Is Cranial Imaging Necessary in Children with First-Time Focal Seizures?

Year 2024, Volume: 14 Issue: 1, 183 - 187, 28.03.2024

Aysun Tekeli Betül Öztürk İlknur Bodur Ayla Akca Çağlar Aytaç Göktuğ Ergin Atasoy Ayse Secil Eksioglu Can Demir Karacan Nilden Tuygun

https://doi.org/10.33808/clinexphealthsci.1261327

Abstract

Objective: Seizures in children represent a common cause of admission to the emergency department. This study aimed to determine clinically significant intracranial abnormalities in children presenting to the pediatric emergency department with first-time focal seizures.
Methods: Patients aged 1 month-18 years, who presented to the pediatric emergency department with first-time focal seizures between 2009 and 2019, were retrospectively screened. Patients with a history of trauma, cases in which focal neurological signs could not be assessed, and patients with pre-existing structural brain or neurological abnormalities, and metabolic disorders were excluded from the study. Cranial computed tomography findings were re-evaluated by a pediatric radiologist. The fourth and fifth-level according to the classification of the International League Against Epilepsy were interpreted as urgent intracranial pathologies requiring medical or surgical intervention. The univariate analysis was performed using the chi-square test for categorical data and the Mann-Whitney U test for continuous data.
Results: The mean age of the 121 patients was 46.8±44.4 months, and 52.9% were male. Clinically significant emergency intracranial pathologies were detected in the neuroimaging of eight patients. Intracranial masses, bleeding, and hematomas were the most common pathologies. The presence of focal neurologic findings and an age below six months were clinically determined as predictors of an urgent intracranial pathology.
Conclusion: We found the rate of urgent cranial pathologies to be 6.6% in patients presenting to the emergency department following the first focal seizure. Children younger than six months with focal neurological signs should be evaluated for emergency neuroimaging.

