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Critical Assessment of Myelography Practices: A Call for Rational Guideline Revision
L M Shah1, P G Kranz2, Y Anzai3
1From the Department of Radiology and Imaging Sciences University (L.M.S., Y.A., T.A.H., N.P., B.W.A., R.H.W.), Utah Health Sciences Center, Salt Lake City, Utah lubdha.shah@hsc.utah.edu.
AJNR. American Journal of Neuroradiology
|November 3, 2018
Summary
Discontinuing seizure threshold-lowering medications before myelography is not necessary, as current nonionic contrast agents pose minimal seizure risk. This practice may even be harmful, suggesting a need to revise guidelines.
Area of Science:
- Neuroradiology
- Clinical Practice Guidelines
- Patient Safety
Background:
- Practices for myelography patient preparation and postprocedural monitoring show significant variation.
- Published guidelines for these practices are not consistently followed.
Purpose of the Study:
- To investigate current variations in discontinuing seizure threshold-lowering medications before myelography.
- To assess the incidence of postmyelographic seizures.
Main Methods:
- An email survey was distributed to members of the American Society of Neuroradiology.
- The survey collected data on postmyelographic seizures, institutional policies on medication discontinuation, and contrast agent types used.
Main Results:
- 57% of respondents do not discontinue seizure threshold-lowering medications; 97% report no patient seizures post-myelography.
- No statistically significant difference in seizure frequency was found between patients who did and did not discontinue these medications (OR = 2.13; P = .08).
- Most institutions (95%) use nonionic hypo-osmolar contrast agents.
Conclusions:
- Current practices for myelography preparation and monitoring are highly variable.
- Discontinuing seizure threshold-lowering medications is not supported by current evidence with nonionic contrast agents.
- Revising recommendations to withhold these medications before myelography is suggested, as it may be unnecessary and potentially harmful.
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