NEUROIMAGING IN CHILDREN DURING THE ACUTE EVALUATION OF NEW ONSET SEIZURES
Abstract number :
1.204
Submission category :
Year :
2002
Submission ID :
3298
Source :
www.aesnet.org
Presentation date :
12/7/2002 12:00:00 AM
Published date :
Dec 1, 2002, 06:00 AM
Authors :
Maria T. Acosta, Taeun Chang, Tenna Rosser, Marian Kolodgie, Joan A. Conry, Phillip L. Pearl, Steve L. Weinstein, Pat Johnson, Gilbert Vezina, Elizabeth Dubovsky, William D. Gaillard. Neurology, Children[ssquote]s National Medical Center, Washington, DC;
RATIONALE: The utility of CT and MRI in children with new onset seizures is debated. Neuroimaging is advocated to determine seizure etiology and prognosis, and plan therapy. CT or MRI has been considered mandatory in patients with partial seizures, focal neurological examination or focal alterations on EEG. Rational utilization of neuroimaging during the evaluation of children that present to the emergency department with a first seizure is discussed in this presentation. Correlation among clinical findings, EEG and neuroimaging is presented for patients with new onset partial seizures.
METHODS: We prospectively evaluated 191 patients diagnosed with New Onset Seizures over 11 months at Children[ssquote]s National Medical Center as part of a clinical care pathway. CT was mandatory as part of the evaluation. MRI was done based on clinical considerations.
RESULTS: A total of 189 patients (99%) had CT and 58 (30%) had MRI. CT scans were abnormal in 48 patients (25%) with 6 acute findings (tumor, hemorrhage, infarct) and 42 chronic findings. MRI was performed for: abnormal CT in 14 (24%), focal neurologic examinations (15), focal EEG [30 including hypsarrhythmia (3)]. Twenty eight MRIs (48%) were abnormal: dysplasia (13), remote symptomaric (5), metabolic (2), acute processes (3), tumors (4) and mesial temporal sclerosis (MTS 1). Abnormal MRI was found in 14 patients (7%) with normal CT: brain stem lesions (2), atrophy (2), ventricular/lobular asymmetries (3), metabolic disease (2), periventricular leukomalacia (1), MTS (1) and migrational disorders (3). 12/14 (85%) of these patients had partial seizures.
109 patients (57%) had partial seizures. 27 (25% ) had abnormal neurological examination and 27 (25%) had abnormal CT including 3 patients with acute pathology (2 ischemia, 1 hemorrhage) and 11 patients with chronic changes (PVL, old infarct, migrational disorders). 17 (16%) had abnormal MRI and 12 (70%) of these patients had previous normal CT.
CONCLUSIONS: Seizure etiology that will change acute medical managemant can be identified mostly with CT. MRI provides additional information regarding etiology, and may provide long term prognostic information, especially in the presence of partial seizures even with normal CT.