Keywords

Children, Computed tomography, Emergency department, Focal seizure

References

• Booth TN. Imaging strategies for new onset seizures. Pediatr Radiol. 2009;39 Suppl 2:S236-238. DOI:10.1007/s00247-009-1173-1.
• Long L, Adams C. Evaluation of a single seizure: guidelines for advance practice nurses. J Am Acad Nurse Pract. 2000;12(4):141-145. DOI:10.1111/j.1745-7599.2000.tb00294.x.
• Nordli DR Jr, Kuroda MM, Hirsch LJ. The ontogeny of partial seizures in infants and young children. Epilepsia 2001;42(8):986-990. DOI:10.1046/j.1528-1157.2001.042008986.x.
• Hsieh DT, Chang T, Tsuchida TN, Vezina LG, Vanderver A, Siedel J, Brown K, Berl MM, Stephens S, Zeitchick A, Gaillard WD. New-onset afebrile seizures in infants: Role of neuroimaging. Neurology. 2010;74(2):150-156. DOI:10.1212/WNL.0b013e3181c91847.
• Warden CR, Brownstein DR, Del Beccaro MA. Predictors of abnormal findings of computed tomography of the head in pediatric patients presenting with seizures. Ann of Emerg Med. 1997;29(4):518-523. DOI:10.1016/S0196-0644(97)70226-9.
• Maytal J, Krauss JM, Novak G, Nagelberg J, Patel M. The role of brain computed tomography in evaluating children with new onset of seizures in the emergency department. Epilepsia 2000;41(8):950-954. DOI:10.1111/j.1528-1157.2000.tb00277.x.
• Sharma S, Riviello JJ, Harper MB, Baskin MN. The role of emergent neuroimaging in children with new-onset afebrile seizures. Pediatrics 2003;111(1):1-5. DOI:10.1542/peds.111.1.1.
• Shinnar S, O'Dell C, Mitnick R, Berg AT, Moshe SL. Neuroimaging abnormalities in children with an apparent first unprovoked seizure. Epilepsy Res. 2001;43(3):261-269. DOI:10.1016/S0920-1211(00)00206-0.
• Hirtz D., Ashwal S., Berg A., Bettis D., Camfield C., Camfield P., Crumrine P., Elterman R., Schneider S., Shinnar S. Practice parameter: evaluating a first nonfebrile seizure in children: report of the quality standards subcommittee of the American Academy of Neurology, The Child Neurology Society, and The American Epilepsy Society. Neurology 2000;55(5):616-623. DOI:10.1212/WNL.55.5.616.
• Freeman JM. Less testing is needed in the emergency room after a first afebrile seizure. Pediatrics 2003;111(1):194-196. DOI:10.1542/peds.111.1.194.
• Gaillard WD, Chiron C, Cross JH, Harvey AS, Kuzniecky R, Hertz-Pannier L, Vezina LG. Guidelines for imaging infants and children with recent-onset epilepsy. Epilepsia 2009;50(9):2147- 53. DOI:10.1111/j.1528-1167.2009.02075.x.
• Al-Shami R, Khair AM, Elseid M, Ibrahim K, Al-Ahmad A, Elsetouhy A, Kamel H, Al Yafei K, Mohamed K. Neuro-imaging evaluation after the first afebrile seizure in children: a retrospective observational study. Seizure 2016;43:26–31. DOI:10.1016/j.seizure.2016.10.008.
• Dayan PS, Lillis K, Bennett J, Conners G, Bailey P, Callahan J, Akman C, Feldstein N, Kriger J, Hauser WA, Kuppermann N. Prevalence of and risk factors for intracranial abnormalities in unprovoked seizures. Pediatrics 2015;136(2):351–360. DOI:10.1542/peds.2014-3550.
• Bautovich T, Numa A. Role of head computed tomography in the evaluation of children admitted to the paediatric intensive care unit with new-onset seizure. Emerg Med Australas. 2012;24(3):313-320. DOI:10.1111/j.1742-6723.2012.01561.x.
• Aprahamian N, Harper MB, Prabhu SP, Monuteaux MC, Sadiq Z, Torres A, Kimia AA. Pediatric first time non-febrile seizure with focal manifestations: Is emergent imaging indicated? Seizure.2014;23(9):740-745. DOI:10.1016/j.seizure.2014.06.003.
• Bui TT, Delgado CA, Simon HK. Infant seizures not so infantile: first-time seizures in children under six months of age presenting to the ED. Am J Emerg Med. 2002;20(6):518–520. DOI:10.1053/ajem.2002.34796.
• Amagasa S, Uematsu S, Tsuji S, Nagai A, Abe Y, Kubota M. Identification of children with first afebrile seizure for whom neuroimaging is unnecessary. Seizure 2021;93:140-144. DOI:10.1016/j.seizure.2021.10.022.
• Garvey MA, Gaillard WD, Rusin JA, Ochsenschlager D, Weinstein S, Conry JA, Winkfield DR, Vezina LG. Emergency brain computed tomography in children with seizures: Who is most likely to benefit? J Pediatr. 1998;133(5):664–669. DOI:10.1016/S0022-3476(98)70109-X.
• Guillou T, Carbajal R, Rambaud J, Titomanlio L, de Pontual L, Biscardi S, Nissack-Obiketeki G, Pellegrino B, Charara O, Angoulvant F, Denis J, Chalard F, Morel B, Loschi S, Chappuy H, Guedj R. Predictors of clinically urgent intracranial pathology at neuroimaging in children with complex febrile seizures: A retrospective cross‐sectional study. Acta Paediatr. 2020;109(2):349-360. DOI:10.1111/apa.14938.
• Teng D, Dayan P, Tyler S, Hauser WA, Chan S, Leary L, Hesdorffer D. Risk of intracranial pathologic conditions requiring emergency intervention after a first complex febrile seizure episode among children. Pediatrics. 2006;117(2):304-308. DOI:10.1542/peds.2005-0759.
• Hassanzadeh Rad A, Tabrizi M, Dadashzadeh P, Aminzadeh V. Is there any need for emergency neuroimaging in children with first complex febrile seizure? Iran J Child Neurol. 2020;14(3):69-78.
• Yücel O, Aka S, Yazicioglu L, Ceran O. Role of early EEG and neuroimaging in determination of prognosis in children with complex febrile seizure. Pediatr Int. 2004;46(4):463-437. DOI: 10.1111/j.1328-8067.2003.01799.x.
• Kimia AA, Ben-Joseph E, Prabhu S, Rudloe T, Capraro A, Sarco D, Hummel D, Harper M. Yield of emergent neuroimaging among children presenting with a first complex febrile seizure. Pediatr Emerg Care. 2012;28(4):316-321. DOI: 10.1097/PEC.0b013e31824d8b0b.