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

ABSTRACT: 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.

SUBMITTER: Shah LM

PROVIDER: S-EPMC7655379 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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

Shah L M LM Kranz P G PG Anzai Y Y Hutchins T A TA Gibbs W N WN Pierson N N Aldred B W BW Wiggins R H RH

AJNR. American journal of neuroradiology 20181101 12

<h4>Background and purpose</h4>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.<h4>Materials and methods</h4>An e-mail survey was sent to American Society of Neuroradiology members concerning the number of postmy ...[more]

PMID: 30385469

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

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

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