Neuroimaging in Children With Newly Diagnosed Epilepsy: A Community-Based Study

Abstract

In children with newly diagnosed epilepsy, neuroimaging reveals a small but significant number of serious abnormalities not previously suspected. Most of these children have partial seizures or focal EEG abnormalities. Neuroimaging should be considered during the evaluation of children with newly diagnosed epilepsy, especially for those with neurologic deficits or partial seizures or focal EEG abnormalities that are not part of an idiopathic localization-related epilepsy syndrome.

Prevalence of and Risk Factors for Intracranial Abnormalities in Unprovoked Seizures

“…[4][5][6][7][8]12,16,17,19 In 2 large previous prospective studies, in which patients were evaluated by neurologists, the risk of any clinically relevant abnormalities on imaging ranged from 21% to 31%, with the higher estimate noted in a study that exclusively used MRIs. 5,12 We identified a somewhat lower estimate of emergent/urgent intracranial abnormalities on neuroimaging than previous studies.…”

“…[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.…”

Role of MRI in audio-vestibular dysfunction; is it cost-effective?

“…6 It has been documented that the diagnostic outcome of MRI screening for audiovestibular symptoms does not compare with that of other situations as for example MRI screening of children with epilepsy, where 12.7% of cases have relevant positive imaging findings. 10,11 In the current study, over the studied 52 patients, MRI of cerebellopontine angle yielded no detectable lesion in any case. Worldwide, there is a constant challenge regarding the cost-effectiveness of MRI in investigating rare disorders amongst a large number of symptomatic patients as in our cases.…”

Epilepsy in children in Navarre

“…El diagnóstico de las epilepsias sigue siendo esencialmente clínico, aunque apoyado por pruebas complementarias cuyos avances técnicos (registro vídeo-EEG, estudios de neuroimagen estructural y/o funcional, análisis metabólicos, etc.) facilitan el diagnóstico y la clasificación sindrómica; lo que permite presumir cursos evolutivos y eventuales respuestas terapéuticas [6][7][8][9][10][11] . No obstante, las cifras disponibles respecto a la incidencia anual de epilepsia infantil son muy variables, oscilando entre 41 y 97 casos por 100.000 1,[12][13][14][15][16][17] , y generalmente debido a razones metodológicas que hacen difícil la comparación de resultados.…”