Neuroimaging abnormalities in children with an apparent first unprovoked seizure

Prevalence of and Risk Factors for Intracranial Abnormalities in Unprovoked Seizures

“…[1][2][3] Approximately 8% to 31% of children with first, unprovoked seizures have abnormalities upon neuroimaging and ,1% to 8% have abnormalities warranting intervention. [4][5][6][7][8][9][10][11][12] The wide range of estimates results from the varying populations studied, differing outcome definitions, and the varied use of MRI. [4][5][6][7][8][9][10][11][12] The majority of patients undergo acute neuroimaging, most frequently computed tomography (CT).…”

“…[5][6][7][8][9][10][11][16][17][18] Most previous studies, however, have been retrospective, have not included standardized evaluations of patients, or the clinical findings were not elicited by acute care providers. [4][5][6][7][8][9][10][11][12][16][17][18][19][20][21] Existing guidelines provide only weak recommendations regarding which children might benefit from prompt neuroimaging. [9][10][11] Our primary aim was to determine the prevalence of, and risk factors for, clinically relevant intracranial abnormalities on neuroimaging in a well-described group of children who presented to medical care for the first time after having sustained unprovoked seizures.…”

“…We chose the clinical findings on the basis of an extensive review of the literature and through detailed discussions with faculty physicians who were expert in pediatric and adult neurology. [5][6][7][8][9][10][11] To assess interrater reliability of clinical findings, a second clinician performed an independent evaluation within 30 minutes of the first assessor on a convenience sample (47%) of those enrolled (details published previously). 22 Clinician assessors were asked to complete the data form before they had knowledge of cranial CT or MRI results, if obtained.…”

“…We defined clinically relevant intracranial abnormalities as those that would potentially result in a change in management. 5,6 We subdivided clinically relevant neuroimaging abnormalities into emergent/urgent and nonurgent categories. We considered emergent/urgent abnormalities as those typically warranting immediate or urgent therapeutic or diagnostic interventions, whether the abnormalities were felt to be the causes of or related to the seizures.…”

Evaluation of the acute symptomatic seizures during central nervous system infections

“…Uyaran olmadan fokal nöbet geçiren, anormal fizik muayene bulguları olan veya EEG'de fokal anormallikleri olan hastalara beyin görüntülemesinin yapılması önerilmektedir [14][15][16]. Çalışmamızda merkezi sinir sistemi enfeksiyonu nedeniyle hastaların tümüne beyin görüntülemesi yapılmış ve %54,1'inde anormallik görülmüştür.…”