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New-onset afebrile seizures in infants: role of neuroimaging
D T Hsieh1, T Chang, T N Tsuchida
1Center for Neuroscience, Children's National Medical Center, Washington, DC 20010, USA.
Insights
New-onset afebrile seizures in infants are often brief but recurrent. Neuroimaging, particularly MRI, is crucial for diagnosis, revealing common cerebral dysgenesis and guiding management.
Area of Science:
- Pediatric Neurology
- Neuroimaging
- Epilepsy
Background:
- New-onset afebrile seizures in infants require prompt evaluation.
- Understanding seizure characteristics and optimal diagnostic yield is essential.
Purpose of the Study:
- To characterize new-onset afebrile seizures in infants aged 1-24 months.
- To assess the diagnostic yield of neuroimaging modalities.
Main Methods:
- Prospective data collection from 317 infants with new-onset afebrile seizures.
- Standardized evaluation including EEG, head CT, and MRI.
- Analysis of seizure characteristics and neuroimaging findings.
Main Results:
- Half of infants presented with partial seizures; primary generalized seizures were rare.
- EEG abnormalities detected in 50%; CT abnormalities in 33%, altering management in 9%.
- MRI revealed abnormalities in over 50%, with cerebral dysgenesis being most common.
Conclusions:
- Infantile seizures are typically brief but recurrent, warranting inpatient observation.
- CT imaging can alter acute management in a subset of infants.
- MRI offers superior diagnostic yield and should be strongly considered due to high rates of cerebral dysgenesis.
Objective:
To investigate the presenting characteristics of new-onset afebrile seizures in infants (age 1-24 months) and the yield of neuroimaging.
Methods:
Prospective data were obtained from a standardized evaluation and management plan mandated by a critical care pathway. A total of 317 infants presented with new-onset afebrile seizures between 2001 and 2007. EEG was performed on 90.3%, head CT was obtained on 94%, and MRI was obtained on 57.4%.
Results:
We found half of the infants had partial features to their seizures, yet evidence for primary generalized seizures was rare. The majority had more than 1 seizure upon presentation. Seizures in this age group tended to be brief, with 44% lasting less than 1 minute. EEG abnormalities were found in half. One-third of CTs were abnormal, with 9% of all CTs requiring acute medical management. Over half of MRIs were abnormal, with cerebral dysgenesis being the most common abnormality (p < 0.05). One-third of normal CTs had a subsequent abnormal MRI-only 1 resulted in altered medical management.
Conclusions:
Infantile seizures are usually brief, but commonly recurrent, and strong consideration should be made for inpatient observation. Acute imaging with CT can alter management in a small but important number of infants. Due to the superior yield, strong consideration for MRI should be given for all infants, as primary generalized seizures are rare, and there is a high rate of cerebral dysgenesis.
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