New-onset afebrile seizures in infants: role of neuroimaging

• Published in: Neurology Vol. 74; no. 2; p. 150
• Main Authors: Hsieh, D T, Chang, T, Tsuchida, T N, Vezina, L G, Vanderver, A, Siedel, J, Brown, K, Berl, M M, Stephens, S, Zeitchick, A, Gaillard, W D
• Format: Journal Article
• Language: English
• Published: United States 12.01.2010
• Subjects: Age Factors; Aging - physiology; Brain - abnormalities; Brain - pathology; Brain - physiopathology; Brain Mapping; Cerebral Cortex - abnormalities; Cerebral Cortex - pathology; Cerebral Cortex - physiopathology; Child, Preschool; Diagnostic Imaging - methods; Diagnostic Imaging - trends; Electroencephalography - methods; Female; Humans; Image Processing, Computer-Assisted - methods; Infant; Infant, Newborn; Male; Nervous System Malformations - complications; Nervous System Malformations - diagnosis; Nervous System Malformations - physiopathology; Predictive Value of Tests; Prospective Studies; Seizures - diagnosis; Seizures - physiopathology; Signal Processing, Computer-Assisted; Tomography, X-Ray Computed - methods
• ISSN: 1526-632X
• DOI: 10.1212/WNL.0b013e3181c91847

To investigate the presenting characteristics of new-onset afebrile seizures in infants (age 1-24 months) and the yield of neuroimaging. 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%. 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. 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.