MRI is typically not indicated in patients with very typical forms of primary generalized epilepsy (eg, juvenile myoclonic epilepsy, childhood absence) or patients with characteristic clinical and EEG features and patients with adequate response to antiepileptic drugs. Sharma et al [31] studied 500 consecutive emergency department patients presenting with a first afebrile seizure. They defined two clinically significant high-risk indicators of abnormal neuroimaging: 1) presence of predisposing condition, and 2) focal seizure. Only 2% of low-risk patients had abnormal imaging findings on MRI. CT Head CT is usually not indicated in the evaluation of an otherwise neurologically normal child with a generalized seizure. The frequency of positive CT findings in patients with idiopathic generalized seizures in children with normal neurologic examination and negative EEG has been estimated to be 2.5% [41,42]. FDG-PET/CT Brain There is no relevant literature to support the use of FDG-PET/CT in the workup of a neurologically normal child with generalized seizure. Seizures-Child HMPAO SPECT or SPECT/CT Brain There is no relevant literature to support the use of Tc-99m HMPAO SPECT/CT in the workup of a neurologically normal child with generalized seizure. US Head There is no relevant literature to support the use of US in the workup of a child with generalized seizure and abnormal neurological findings. MRI Head Patients with generalized seizures and abnormal neurologic findings can significantly benefit from MRI. MRI offers higher soft-tissue contrast than CT and provides additional information regarding brain anatomy. CT Head CT has a limited role in the evaluation of a child with generalized seizures and abnormal neurological examination. Young et al [33] reported only 6% of CT examinations were positive for generalized seizures in contrast to nearly 50% positivity in focal epilepsy.
Seizures Child. MRI is typically not indicated in patients with very typical forms of primary generalized epilepsy (eg, juvenile myoclonic epilepsy, childhood absence) or patients with characteristic clinical and EEG features and patients with adequate response to antiepileptic drugs. Sharma et al [31] studied 500 consecutive emergency department patients presenting with a first afebrile seizure. They defined two clinically significant high-risk indicators of abnormal neuroimaging: 1) presence of predisposing condition, and 2) focal seizure. Only 2% of low-risk patients had abnormal imaging findings on MRI. CT Head CT is usually not indicated in the evaluation of an otherwise neurologically normal child with a generalized seizure. The frequency of positive CT findings in patients with idiopathic generalized seizures in children with normal neurologic examination and negative EEG has been estimated to be 2.5% [41,42]. FDG-PET/CT Brain There is no relevant literature to support the use of FDG-PET/CT in the workup of a neurologically normal child with generalized seizure. Seizures-Child HMPAO SPECT or SPECT/CT Brain There is no relevant literature to support the use of Tc-99m HMPAO SPECT/CT in the workup of a neurologically normal child with generalized seizure. US Head There is no relevant literature to support the use of US in the workup of a child with generalized seizure and abnormal neurological findings. MRI Head Patients with generalized seizures and abnormal neurologic findings can significantly benefit from MRI. MRI offers higher soft-tissue contrast than CT and provides additional information regarding brain anatomy. CT Head CT has a limited role in the evaluation of a child with generalized seizures and abnormal neurological examination. Young et al [33] reported only 6% of CT examinations were positive for generalized seizures in contrast to nearly 50% positivity in focal epilepsy.