of choice, and many clinicians perform it in all patients with posttraumatic seizures. If MRI is not readily available, head computed tomography (CT) can be substituted. CT is less sensitive than MRI, but should be able to depict all pathology (eg, intracranial bleed) that needs urgent intervention.

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Electroencephalography

Electroencephalography (EEG) is useful mainly for localizing seizure foci and for prognosticating their severity. EEG is not helpful in predicting the likelihood of posttraumatic seizure in a given patient. However, it may be helpful in predicting relapse before anticonvulsant medication is withdrawn.

EEG-video monitoring may be helpful in differentiating between pseudoseizures and posttraumatic epilepsy seizures.

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Contributor Information and Disclosures
Author

Ewa Posner, MD, MRCP  Consultant Pediatrician, Department of Pediatrics, University Hospital of North Durham, UK

Ewa Posner, MD, MRCP is a member of the following medical societies: European Paediatric Neurology Society and Royal College of Paediatrics and Child Health

Disclosure: Nothing to disclose.

Coauthor(s)

Nicholas Lorenzo, MD  Chief Editor, eMedicine Neurology; Consulting Staff, Neurology Specialists and Consultants

Nicholas Lorenzo, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, and American College of Physician Executives

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Jose E Cavazos, MD, PhD, FAAN  Associate Professor with Tenure, Departments of Neurology, Pharmacology, and Physiology, Program Director of the Clinical Neurophysiology Fellowship, University of Texas School of Medicine at San Antonio; Co-Director, South Texas Comprehensive Epilepsy Center, University Hospital System; Director of the San Antonio Veterans Affairs Epilepsy Center of Excellence and Neurodiagnostic Centers, Audie L Murphy Veterans Affairs Medical Center

Jose E Cavazos, MD, PhD, FAAN is a member of the following medical societies: American Academy of Neurology, American Clinical Neurophysiology Society, American Epilepsy Society, and American Neurological Association

Disclosure: GXC Global, Inc. Intellectual property rights Medical Director - company is to develop a seizure detecting device. No conflict with any of the eMedicine articles that I wrote or edited.

Chief Editor

Selim R Benbadis, MD  Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association

Disclosure: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Honoraria Speaking, consulting

References

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