NEUROLOGY 2010;74:150-156
© 2010 American Academy of Neurology
New-onset afebrile seizures in infants
Role of neuroimaging
D. T. Hsieh, MD,
T. Chang, MD,
T. N. Tsuchida, MD, PhD,
L. G. Vezina, MD,
A. Vanderver, MD,
J. Siedel, BA,
K. Brown, MD,
M. M. Berl, PhD,
S. Stephens, BA,
A. Zeitchick, BA and
W. D. Gaillard, MD
From the Center for Neuroscience (D.T.H., T.C., T.N.T., A.V., J.S., M.M.B., S.S., A.Z., W.D.G.), Department of Neuroradiology (L.G.V.), and Department of Emergency Medicine (K.B.), Children's National Medical Center, Washington, DC; and San Antonio Military Medical Center (D.T.H.), Division of Child Neurology, Wilford Hall Medical Center, Lackland AFB, TX.
Address correspondence and reprint requests to Dr. William Davis Gaillard, Center for Neuroscience, Children's National Medical Center, Washington, DC 20010 wgaillar{at}cnmc.org
Objective: To investigate the presenting characteristics of new-onset afebrile seizures in infants (age 1–24 months) and the yield of neuroimaging.
Methods: Prospective data were obtained from a standardized evaluation and management plan mandated by a critical care pathway. A total of 317 infants presented with new-onset afebrile seizures between 2001 and 2007. EEG was performed on 90.3%, head CT was obtained on 94%, and MRI was obtained on 57.4%.
Results: We found half of the infants had partial features to their seizures, yet evidence for primary generalized seizures was rare. The majority had more than 1 seizure upon presentation. Seizures in this age group tended to be brief, with 44% lasting less than 1 minute. EEG abnormalities were found in half. One-third of CTs were abnormal, with 9% of all CTs requiring acute medical management. Over half of MRIs were abnormal, with cerebral dysgenesis being the most common abnormality (p < 0.05). One-third of normal CTs had a subsequent abnormal MRI—only 1 resulted in altered medical management.
Conclusions: Infantile seizures are usually brief, but commonly recurrent, and strong consideration should be made for inpatient observation. Acute imaging with CT can alter management in a small but important number of infants. Due to the superior yield, strong consideration for MRI should be given for all infants, as primary generalized seizures are rare, and there is a high rate of cerebral dysgenesis.
Abbreviations: ED = emergency department; ILAE = International League Against Epilepsy; IRB = Institutional Review Board.
Supplemental data at www.neurology.org
The views expressed in this article are those of the author(s) and do not reflect the official policy or position of the United States Air Force, Department of Defense, or the U.S. Government.
Disclosure: Author disclosures are provided at the end of the article.
Received February 2, 2009. Accepted in final form October 27, 2009.
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M. Garber
Role of Neuroimaging in New-onset Afebrile Seizures in Infants
AAP Grand Rounds,
May 1, 2010;
23(5):
51 - 51.
[Full Text]
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Neuroimaging for Afebrile Seizures in Infants
Journal Watch Neurology,
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2010(427):
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