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<meta name="DC.Title" content="Critical Assessment of Myelography Practices: A Call for Rational Guideline Revision" />
<meta name="DC.Identifier" content="10.3174/ajnr.A5867" />
<meta name="DC.Date" content="2018-12-01" />
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<meta name="DC.Description" content="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.

STLM
:   seizure threshold–lowering medications" />
<meta name="DC.Contributor" content="L.M. Shah" />
<meta name="DC.Contributor" content="P.G. Kranz" />
<meta name="DC.Contributor" content="Y. Anzai" />
<meta name="DC.Contributor" content="T.A. Hutchins" />
<meta name="DC.Contributor" content="W.N. Gibbs" />
<meta name="DC.Contributor" content="N. Pierson" />
<meta name="DC.Contributor" content="B.W. Aldred" />
<meta name="DC.Contributor" content="R.H. Wiggins" />
<meta name="article:published_time" content="2018-12-01" />
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<meta name="citation_title" content="Critical Assessment of Myelography Practices: A Call for Rational Guideline Revision" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;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.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;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.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;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; &lt;i&gt;P&lt;/i&gt; = .08). Most (95%) reported using nonionic hypo-osmolar agents.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;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.&lt;/p&gt;" />
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<meta name="twitter:title" content="Critical Assessment of Myelography Practices: A Call for Rational Guideline Revision" />
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<meta name="twitter:description" content="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.

STLM
:   seizure threshold–lowering medications" />
<meta name="og-title" property="og:title" content="Critical Assessment of Myelography Practices: A Call for Rational Guideline Revision" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/39/12/2378" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="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.

STLM
:   seizure threshold–lowering medications" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node64714--5" data-node-nid="64714" id="top-node-64714--61167990851" data-pisa="ajnr;39/12/2378" data-pisa-master="ajnr;ajnr.A5867" data-apath="/ajnr/39/12/2378.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
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      <h1 class="highwire-cite-title" id="page-title">Critical Assessment of Myelography Practices: A Call for Rational Guideline Revision</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">L.M. Shah</span>, <span class="highwire-citation-author" data-delta="1">P.G. Kranz</span>, <span class="highwire-citation-author" data-delta="2">Y. Anzai</span>, <span class="highwire-citation-author" data-delta="3">T.A. Hutchins</span>, <span class="highwire-citation-author" data-delta="4">W.N. Gibbs</span>, <span class="highwire-citation-author" data-delta="5">N. Pierson</span>, <span class="highwire-citation-author" data-delta="6">B.W. Aldred</span> and <span class="highwire-citation-author" data-delta="7">R.H. Wiggins</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">December 2018,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">39 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(12) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">2378-2384; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A5867 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-64714--61167990851" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">L.M. Shah </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From 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</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=L.M.%2BShah%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Shah%20L&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AL.M.%2BShah%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-1303-3533" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for L.M. Shah</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">P.G. Kranz </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Department of Radiology (P.G.K.), Duke University Medical Center, Durham, North Carolina</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=P.G.%2BKranz%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Kranz%20P&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AP.G.%2BKranz%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-5410-7135" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for P.G. Kranz</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">Y. Anzai </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From 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</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Y.%2BAnzai%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Anzai%20Y&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AY.%2BAnzai%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-2988-7445" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Y. Anzai</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">T.A. Hutchins </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From 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</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=T.A.%2BHutchins%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Hutchins%20T&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AT.A.%2BHutchins%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-1329-4402" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for T.A. Hutchins</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">W.N. Gibbs </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Department of Radiology (W.N.G.), Keck Medical Center of University of Southern California, Los Angeles, California.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=W.N.%2BGibbs%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Gibbs%20W&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AW.N.%2BGibbs%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-6493-1942" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for W.N. Gibbs</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">N. Pierson </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From 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</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=N.%2BPierson%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Pierson%20N&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AN.%2BPierson%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-4090-6195" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for N. 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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 39</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 12 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Dec 2018 </div></div>
      
      
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      <div class="highwire-cite-title">Critical Assessment of Myelography Practices: A Call for Rational Guideline Revision</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">L.M.</span> <span class="nlm-surname">Shah</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">P.G.</span> <span class="nlm-surname">Kranz</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">Y.</span> <span class="nlm-surname">Anzai</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">T.A.</span> <span class="nlm-surname">Hutchins</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">W.N.</span> <span class="nlm-surname">Gibbs</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">N.</span> <span class="nlm-surname">Pierson</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">B.W.</span> <span class="nlm-surname">Aldred</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">R.H.</span> <span class="nlm-surname">Wiggins</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Dec 2018, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">39 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(12) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">2378-2384; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A5867 </span></div>
  
  
  
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      <div class="highwire-cite-title">Critical Assessment of Myelography Practices: A Call for Rational Guideline Revision</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">L.M.</span> <span class="nlm-surname">Shah</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">P.G.</span> <span class="nlm-surname">Kranz</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">Y.</span> <span class="nlm-surname">Anzai</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">T.A.</span> <span class="nlm-surname">Hutchins</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">W.N.</span> <span class="nlm-surname">Gibbs</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">N.</span> <span class="nlm-surname">Pierson</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">B.W.</span> <span class="nlm-surname">Aldred</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">R.H.</span> <span class="nlm-surname">Wiggins</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Dec 2018, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">39 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(12) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">2378-2384; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A5867 </span></div>
  
  
  
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