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Neuroimaging in children with first afebrile seizures: to order or not to order?
Fariba Khodapanahandeh1, Homayon Hadizadeh
1Department of Pediatrics, * Iran University of Medical Sciences, Tehran, Iran. faribakoda@yahoo.com
Insights
Neuroimaging for children with new-onset afebrile seizures is often normal. Brain CT or MRI is recommended for those with focal seizures, abnormal findings, or under two years old.
Area of Science:
- Pediatric Neurology
- Emergency Medicine
- Diagnostic Imaging
Background:
- Seizures are a common pediatric emergency, accounting for 5% of emergency department visits.
- The utility of emergent neuroimaging for first-time afebrile seizures in children lacks clear definition.
Purpose of the Study:
- To evaluate the role and yield of emergent neuroimaging (CT scan or MRI) in children experiencing their first afebrile seizure.
Main Methods:
- Retrospective review of medical charts for 125 children admitted with new-onset afebrile seizures.
- Analysis of neuroimaging results (CT or MRI) performed within hours of emergency department arrival.
Main Results:
- Neuroimaging was performed in 95% of eligible children.
- The vast majority (90%) of neuroimaging results were normal.
- Abnormal neuroimaging showed a significant association with focal seizures (P < 0.001) and younger age (< 2 years, P < 0.002).
Conclusions:
- Emergent neuroimaging in children with first afebrile seizures has a low yield, with most results being normal.
- Recommend CT scan or MRI for children with first afebrile seizures who exhibit focal seizures, abnormal neurological findings, or are under two years of age.
Abstract:
Seizures are common in children and 5% of all medical attendances to accident and emergency departments are related to seizures. The role of emergent neuroimaging for those children with first afebrile seizure is, however, not well-defined. We reviewed medical charts of 125 children who were admitted with a new-onset afebrile seizure to the Pediatric Ward of Rasool Akram Hospital and underwent CT scan or MRI of the brain. Neuroimaging was performed for 95% (119/125) of these children over the first few hours of their arrival to the Emergency Department. In 90% (107/119) of them, the result was normal. There was a significant relationship between abnormal neuroimaging and focal seizure (P < 0.001), and with age under 2 years (P < 0.002). Therefore, it is recommended that CT scan or MRI to be performed in children with first afebrile seizure who present with focal seizures, abnormal neurologic findings, or age under 2 years.
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