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.
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.
Authors: Peter S Dayan; Kathleen Lillis; Jonathan Bennett; Gregory Conners; Pam Bailey; James Callahan; Cigdem Akman; Neil Feldstein; Joshua Kriger; W Allen Hauser; Nathan Kuppermann Journal: Pediatrics Date: 2015-07-20 Impact factor: 7.124
Authors: Todd W Lyons; Kara B Johnson; Kenneth A Michelson; Lise E Nigrovic; Tobias Loddenkemper; Sanjay P Prabhu; Amir A Kimia Journal: Seizure Date: 2015-12-25 Impact factor: 3.184
Authors: D T Hsieh; T Chang; T N Tsuchida; L G Vezina; A Vanderver; J Siedel; K Brown; M M Berl; S Stephens; A Zeitchick; W D Gaillard Journal: Neurology Date: 2010-01-12 Impact factor: 9.910
Authors: Andrew J Kalnin; Philip S Fastenau; Ton J deGrauw; Beverly S Musick; Susan M Perkins; Cynthia S Johnson; Vincent P Mathews; John C Egelhoff; David W Dunn; Joan K Austin Journal: Pediatr Neurol Date: 2008-12 Impact factor: 3.372