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Neuro-imaging evaluation after the first afebrile seizure in children: A retrospective observational study
Rana Al-Shami1, Abdulhafeez M Khair1, Mahmoud Elseid2
1Pediatric Neurology Division, Hamad Medical Corporation, Doha, Qatar.
Insights
Neuro-imaging is crucial for children experiencing their first afebrile seizure, especially those under two years old or with prolonged seizures. Abnormalities were found in 33% of cases, highlighting the importance of imaging in pediatric epilepsy evaluation.
Area of Science:
- Pediatric Neurology
- Neuroimaging
- Epilepsy
Background:
- The first afebrile seizure in children necessitates careful evaluation to determine underlying causes and prognosis.
- Neuro-imaging plays a vital role in identifying structural abnormalities contributing to seizures.
Purpose of the Study:
- To assess the utility of neuro-imaging in children with their first afebrile seizure.
- To identify factors influencing neuro-imaging outcomes in a pediatric emergency setting.
Main Methods:
- Retrospective review of medical records for children with the first non-febrile seizure.
- Utilized the International League Against Epilepsy (ILAE) classification system for seizure categorization.
- All neuro-imaging studies were interpreted by experienced neuroradiologists.
Main Results:
- Ninety-six children underwent neuro-imaging, with 33% showing abnormalities.
- Children under two years old had a significantly higher rate of abnormal imaging (59%, p=0.002).
- Prolonged seizures (status epilepticus) were associated with a high percentage of abnormalities (58%, p=0.003).
Conclusions:
- Infants and children with prolonged or focal seizures warrant neuro-imaging.
- Neuro-imaging findings influenced clinical decision-making in 6-8% of cases.
- Early identification of abnormalities through neuro-imaging aids in pediatric epilepsy management.
Purpose:
To evaluate the role of neuro-imaging in children presenting with the first afebrile seizure and determine factors that influence the outcome of imaging in a large paediatric emergency centre.
Method:
This is a retrospective review of the medical records of all patients presenting with the first non-febrile seizure to a large paediatric emergency centre in the state of Qatar. Seizure classification followed the current ILAE classification system. Imaging was undertaken in our tertiary hospital and all images were reviewed by experienced neuro-radiologists. Student t test was used for statistical analysis.
Results:
Ninety-six children underwent neuro-imaging following the first afebrile seizure. Of them, thirty-two patients (33%) were reported to have abnormalities. Children below the age of two demonstrated a significantly higher percentage of abnormal imaging (59%); (p=0.002). Children presenting with prolonged seizures showed a high percentage of imaging abnormalities (58%); (p=0.003). Children with focal seizures demonstrated a higher percentage of imaging abnormality compared to those presenting with generalized seizures (35% vs 31%). This difference did not reach statistical significance.
Conclusion:
Children below the age of two demonstrated significantly higher percentages of abnormal imaging (59%), as did children presenting with status epilepticus (58%). Neuro-imaging should be considered in infants and those with focal or prolonged seizures. Neuro-imaging informed decision making in 6-8% of children.
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