New onset seizure

Today, we discussed a case of an elderly gentleman with an extensive smoking history who presented with symptoms of a simple partial seizure, found to have multiple metastatic brain mets secondary to NSCLC.

Learning points from the case:

1) Simple partial seizures do not impair consciousness and symptoms depend on the area of the brain involved.

2) The initial approach to a patient with a first seizure generally includes:

  • stabilization focusing on airway and vitals
  • lab evaluation including glucose, BMP, LFTs
  • EKG, consider urine tox, serum alcohol level in certain patients
  • neuroimaging is indicated in most patients with first unprovoked seizure (choice between CT head without contrast and MRI depends on clinical stability and availability)
  • EEG generally recommended for all patients with unprovoked seizure
  • LP considered if risk factors for meningitis/encephalitis

3) Dr. Fine reviewed the literature on whole brain radiation therapy (WBRT), specifically focusing on the QUARTZ trial published in the Lancet in Oct 2016, which showed no difference in overall survival comparing dexamethasone with or without WBRT.