Related Experiment Videos
Emergency brain computed tomography in children with seizures: who is most likely to benefit?
M A Garvey1, W D Gaillard, J A Rusin
1Department of Neurology, Children's National Medical Center, Washington, DC 20010, USA.
Insights
Neuroimaging guidelines for new-onset seizures may not apply to children. In pediatric patients, a seizure during fever rarely signals an unexpected brain lesion needing intervention.
Area of Science:
- Pediatric Neurology
- Neuroimaging
- Epilepsy
Background:
- Published guidelines for neuroimaging in new-onset seizures exist.
- The applicability of these guidelines to pediatric populations is uncertain.
Purpose of the Study:
- To evaluate the applicability of current neuroimaging guidelines to children presenting with new-onset seizures.
Main Methods:
- Retrospective analysis of 107 neurologically normal children (excluding simple febrile seizures) who underwent neuroimaging for a possible first seizure.
- Computed tomography (CT) scans were analyzed for brain abnormalities.
Main Results:
- Eight children had non-epileptic events; 49 had provoked seizures, and 50 had unprovoked seizures.
- Nineteen children had CT scan abnormalities; 7 required further investigation or intervention (tumors, vascular anomalies, cysticercosis, hydrocephalus).
- CT scan abnormalities were more common in children with unprovoked seizures (P < .01) and focal seizure onset or neurological findings (P < .04).
Conclusions:
- A seizure in a febrile child rarely indicates an unexpected CT scan lesion requiring intervention.
- Current neuroimaging guidelines may need specific consideration for pediatric patients.
Objective:
To determine whether the recently published guidelines on neuroimaging in patients with new-onset seizures are applicable to children.
Methods:
We carried out a retrospective analysis of 107 neurologically normal children (excluding children with simple febrile seizures) who had undergone neuroimaging when they presented to the emergency department with a possible "first seizure."
Results:
Eight of the 107 children had nonepileptic events (gastroesophageal reflux, syncopal event, rigor). Of the remaining 99 children, 49 had provoked seizures (complicated febrile seizure, meningo-encephalitis, toxic or metabolic abnormalities), and 50 had unprovoked seizures. A total of 19 children had brain abnormalities identified on computed tomography (CT) scan; 7 received further investigation or intervention as a result of CT scan findings (2 with tumors, 3 with vascular anomalies, 1 with cysticercosis, and 1 with obstructive hydrocephalus). CT scan abnormalities requiring treatment or monitoring were more frequently seen in children with their first unprovoked seizure (P < .01) and in those children whose seizure onset had been focal or who had focal abnormalities identified on postictal neurologic examination (P < .04).
Conclusion:
In a child, a seizure in the setting of a fever rarely indicates the presence of an unexpected CT scan lesion requiring intervention.