Identification of children with first afebrile seizure for whom neuroimaging is unnecessary

Amagasa, Shunsuke; Uematsu, Satoko; Tsuji, Satoshi; Nagai, Akiko; Abe, Yoshiharu; Kubota, Minoru

doi:10.1016/j.seizure.2021.10.022

Cited by 7 publications

(7 citation statements)

References 16 publications

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“…After excluding patients with predisposing conditions, they found that 12.7% of the focal seizure patients had clinically significant abnormal imaging findings, mostly at younger ages, and suggested emergent imaging for focal seizure patients if the age is under 33 months. 9 In a recent study, Amagasa et al 18 found that focal seizure, prolonged seizure, and seizure cluster (similar to ours') were risk factors for CT or MRI abnormalities. The only study in the literature that included solely first afebrile The Turkish Journal of Pediatrics ▪ January-February 2023 seizure patients with focal manifestations with quite wide exclusion criteria such as underlying chronic disease, altered mental status, acute trauma, etc., found the rate of clinically urgent intracranial pathology as 4.1%, with hemorrhage and infarction being the most common.…”

Section: Discussionsupporting

confidence: 78%

“…There are a few studies pointing to the number of seizures at the presentation of the first seizure. 3,18 Other than emergent imaging, recurrence of seizure also supports the need for a longer follow-up at the PED or admission to the wards. 19 In the current study, there was a discrepancy between the yields of CT and MRI results in 12 patients (36%) with normal CT and abnormal MRI results.…”

Section: Discussionmentioning

confidence: 99%

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Clinically important intracranial abnormalities in children presenting with first focal seizure

et al. 2023

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Background. Management of pediatric patients presenting with first seizure is challenging, especially with regards to emergent neuroimaging. The rate of abnormal neuroimaging findings is known to be higher in focal seizures than in generalized seizures, but those intracranial abnormalities are not always clinically emergent. In this study, we aimed to determine the rate and indicators for clinically important intracranial abnormalities that change acute management in children presenting with a first focal seizure to the pediatric emergency department (PED).Methods. This study was conducted retrospectively in the PED at a University Children's Hospital setting. The study population consisted of patients aged between 30 days and 18 years with first focal seizure and who had emergent neuroimaging at the PED between the years 2001 and 2012.Results. There were 65 eligible patients meeting the study criteria. Clinically important intracranial abnormalities requiring emergent neurosurgical or medical intervention were detected in 18 patients (27.7%) at the PED. Four patients (6.1%) underwent emergent surgical procedures. Seizure recurrence and the need for acute seizure treatment in the PED were significantly associated with clinically important intracranial abnormalities. Conclusions.Neuroimaging study yielding of 27.7% shows that first focal seizure must be evaluated meticulously. From the emergency department's point of view; we suggest that first focal seizures in children should be evaluated with emergent neuroimaging, if possible with magnetic resonance imaging. Especially patients with recurrent seizures at presentation requires more careful evaluation.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Clinically important intracranial abnormalities in children presenting with first focal seizure

et al. 2023

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“…Cain et al determined that the frequency of emergency imaging is higher in general ERs and the low rate of positive findings supports the need for an evidence-based clinical decision tool for neuroimaging in the acute care setting [29]. Amagasa et al recommended that; the clinician could determine the necessity of neuroimaging by seizure cluster, prolonged seizure, focal seizure, and abnormal neurological examination [30]. We detected abnormal examination findings is increased the risk of abnormality in MRI.…”

