Should a lumbar puncture be routinely performed in an adult presenting with an apparent unprovoked first seizure?
Conclusion Data from two Class III studies revealed significant abnormalities in up to 8% of a mixed group of patients presenting to an emergency department with a first seizure. However, the studies selectively performed lumbar punctures based on clinical findings and included patients who did not meet our inclusion criteria, such as those with acute symptomatic causes for their seizures or who had not returned to their normal baseline function. Recommendation In the adult initially presenting with an apparent unprovoked first seizure, lumbar puncture may be helpful in specific clinical circumstances, such as patients who are febrile, but there are insufficient data to support or refute recommending routine lumbar puncture (Level U). Should toxicologic screening be routinely ordered in an adult presenting with an apparent unprovoked first seizure? Conclusion In two Class III studies considering the value of toxicology screening in adult patients presenting with a seizure, some patient
