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Pediatrics. 2015 Aug;136(2):e351-60. doi: 10.1542/peds.2014-3550. Epub 2015 Jul 20.

Prevalence of and Risk Factors for Intracranial Abnormalities in Unprovoked Seizures.

Author information

1
Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York; psd6@columbia.edu.
2
Department of Pediatrics, State University of New York at Buffalo, Buffalo, New York;
3
Department of Pediatrics, Alfred I. duPont Hospital for Children, Wilmington, Delaware;
4
Department of Emergency Medicine, University of Rochester, Rochester, New York;
5
Department of Pediatrics, Baylor College of Medicine, Houston, Texas;
6
Departments of Emergency Medicine and Pediatrics, Upstate Medical College, Syracuse, New York;
7
Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York;
8
Department of Biostatistics, Columbia University Medical Center, New York, New York;
9
Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York; Gertrude Sergievsky Center, New York, New York; and.
10
Departments of Emergency Medicine and Pediatrics, Davis School of Medicine, University of California, Sacramento, California.

Abstract

BACKGROUND AND OBJECTIVES:

Prospective data are lacking to determine which children might benefit from prompt neuroimaging after unprovoked seizures. We aimed to determine the prevalence of, and risk factors for, relevant intracranial abnormalities in children with first, unprovoked seizures.

METHODS:

We conducted a 6-center prospective study in children aged >28 days to 18 years with seemingly unprovoked seizures. Emergency department (ED) clinicians documented clinical findings on a standardized form. Our main outcome was the presence of a clinically relevant intracranial abnormality on computed tomography (CT) or MRI, defined as those that might change management, either emergently, urgently, or nonurgently.

RESULTS:

We enrolled 475 of 625 (76%) eligible patients. Of 354 patients for whom cranial MRI or CT scans were obtained in the ED or within 4 months of the ED visit, 40 (11.3%; 95% confidence interval [CI]: 8.0-14.6%) had clinically relevant intracranial abnormalities, with 3 (0.8%; 95% CI: 0.1-1.8%) having emergent/urgent abnormalities. On logistic regression analysis, a high-risk past medical history (adjusted odds ratio: 9.2; 95% CI: 2.4-35.7) and any focal aspect to the seizure (odds ratio: 2.5; 95% CI: 1.2-5.3) were independently associated with clinically relevant abnormalities.

CONCLUSIONS:

Clinically relevant intracranial abnormalities occur in 11% of children with first, unprovoked seizures. Emergent/urgent abnormalities, however, occur in <1%, suggesting that most children do not require neuroimaging in the ED. Findings on patient history and physical examination identify patients at higher risk of relevant abnormalities.

PMID:
26195538
PMCID:
PMC4516940
DOI:
10.1542/peds.2014-3550
[Indexed for MEDLINE]
Free PMC Article

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