EMERGENCY BRAIN COMPUTED-TOMOGRAPHY IN CHILDREN WITH SEIZURES - WHO IS MOST LIKELY TO BENEFIT

Objective: To determine whether the recently published guidelines on n euroimaging in patients with new-onset seizures are applicable to chil dren. Methods: We carried out a retrospective analysis of 107 neurolog ically normal children (excluding children with simple febrile seizure s) who had undergone neuroimaging when they presented to the emergency department with a possible ''first seizure.'' Results: Eight of the 1 07 children had nonepileptic events (gastroesophageal reflux, syncopal event, rigor). Of the remaining 99 children, 49 had provoked seizures (complicated febrile seizure, meningo-encephalitis, toxic or metaboli c abnormalities), and 50 had unprovoked seizures. A total of 19 childr en had brain abnormalities identified on computed tomography (CT) scan ; 7 received further investigation or intervention as a result of CT s can findings (2 with tumors, 3 with vascular anomalies, 1 with cystice rcosis, and 1 with obstructive hydrocephalus). CT scan abnormalities r equiring treatment or monitoring were more frequently seen in children with their first unprovoked seizure (P <.01) and in those children wh ose seizure onset had been focal or who had focal abnormalities identi fied on postictal neurologic examination (P <.04). Conclusion: In a ch ild, a seizure in the setting of a fever rarely indicates the presence of an unexpected CT scan lesion requiring intervention.