Related Experiment Video
Updated: Aug 8, 2025
Author Spotlight: Advancing Pediatric Epilepsy Surgery in Children Through Novel Biomarkers and Enhanced Localization
Published on: September 20, 2024
Clinically important intracranial abnormalities in children presenting with first focal seizure
Tuba Kasap1, Özlem Tekşam2, Güzide Turanlı3
1Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara.
Insights
In children with a first focal seizure, nearly 28% had significant intracranial abnormalities requiring urgent treatment. Recurrent seizures at presentation were a key indicator for these findings.
Area of Science:
- Pediatric Neurology
- Emergency Medicine
- Neuroimaging
Background:
- Managing pediatric first seizures requires careful consideration of emergent neuroimaging.
- Focal seizures have a higher rate of abnormal neuroimaging than generalized seizures, but findings are not always emergent.
- Determining clinically important intracranial abnormalities in first focal seizures is crucial for acute management in pediatric emergency departments.
Purpose of the Study:
- To determine the rate of clinically important intracranial abnormalities in children presenting with a first focal seizure.
- To identify indicators associated with these abnormalities in the pediatric emergency department (PED).
Main Methods:
- Retrospective study conducted in a pediatric emergency department at a University Children's Hospital.
- Included patients aged 30 days to 18 years with a first focal seizure and emergent neuroimaging (2001-2012).
Main Results:
- Out of 65 eligible patients, 18 (27.7%) had clinically important intracranial abnormalities requiring emergent intervention.
- Four patients (6.1%) underwent emergent surgical procedures.
- Seizure recurrence and the need for acute treatment in the PED were significantly associated with clinically important abnormalities.
Conclusions:
- The 27.7% neuroimaging yield underscores the need for meticulous evaluation of first focal seizures in children.
- Emergent neuroimaging, preferably MRI, is recommended for first focal seizures in the pediatric emergency department.
- Children with recurrent seizures at presentation warrant particularly careful evaluation.
Background:
Management of pediatric patients presenting with first seizure is challenging, especially with regards to emergent neuroimaging. The rate of abnormal neuroimaging findings is known to be higher in focal seizures than in generalized seizures, but those intracranial abnormalities are not always clinically emergent. In this study, we aimed to determine the rate and indicators for clinically important intracranial abnormalities that change acute management in children presenting with a first focal seizure to the pediatric emergency department (PED).
Methods:
This study was conducted retrospectively in the PED at a University Children`s Hospital setting. The study population consisted of patients aged between 30 days and 18 years with first focal seizure and who had emergent neuroimaging at the PED between the years 2001 and 2012.
Results:
There were 65 eligible patients meeting the study criteria. Clinically important intracranial abnormalities requiring emergent neurosurgical or medical intervention were detected in 18 patients (27.7%) at the PED. Four patients (6.1%) underwent emergent surgical procedures. Seizure recurrence and the need for acute seizure treatment in the PED were significantly associated with clinically important intracranial abnormalities.
Conclusions:
Neuroimaging study yielding of 27.7% shows that first focal seizure must be evaluated meticulously. From the emergency department`s point of view; we suggest that first focal seizures in children should be evaluated with emergent neuroimaging, if possible with magnetic resonance imaging. Especially patients with recurrent seizures at presentation requires more careful evaluation.
