The frequency of recurrence of focal seizures was found to be up to 94%, which is considerably greater than that for generalized seizures (72%) [34]. Several seizure syndromes (eg, benign rolandic seizures, benign occipital epilepsy with classic EEG findings) are sufficiently characteristic to be diagnosed clinically or through specific EEG patterns and usually do not require imaging. Patients that may benefit from imaging include those who do not have typical clinical or EEG findings. US Head There is no relevant literature to support the use of US in the workup of a child with focal seizures. MRI Head Seizures can result from multiple intracranial pathologies including developmental abnormalities, hemorrhage, neoplasm, and gliosis. Aprahamian et al [35] found that approximately 4% of children with first-time afebrile seizures and focal manifestations had urgent intracranial pathology, most commonly infarction, hemorrhage, and thrombosis. MRI is more sensitive than CT in detection of brain abnormalities and therefore should be the primary Seizures-Child imaging in children with newly diagnosed seizures [36]. In a study by Jan et al [37], MRI demonstrated focal brain abnormalities in 55% of children with seizures, whereas CT was positive in only 18% of children. In the Aprahamian et al [35] study, 205 of 252 children who had a CT scan for their urgent imaging also had a subsequent MRI. Of these 205 children, 58 (28.2%) had abnormal findings on MRI, 29% of abnormal intracranial findings were not seen on initial CT in children with new-onset afebrile seizures with focal features [35]. In a study by Singh et al [38], MRI detected abnormalities not identified by CT in 47% of children who presented with new-onset status epilepticus. Additionally, MRI is superior to CT in identifying peri-ictal cortical abnormalities that might explain clinical deficits after acute seizure [39]. The epileptogenic lesion may not be detected using routine MRI protocols.
Seizures Child. The frequency of recurrence of focal seizures was found to be up to 94%, which is considerably greater than that for generalized seizures (72%) [34]. Several seizure syndromes (eg, benign rolandic seizures, benign occipital epilepsy with classic EEG findings) are sufficiently characteristic to be diagnosed clinically or through specific EEG patterns and usually do not require imaging. Patients that may benefit from imaging include those who do not have typical clinical or EEG findings. US Head There is no relevant literature to support the use of US in the workup of a child with focal seizures. MRI Head Seizures can result from multiple intracranial pathologies including developmental abnormalities, hemorrhage, neoplasm, and gliosis. Aprahamian et al [35] found that approximately 4% of children with first-time afebrile seizures and focal manifestations had urgent intracranial pathology, most commonly infarction, hemorrhage, and thrombosis. MRI is more sensitive than CT in detection of brain abnormalities and therefore should be the primary Seizures-Child imaging in children with newly diagnosed seizures [36]. In a study by Jan et al [37], MRI demonstrated focal brain abnormalities in 55% of children with seizures, whereas CT was positive in only 18% of children. In the Aprahamian et al [35] study, 205 of 252 children who had a CT scan for their urgent imaging also had a subsequent MRI. Of these 205 children, 58 (28.2%) had abnormal findings on MRI, 29% of abnormal intracranial findings were not seen on initial CT in children with new-onset afebrile seizures with focal features [35]. In a study by Singh et al [38], MRI detected abnormalities not identified by CT in 47% of children who presented with new-onset status epilepticus. Additionally, MRI is superior to CT in identifying peri-ictal cortical abnormalities that might explain clinical deficits after acute seizure [39]. The epileptogenic lesion may not be detected using routine MRI protocols.