First Afebrile Seizure in Children: Which Patients Require Emergent Neuroimaging?

Abstract

Introduction: The aim of this study was to investigate the frequency of intra-cranial pathology in children presenting to emergency department with a first afebrile seizure and to determine patients at high risk for abnormal neuroimaging. Methods: The medical files of 173 children who presented to the emergency department with a first afebrile seizure and underwent neuroimaging within 24 hours of presentation were retrospectively evaluated. We defined clinically emergent intracranial pathology as any lesion requiring immediate medical or surgical intervention. The relationship of age, seizure characteristics, predisposing conditions, presence of new-onset neurologic deficits, and baseline neurological status with neuroimaging findings were compared. Results: There were 103 males (59.5%) and 70 females. The mean age was 80±60.4 months (1-204). Of the 173 children, 87 (50.3%) had a computed tomography scan, 50 (28.9%) had magnetic resonance imaging, and 36 (20.8%) underwent both magnetic resonance imaging and computed tomography. Neuroimaging results were abnormal in 24.3% of patients whereas 5.2% had an emergent intracranial pathology. The conditions associated with abnormal neuroimaging were: 1) focal seizures, 2) new-onset neurological deficits 3) pre-existing neurological abnormalities, 4) predisposing conditions, and 5) being younger than 24 months of age. Conclusion: Planning emergency neuroimaging in children with a first afebrile seizure seems rational if the child is younger than 24 moths of age, has focal seizure(s), abnormal neurologic status prior seizure, new-onset neurological symptoms, or predisposing conditions.

Keywords

• Children
• first afebrile seizure
• neuroimaging abnormality