Pediatric first time non-febrile seizure with focal manifestations: Is emergent imaging indicated?

Aprahamian, Nadine; Harper, Marvin B.; Prabhu, Sanjay P.; Monuteaux, Michael C.; Sadiq, Ziad M.; Torres, Alcy; Kimia, Amir A.

doi:10.1016/j.seizure.2014.06.003

Cited by 27 publications

(31 citation statements)

References 19 publications

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“…Other investigations have variably found prolonged seizure duration as a potential predictor of intracranial abnormalities. 5,17,18 In addition, we found no association between the presence of clinically relevant intracranial abnormalities and young age. Our results regarding age are similar to those of the largest similar previous study but conflict with previous (retrospective) studies that suggested that age ,6 months was an important predictor.…”

Section: Discussioncontrasting

confidence: 66%

“…5,16,20 One recent study reported that younger age may help identify children with focal seizures at higher risk of emergent abnormalities. 18 The clinical risk factors that were independently associated with intracranial abnormalities have been previously shown to have moderateto-substantial interobserver agreement among pediatric emergency medicine physicians (eg, any seizure focality: k = 0.58; 95% CI: 0.45-0.71; any focal neurologic findings on examination: k = 0.66; 95% CI: 0.3-1.0). 22 However, clinical findings are likely to be interpreted differently among physicians with different areas of expertise (eg neurologists, and ED physicians) and different levels of training (eg, faculty versus residents), as well as among clinicians with similar training.…”

Section: Discussionmentioning

confidence: 98%

“…[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.…”

Section: What This Study Addsmentioning

confidence: 99%

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Prevalence of and Risk Factors for Intracranial Abnormalities in Unprovoked Seizures

et al. 2015

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Section: Discussioncontrasting

confidence: 66%

Section: Discussionmentioning

confidence: 98%

Section: What This Study Addsmentioning

confidence: 99%

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Prevalence of and Risk Factors for Intracranial Abnormalities in Unprovoked Seizures

et al. 2015

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“…Similarly, 13 (4.1%) of the 319 children who underwent imaging for a first episode of nonfebrile seizure with focal manifestations were found, in a previous study, to have clinically urgent intracranial pathology resulting in a change of initial patient management. 21 In another report on 319 patients who were admitted to the emergency department with a first attack of seizure, 61 underwent neuroimaging studies and 16 patients were found to have abnormal imaging findings.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Children Admitted to the Emergency Department with Convulsive Epileptic Seizures: A Single-Center Study

Berksoy¹,

Yılmaz²,

İşgüder³

et al. 2017

cayd

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Introduction:To evaluate the etiology and characteristics of children admitted to the emergency department with an acute convulsive epileptic seizure. Methods: Data of patients who were admitted to the emergency department with a convulsive epileptic seizure were reviewed. The patients were divided into febrile seizure, first idiopathic non-febrile seizure, idiopathic epilepsy, symptomatic epilepsy, and symptomatic seizure groups. Results: A total of 335 children were included in the study. Febrile seizures were the most common cause of convulsive seizure (38.5% of all visits), followed by idiopathic epilepsy-related seizures (35.8%), symptomatic epilepsy-related seizures (8.1%), first non-febrile seizures (17.6%), and symptomatic seizures (1.5%). The mean age of the patients was 4.73 years, and it was significantly lower in patients with febrile seizures when compared to the other groups (p<0.001). Conclusion: Knowing the characteristics of children admitted to the emergency department with a convulsive epileptic seizure is important to guide appropriate management and individualized follow-up. Keywords: Emergency department, children, epilepsy, convulsion, seizure

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“…[2][3][4][5] CT identifies imaging abnormalities in 7-24% of children but alters immediate medical management in only a minority. 4,6,7 The American Academy of Neurology states that there is insufficient evidence to support a recommendation at the level of standard or guideline for the use of routine neuroimaging in children with a first afebrile seizure. 8 Therefore, emergent neuroimaging is indicated for selected cases according to history and physical examination considering potential risks of radiation, sedation and contrast agent.…”

Section: Introductionmentioning

confidence: 99%

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

Besli¹,

Karatoprak²,

Saltık³

et al. 2017

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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 . 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 Amaç: Bu çalışmanın amacı ilk kez afebril nöbet geçirerek çocuk acil servisine getirilen çocuklarda nöroradyolojik bozukluk saptanma sıklığının ve hangi hastalarda bu riskin daha yüksek olduğunun belirlenmesidir. Yöntemler: Çocuk acil servisinde ilk afebril nöbet nedeniyle izlenen ve ilk 24 saat içinde kraniyal görüntüleme yapılmış olan 173 hasta geriye dönük incelendi. Görüntüleme sonucunda acil medikal ya da cerrahi girişim gerektiren lezyonlar klinik olarak acil intrakraniyal patoloji olarak tanımlandı. Yaş, nöbet özellikleri, nöbet açısından predispozan faktör varlığı, nöbet sonrası yeni nörolojik bozukluk olması ve nöbet öncesinde bazal nörolojik bozukluk olması ile nöroradyolojik bulgular arasındaki ilişki karşılaştırıldı. Bulgular: Hastaların 103'ü (%59,5) erkek, 70'i (%40,5) kız idi. Ortalama 80±60,4 ay (1-204 ay) idi. Hastaların %50,3'üne (87/173) bilgisayarlı tomografi, %28,9'una (50/173) manyetik rezonans, %20,8'ine (36/173) bilgisayarlı tomografi ve manyetik rezonans görüntüleme yapıldı. Olguların %24,3'ünde nöroradyolojik bozukluk saptandı. Acil intrakraniyal patoloji saptanma oranı ise %5,2 idi. Parsiyel tipte nöbet geçiren, yeni nörolojik defisit saptanan, nöbet öncesinde bazal nörolojik bozukluğu olan, öyküsünde nöbet açısından predispozan faktör saptanan ve 24 ay ve altında olan hastalarda nöroradyolojik bozukluk ...

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Pediatric first time non-febrile seizure with focal manifestations: Is emergent imaging indicated?

Abstract: Four percent of children imaged with first time, afebrile focal seizures have findings important to initial management. Children younger than ≤ 18 months are at increased risk.

Cited by 27 publications

References 19 publications

Prevalence of and Risk Factors for Intracranial Abnormalities in Unprovoked Seizures

Prevalence of and Risk Factors for Intracranial Abnormalities in Unprovoked Seizures

Characteristics of Children Admitted to the Emergency Department with Convulsive Epileptic Seizures: A Single-Center Study

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

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