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Focal electroencephalographic abnormalities and computerised tomography findings in children with seizures
J Gibbs1, R E Appleton, H Carty
1Department of Paediatric Neurology, Royal Liverpool Children's Hospital.
Insights
Electroencephalograms (EEG) revealed focal abnormalities in 16% of children with seizures. CT head scans, performed on a subset, infrequently identified abnormalities that altered patient management, suggesting limited utility in routine seizure evaluation.
Area of Science:
- Pediatric Neurology
- Neuroimaging
- Epileptology
Background:
- Electroencephalograms (EEG) are crucial for diagnosing seizures in children.
- The role of neuroimaging, specifically CT head scans, in evaluating focal EEG abnormalities requires clarification.
- Understanding the yield of CT scans in pediatric seizure patients is important for clinical practice.
Purpose of the Study:
- To determine the frequency of focal abnormalities on EEG in children with seizures.
- To assess the diagnostic yield of CT head scans in children with focal EEG abnormalities.
- To evaluate the impact of CT findings on clinical management.
Main Methods:
- Retrospective analysis of 157 children with focal EEG abnormalities from 964 consecutive pediatric seizure cases.
- CT head scans were performed in 121 children with EEG abnormalities.
- Correlation of EEG findings (delta/slow wave vs. spike/sharp wave focus) with CT results and management changes.
Main Results:
- Persistent focal abnormalities were found in 16% of EEGs.
- CT head scans revealed abnormalities in 21% of evaluated children, with 81% being localized.
- No significant difference in CT abnormality detection between delta/slow wave and spike/sharp wave foci.
- Abnormal CT scans were uncommon after a single seizure.
- CT findings influenced management in only 1.7% of cases.
Conclusions:
- Focal EEG abnormalities are present in a notable proportion of children with seizures.
- CT head scans have a low yield in identifying abnormalities in this population.
- The routine use of CT head scans in children with focal EEG abnormalities has limited impact on clinical management decisions.
Abstract:
A persistent focal abnormality was observed in 157 (16%) electroencephalograms undertaken in 964 consecutive children with epileptic and non-epileptic seizures seen over one year. CT head scans were performed in 121 (77%) of the 157 children with a focus on the EEG; 26 (21%) showed an abnormality, and 21 (81%) of the abnormalities were localised. There was no difference in the proportion of abnormal scans associated with a delta or slow wave focus compared with a spike or sharp wave focus. An abnormal scan was uncommon after a single seizure. In only two patients (1.7% of all scans) did the findings on CT alter or greatly influence subsequent management.