Pediatric neuroimaging of seizures

Abstract

Key Points: □ Neuroimaging (MRI/CT) in children with seizures rules out life-threatening brain lesions requiring immediate medical or surgical treatment (moderate evidence). □ Magnetic resonance imaging is the neuroimaging study of choice in the workup of first unprovoked seizure (moderate evidence). □ Emergency imaging with CT or MR should be performed in cases of long-lasting post-ictal confusion or focal deficit, in first unprovoked seizure (limited to moderate evidence). □ Magnetic resonance is indicated in children with motor or developmental delays or under 1 year of age with symptomatic seizures (moderate evidence). □ Neuroimaging is not recommended for a simple febrile seizure (limited evidence). □ MRI is more sensitive than CT in detecting temporal lobe pathology (limited evidence). □ The presence of a focal lesion on MRI is a strong predictor of intractable seizures in children with new onset of temporal lobe epilepsy (TLE) (moderate evidence). □ Abnormal MRI may be found in more than 35% of patients with TLE (moderate evidence). □ Generalized abnormalities in neuroimaging are correlated with higher risk of status epilepticus (moderate evidence). □ Use of fMR increases importantly the post-test probabilities of hemispheric language dominance in patients with epilepsy (Bayesian analysis). © 2010 Springer-Verlag New York.