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The utility of computed tomography for recent-onset partial seizures in childhood
George H Swingler1, Anthony T R Westwood, Karen Iloni
1School of Child and Adolescent Health, University of Cape Town, South Africa. swingler@ich.uct.ac.za
Insights
Routine head CT scans in children with first partial seizures in high-prevalence neurocysticercosis areas rarely alter management. The diagnostic yield is low, with most findings being neurocysticercosis, suggesting targeted treatment may be more efficient than routine imaging.
Area of Science:
- Pediatric Neurology
- Neuroimaging
- Infectious Diseases
Background:
- Partial seizures in children necessitate accurate diagnosis.
- High prevalence of neurocysticercosis and tuberculosis in certain regions complicates seizure etiology.
- Computed tomography (CT) of the head is a common diagnostic tool.
Purpose of the Study:
- To evaluate the diagnostic yield of head CT scans for children experiencing their first partial seizure.
- To assess the impact of CT findings on clinical management in regions with high rates of neurocysticercosis and tuberculosis.
Main Methods:
- Prospective cohort study conducted at a secondary-level ambulatory service.
- Included children aged 6 months to 12 years with a first partial seizure.
- Analyzed abnormal and clinically unsuspected CT findings.
Main Results:
- Of 94 children with available CT scans, 34% were normal, 48% showed granulomas (suggestive of neurocysticercosis), and 18% had other findings.
- Clinically unsuspected abnormal CT findings were rare.
- CT scans often did not reveal unexpected findings that altered management.
Conclusions:
- Routine head CT scans in children with first partial seizures in high neurocysticercosis prevalence areas have limited utility beyond identifying neurocysticercosis.
- The findings suggest that targeted treatment for neurocysticercosis might be more effective than routine CT scanning for seizure prevention in this population.
- The study highlights the need to reconsider the routine use of head CT in specific epidemiological contexts.
Objectives:
To determine the diagnostic yield of computed tomography (CT) of the head in children presenting for the first time with partial seizures in a region with a high prevalence of tuberculosis and neurocysticercosis.
Design:
Prospective cohort study.
Setting:
The secondary-level ambulatory service of Red Cross Children's Hospital, Cape Town.
Subjects:
Children aged 6 months-12 years with a first partial seizure. Outcome measures. Abnormal CT findings; clinically unsuspected abnormal CT findings.
Results:
Of 118 enrolled children, CT findings were available for 94 (80%). Sixteen (33%) of 49 children scheduled to return later for an initial CT scan failed to do so. Thirty-two scans (34%) were reported normal, 45 (48%) showed single or multiple granulomas, and 17 (18%) showed other findings. All 8 children with persistent specific CT findings were suspected of having the condition before CT scan. Of 68 cases with prospectively recorded clinically expected CT findings, normal scans were expected in 2 cases (3%) and occurred in 33 cases (49%).
Conclusions:
Routine CT scan for children presenting with a first partial seizure in an area with a high prevalence of neurocysticercosis failed to identify findings other than neurocysticercosis that meaningfully altered clinical management. Assuming a 70% relative reduction of seizures with albendazole treatment for neurocysticercosis, routine CT scanning in the study population would require 11 scans and 5 courses of albendazole to prevent 1 child from having seizures, compared with no CT scans and 11 courses of albendazole with blanket use of albendazole.
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