Section: Discussionmentioning

confidence: 81%

Emergency brain imaging findings in children with first afebril convulsion

Ozcora¹,

Bektaş²

2022

Med-Science

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Convulsion is the most common neurological disease seen in childhood and constitutes 4-10% of all neurological diseases and 2% of the admissions to child emergency rooms. While the primary purpose of performing emergency neuroimaging in a child presenting with the first afebrile convulsion is to investigate intracranial pathologies that may require urgent intervention. The cranial imaging to be performed for this purpose are transfontanellar ultrasonography, computed tomography, and magnetic resonance imaging. We aimed to evaluate the necessity, the contribution to diagnosis, and the effect of treatment of magnetic resonance imaging that was performed in the emergency rooms. Patients who were admitted to the pediatric emergency room for a one-year complaint of their first afebrile convulsion and performed brain magnetic resonance imaging in the pediatric emergency room within the first 24 hours of hospital admission were evaluated retrospectively. A statistically significant correlation was found between the abnormal magnetic resonance imaging and abnormal physical examination of the patients (p<0.001). By the brain magnetic resonance imaging findings acute changes were made in the treatment of 7 cases (1.3%) There was no statistically significant relationship between the magnetic resonance imaging abnormality and emergency seizures. We determined that it would be more appropriate to perform magnetic resonance imaging in outpatient clinics in cases where transportation can be provided early, in cases above 6 years of age without risk factors, and have a normal examination. Nonetheless, higher magnetic resonance imaging rates lead to lower computed tomography rates and ıts beneficial for pediatric patients in limiting radiation and providing definitive structural imaging for seizures.

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“… 11 Amagasa et al also reported that neurological disorder, including impaired awareness, Todd’s paralysis, and ataxia in physical examinations, was a risk factor for brain imaging abnormalities in children with first afebrile seizure. 21 In our study, we investigated both Todd’s paralysis and physical findings such as neck stiffness and Babinski sign. We found that Todd’s paralysis was a significant associated factor of neuroimaging abnormalities, while age, neck stiffness, and Babinski sign were not.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Neuroimaging Abnormalities in Children with Afebrile Seizure: A Retrospective Multicenter Study

Woo

Nah

Kim

et al. 2023

WestJEM

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Introduction: Neuroimaging is recommended for patients with seizures to identify intracranial pathology. However, emergency physicians should consider the risks and benefits of neuroimaging in pediatric patients because of their need for sedation and greater sensitivity to radiation than adults. The purpose of this study was to identify associated factors of neuroimaging abnormalities in pediatric patients experiencing their first afebrile seizure. Methods: This was a retrospective, multicenter study that included children who presented to the emergency departments (ED) of three hospitals due to afebrile seizures between January 2018– December 2020. We excluded children with a history of seizure or acute trauma and those with incomplete medical records. A single protocol was followed in the three EDs for all pediatric patients experiencing their first afebrile seizure. We performed multivariable logistic regression analysis to identify factors associated with neuroimaging abnormalities. Results: In total, 323 pediatric patients fulfilled the study criteria, and neuroimaging abnormalities were observed in 95 patients (29.4%). Multivariable logistic regression analysis showed that Todd’s paralysis (odds ratio [OR] 3.72, 95% confidence interval [CI] 1.03-13.36; P=0.04), absence of poor oral intake (POI) (OR 0.21, 95% CI 0.05-0.98; P=0.05), lactic acidosis (OR 1.16, 95% CI 1.04- 1.30; P=0.01), and higher level of bilirubin (OR 3.33, 95% CI 1.11-9.95; P=0.03) were significantly associated with neuroimaging abnormalities. Based on these results, we constructed a nomogram to predict the probability of brain imaging abnormalities. Conclusion: Todd’s paralysis, absence of POI, and higher levels of lactic acid and bilirubin were associated factors of neuroimaging abnormalities in pediatric patients with afebrile seizure.

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Identification of children with first afebrile seizure for whom neuroimaging is unnecessary

Cited by 7 publications

References 16 publications

Clinically important intracranial abnormalities in children presenting with first focal seizure

Clinically important intracranial abnormalities in children presenting with first focal seizure

Emergency brain imaging findings in children with first afebril convulsion

Factors Associated with Neuroimaging Abnormalities in Children with Afebrile Seizure: A Retrospective Multicenter Study

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