New-onset afebrile seizures in infants: role of neuroimaging.
OBJECTIVE
To investigate the presenting characteristics of new-onset afebrile seizures in infants (age 1-24 months) and the yield of neuroimaging.


METHODS
Prospective data were obtained from a standardized evaluation and management plan mandated by a critical care pathway. A total of 317 infants presented with new-onset afebrile seizures between 2001 and 2007. EEG was performed on 90.3%, head CT was obtained on 94%, and MRI was obtained on 57.4%.


RESULTS
We found half of the infants had partial features to their seizures, yet evidence for primary generalized seizures was rare. The majority had more than 1 seizure upon presentation. Seizures in this age group tended to be brief, with 44% lasting less than 1 minute. EEG abnormalities were found in half. One-third of CTs were abnormal, with 9% of all CTs requiring acute medical management. Over half of MRIs were abnormal, with cerebral dysgenesis being the most common abnormality (p < 0.05). One-third of normal CTs had a subsequent abnormal MRI-only 1 resulted in altered medical management.


CONCLUSIONS
Infantile seizures are usually brief, but commonly recurrent, and strong consideration should be made for inpatient observation. Acute imaging with CT can alter management in a small but important number of infants. Due to the superior yield, strong consideration for MRI should be given for all infants, as primary generalized seizures are rare, and there is a high rate of cerebral dysgenesis.
Hsieh
D T
DT
Center for Neuroscience, Children's National Medical Center, Washington, DC 20010, USA.
Chang
T
T
Tsuchida
T N
TN
Vezina
L G
LG
Vanderver
A
A
Siedel
J
J
Brown
K
K
Berl
M M
MM
Stephens
S
S
Zeitchick
A
A
Gaillard
W D
WD
D000367:Age Factors; D000375:Aging / Q000502:physiology*; D001921:Brain / Q000002:abnormalities / Q000473:pathology* / Q000503:physiopathology*; D001931:Brain Mapping; D002540:Cerebral Cortex / Q000002:abnormalities / Q000473:pathology / Q000503:physiopathology; D002675:Child, Preschool; D003952:Diagnostic Imaging / Q000379:methods* / Q000639:trends*; D004569:Electroencephalography / Q000379:methods; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009421:Nervous System Malformations / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012640:Seizures / Q000175:diagnosis* / Q000503:physiopathology*; D012815:Signal Processing, Computer-Assisted; D014057:Tomography, X-Ray Computed / Q000379:methods