Compared with children with simple febrile seizures, children with complex febrile seizures were found to be more likely to have an imaging abnormality (14.8% in patients with complex febrile seizures and 11.4% in patients with simple febrile seizures), but these findings did not alter the clinical management. In the absence of other neurological indications such as post ictal focal deficits, neuroimaging in complex febrile seizures is unnecessary [18]. Imaging may be performed in selected patients where complex febrile seizure is part of the differential diagnosis but etiologies such as meningitis, encephalitis, or trauma are being considered clinically as the underlying cause of the seizures [19,22]. MRI may also be indicated in children with febrile status epilepticus (seizure lasting >30 minutes) because increased association with imaging findings have been demonstrated in this patient population [23]. CT Head CT is usually not indicated in the workup of a child with complex febrile seizures. An analysis of six studies, including a total of 161 children with complex febrile seizures, demonstrated that head CT revealed no findings requiring intervention [22]. FDG-PET/CT Brain FDG-PET/CT is usually not indicated in the workup of a child with complex febrile seizures. HMPAO SPECT or SPECT/CT Brain Tc-99m HMPAO SPECT or SPECT/CT is usually not indicated in the workup of a child with complex febrile seizures. Seizures-Child US Head There is no relevant literature to support the use of US in the workup of a child with post-traumatic seizures. MRI Head A typical MRI examination is longer compared with CT and may not be suited for an intimal examination in the acute trauma setting. MRI may not be practically feasible compared with CT, depending on the overall clinical status of the child. However, MRI has high sensitivity for detecting intracranial hemorrhage, microhemorrhage, and parenchymal injury.
Seizures Child. Compared with children with simple febrile seizures, children with complex febrile seizures were found to be more likely to have an imaging abnormality (14.8% in patients with complex febrile seizures and 11.4% in patients with simple febrile seizures), but these findings did not alter the clinical management. In the absence of other neurological indications such as post ictal focal deficits, neuroimaging in complex febrile seizures is unnecessary [18]. Imaging may be performed in selected patients where complex febrile seizure is part of the differential diagnosis but etiologies such as meningitis, encephalitis, or trauma are being considered clinically as the underlying cause of the seizures [19,22]. MRI may also be indicated in children with febrile status epilepticus (seizure lasting >30 minutes) because increased association with imaging findings have been demonstrated in this patient population [23]. CT Head CT is usually not indicated in the workup of a child with complex febrile seizures. An analysis of six studies, including a total of 161 children with complex febrile seizures, demonstrated that head CT revealed no findings requiring intervention [22]. FDG-PET/CT Brain FDG-PET/CT is usually not indicated in the workup of a child with complex febrile seizures. HMPAO SPECT or SPECT/CT Brain Tc-99m HMPAO SPECT or SPECT/CT is usually not indicated in the workup of a child with complex febrile seizures. Seizures-Child US Head There is no relevant literature to support the use of US in the workup of a child with post-traumatic seizures. MRI Head A typical MRI examination is longer compared with CT and may not be suited for an intimal examination in the acute trauma setting. MRI may not be practically feasible compared with CT, depending on the overall clinical status of the child. However, MRI has high sensitivity for detecting intracranial hemorrhage, microhemorrhage, and parenchymal injury.