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Critical Assessment of Myelography Practices: A Call for Rational Guideline Revision.

Publication ,  Journal Article
Shah, LM; Kranz, PG; Anzai, Y; Hutchins, TA; Gibbs, WN; Pierson, N; Aldred, BW; Wiggins, RH
Published in: AJNR Am J Neuroradiol
December 2018

BACKGROUND AND PURPOSE: Patient preparation for myelography and postprocedural monitoring varies widely between practices, despite published guidelines. Our aim was to examine the current practice variations in discontinuing reportedly seizure threshold-lowering medications before myelography and to assess the reported incidence of postmyelographic seizures. MATERIALS AND METHODS: An e-mail survey was sent to American Society of Neuroradiology members concerning the number of postmyelographic seizures experienced in the past 5 years, the presence of an institutional policy for discontinuing seizure threshold-lowering medications, and the type of myelographic contrast used. We compared the postmyelographic seizure frequency in the responses. RESULTS: Of 700 survey responses, 57% reported that they do not discontinue seizure threshold-lowering medications before myelography. Most (97%) indicated never having a patient experience a seizure following myelography. The number of postmyelographic seizures between those who discontinue seizure threshold-lowering medications and those who do not was not statistically significant (OR = 2.13; 95% CI, 0.91-4.98; P = .08). Most (95%) reported using nonionic hypo-osmolar agents. CONCLUSIONS: Survey results revealed widely variable practices for patient myelography preparation and postprocedural monitoring. We found no difference in reported seizures between those who discontinued seizure threshold-lowering medications and those who did not. In light of our findings, we propose that discontinuing reportedly seizure threshold-lowering medications is not warranted with the current nonionic water-soluble contrast agents and may be potentially harmful in some instances. This work supports revision of existing recommendations to withhold such medications before myelography.

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Published In

AJNR Am J Neuroradiol

DOI

EISSN

1936-959X

Publication Date

December 2018

Volume

39

Issue

12

Start / End Page

2378 / 2384

Location

United States

Related Subject Headings

  • Surveys and Questionnaires
  • Seizures
  • Practice Patterns, Physicians'
  • Practice Guidelines as Topic
  • Nuclear Medicine & Medical Imaging
  • Myelography
  • Male
  • Humans
  • Guideline Adherence
  • Anticonvulsants
 

Citation

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Shah, L. M., Kranz, P. G., Anzai, Y., Hutchins, T. A., Gibbs, W. N., Pierson, N., … Wiggins, R. H. (2018). Critical Assessment of Myelography Practices: A Call for Rational Guideline Revision. AJNR Am J Neuroradiol, 39(12), 2378–2384. https://doi.org/10.3174/ajnr.A5867
Shah, L. M., P. G. Kranz, Y. Anzai, T. A. Hutchins, W. N. Gibbs, N. Pierson, B. W. Aldred, and R. H. Wiggins. “Critical Assessment of Myelography Practices: A Call for Rational Guideline Revision.AJNR Am J Neuroradiol 39, no. 12 (December 2018): 2378–84. https://doi.org/10.3174/ajnr.A5867.
Shah LM, Kranz PG, Anzai Y, Hutchins TA, Gibbs WN, Pierson N, et al. Critical Assessment of Myelography Practices: A Call for Rational Guideline Revision. AJNR Am J Neuroradiol. 2018 Dec;39(12):2378–84.
Shah, L. M., et al. “Critical Assessment of Myelography Practices: A Call for Rational Guideline Revision.AJNR Am J Neuroradiol, vol. 39, no. 12, Dec. 2018, pp. 2378–84. Pubmed, doi:10.3174/ajnr.A5867.
Shah LM, Kranz PG, Anzai Y, Hutchins TA, Gibbs WN, Pierson N, Aldred BW, Wiggins RH. Critical Assessment of Myelography Practices: A Call for Rational Guideline Revision. AJNR Am J Neuroradiol. 2018 Dec;39(12):2378–2384.

Published In

AJNR Am J Neuroradiol

DOI

EISSN

1936-959X

Publication Date

December 2018

Volume

39

Issue

12

Start / End Page

2378 / 2384

Location

United States

Related Subject Headings

  • Surveys and Questionnaires
  • Seizures
  • Practice Patterns, Physicians'
  • Practice Guidelines as Topic
  • Nuclear Medicine & Medical Imaging
  • Myelography
  • Male
  • Humans
  • Guideline Adherence
  • Anticonvulsants