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Neuroimaging Evaluation for First Attack of Unprovoked Nonfebrile Seizure in Pediatrics: When to Order?
Hussain Sadeq1, Jumanah Karim, Yousef Marwan
1Department of Pediatrics, Al-Adan Hospital, Kuwait City, Kuwait.
Insights
Neuroimaging studies, including CT scans and MRIs, were not valuable for evaluating children experiencing their first unprovoked, nonfebrile seizure. Most abnormal findings were clinically insignificant, with only one case showing a significant diagnosis.
Area of Science:
- Pediatric Neurology
- Diagnostic Imaging
Background:
- First-time seizures in children warrant thorough evaluation to determine underlying causes.
- Neuroimaging is often considered to identify structural brain abnormalities.
Purpose of the Study:
- To evaluate the diagnostic utility of neuroimaging studies (CT and MRI) in pediatric patients presenting with a first-time unprovoked, nonfebrile seizure.
Main Methods:
- Retrospective review of medical records for pediatric patients (28 days to 12 years) with a first unprovoked, afebrile seizure.
- Analysis of computed tomography (CT) and magnetic resonance imaging (MRI) results, classifying abnormalities as clinically significant or insignificant.
- Exclusion of patients with known predisposing seizure conditions.
Main Results:
- Out of 50 pediatric patients, 16 (32%) had abnormal neuroimaging findings.
- Only one patient (2%) had a clinically significant abnormality, diagnosed as Moyamoya disease.
- The majority of abnormal neuroimaging results were deemed clinically insignificant.
Conclusions:
- Neuroimaging studies demonstrated limited value in the initial evaluation of pediatric patients with a first unprovoked, nonfebrile seizure.
- Routine neuroimaging may not be cost-effective or diagnostically beneficial in this specific patient population.
Objective:
To assess the value of neuroimaging studies in evaluating pediatric patients presenting with a first attack of nonfebrile seizure.
Method:
We reviewed the medical records of pediatric patients aged 28 days to 12 years who were admitted between 1 January and 31 December 2013 with a first attack of unprovoked, afebrile seizure. These patients had undergone neuroimaging studies. The exclusion criterion was patients with known predisposing conditions for seizure. The computed tomography (CT) scan and magnetic resonance imaging (MRI) results were either normal or abnormal, and the abnormal ones were further classified into clinically insignificant or significant. Descriptive analysis was performed to summarize the data.
Result:
Fifty children were identified with a mean age of 5.2 ± 3.8 years. Of the 50 subjects, 29 (58.0%) were males and 21 (42.0%) were females. Sixteen patients (32.0%) had abnormal neuroimaging studies (CT scan, MRI or both); however, only 1 was considered to have a clinically significant abnormality, later diagnosed as Moyamoya disease.
Conclusion:
In this study, the neuroimaging studies were found not to be useful in evaluating pediatric patients presenting with a first attack of unprovoked, nonfebrile seizures.
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