In a small prospective study of children with febrile seizures, definite abnormalities on brain MRI were found in 11.4% of children with simple febrile seizures, suggesting that brain abnormalities may lower seizure threshold in febrile children, but none of the imaging findings affected clinical management, hence it did not alter the recommendation that imaging is not indicated [17,18]. CT Head There is no relevant literature to support the use of CT in the workup of a child with simple febrile seizures. FDG-PET/CT Brain There is no relevant literature to support the use of FDG-PET/CT in the workup of a child with simple febrile seizures. HMPAO SPECT or SPECT/CT Brain There is no relevant literature to support the use of Tc-99m HMPAO SPECT or SPECT/CT in the workup of a child with simple febrile seizures. Variant 3: Children 6 months to 5 years of age. Complex febrile seizures. Initial imaging. Complex febrile seizures account for about a third of all febrile seizures in infants and young children (6 months to 5 years of age). Complex febrile seizures are defined as seizures that last >15 minutes, recur more than once in 24 hours, or are focal [19,20]. Seizures in the setting of fever associated with underlying pathology, such as meningitis, encephalitis, or child abuse may present similarly, but are not considered complex febrile seizures by definition. There is a small increased risk for children with complex febrile seizures to develop epilepsy (ie, subsequent afebrile seizures) later in life, but other than an EEG and evaluation by a neurologist, imaging recommendations are the same as for simple febrile seizures [21]. US Head There is no relevant literature to support the use of US in the workup of a child with complex febrile seizures. MRI Head In one study of children with febrile seizures recurrent within 24 hours, neuroimaging revealed benign findings in 7.4% of patients and did not add significant diagnostic or prognostic information [17].
Seizures Child. In a small prospective study of children with febrile seizures, definite abnormalities on brain MRI were found in 11.4% of children with simple febrile seizures, suggesting that brain abnormalities may lower seizure threshold in febrile children, but none of the imaging findings affected clinical management, hence it did not alter the recommendation that imaging is not indicated [17,18]. CT Head There is no relevant literature to support the use of CT in the workup of a child with simple febrile seizures. FDG-PET/CT Brain There is no relevant literature to support the use of FDG-PET/CT in the workup of a child with simple febrile seizures. HMPAO SPECT or SPECT/CT Brain There is no relevant literature to support the use of Tc-99m HMPAO SPECT or SPECT/CT in the workup of a child with simple febrile seizures. Variant 3: Children 6 months to 5 years of age. Complex febrile seizures. Initial imaging. Complex febrile seizures account for about a third of all febrile seizures in infants and young children (6 months to 5 years of age). Complex febrile seizures are defined as seizures that last >15 minutes, recur more than once in 24 hours, or are focal [19,20]. Seizures in the setting of fever associated with underlying pathology, such as meningitis, encephalitis, or child abuse may present similarly, but are not considered complex febrile seizures by definition. There is a small increased risk for children with complex febrile seizures to develop epilepsy (ie, subsequent afebrile seizures) later in life, but other than an EEG and evaluation by a neurologist, imaging recommendations are the same as for simple febrile seizures [21]. US Head There is no relevant literature to support the use of US in the workup of a child with complex febrile seizures. MRI Head In one study of children with febrile seizures recurrent within 24 hours, neuroimaging revealed benign findings in 7.4% of patients and did not add significant diagnostic or prognostic information [17].