CSEConvulsive status epilepticus GOSH Great Ormond Street Hospital HIMAL Hippocampal malrotation PFS Prolonged febrile seizure STEPIN Status Epilepticus Imaging and Neurocognitive Study AIM The aim of this study was to determine the yield of magnetic resonance imaging (MRI) after an episode of childhood convulsive status epilepticus (CSE) and to identify the clinical predictors of an abnormal brain scan.METHOD Children were recruited following an episode of CSE from an established clinical network in north London. Eighty children (age range 1mo-16y; 39 males; 41 females) were enrolled and seen for clinical assessment and brain MRI within 13 weeks of suffering from an episode of CSE. Scans were reviewed by two neuroradiologists and classified as normal (normal ⁄ normal-variant) or abnormal (minor ⁄ major abnormality). Factors predictive of an abnormal scan were investigated using logistic regression.RESULTS Eighty children were recruited at a mean of 31.8 days (5-90d) after suffering from CSE.Structural abnormalities were found in 31%. Abnormal neurological examination at assessment (odds ratio [OR] 190.46), CSE that was not a prolonged febrile seizure (OR 77.12), and a continuous rather than an intermittent seizure (OR 29.98) were all predictive of an abnormal scan. No children with previous neuroimaging had new findings that altered their clinical management.INTERPRETATION Brain MRI should be considered for all children with a history of CSE who have not previously undergone MRI, especially those with non-prolonged febrile seizure CSE, those with persisting neurological abnormalities 2 to 13 weeks after CSE, and those with continuous CSE.Convulsive status epilepticus (CSE) in children is common [1][2][3] and potentially life-threatening, 1,4 with high associated morbidity. Guidelines on acute management of CSE 5 focus on drug therapy 6 and seizure termination, but guidance on optimal follow-up investigations remains unclear. 7 In particular, one investigation frequently considered is the need for and type of neuroimaging. Since the outcome is largely dependent on the aetiology, 1,8 determining the underlying diagnosis is important for both treatment and prognosis, and neuroimaging may thus be useful.From historical data, a minimum yield of detectable lesions of 7.8% has been estimated amongst all children with CSE who underwent neuroimaging. 7 In practice, this may be conservative, particularly if imaging is restricted to children at particular risk of structural brain lesions. It would be beneficial to determine yield in the general population of children with CSE and identify risk factors for structural lesions so that unnecessary imaging is avoided and those children likely to benefit are treated appropriately.The Status Epilepticus Imaging and Neurocognitive Study (STEPIN) is a prospective study on the effects of childhood CSE within the first year of suffering from an episode of CSE. In this paper, we report on the clinical and magnetic resonance imaging (MRI) findings within 13 weeks of CSE and on facto...