title: Pediatric first time non-febrile seizure with focal manifestations: is emergent imaging indicated?
abstract: OBJECTIVE
  To assess the prevalence of clinically urgent intra-cranial pathology among children who had imaging for a first episode of non-febrile seizure with focal manifestations.
  
  
  METHODS
  We performed a cross sectional study of all children age 1 month to 18 years evaluated for first episode of non-febrile seizure with focal manifestations and having neuroimaging performed within 24h of presentation at a single pediatric ED between 1995 and 2012. We excluded intubated patients, those with known structural brain abnormality and trauma. A single neuro-radiologist reviewed all cranial computed tomography and/or magnetic resonance imaging performed. We defined clinically urgent intracranial pathology as any finding resulting in a change of initial patient management. We performed univariate analysis using χ(2) analysis for categorical data and Mann-Whitney U test for continuous data.
  
  
  RESULTS
  We identified 319 patients having a median age of 4.6 years [IQR 1.8-9.4] of which 45% were female. Two hundred sixty-two children had a CT scan, 15 had an MR and 42 had both. Clinically urgent intra-cranial pathology was identified on imaging of 13 patients (4.1%; 95% CI: 2.2, 7.0). Infarction, hemorrhage and thrombosis were most common (9/13). Twelve of 13 were evident on CT scan. Persistent Todd's paresis and age ≤ 18 months were predictors of clinically urgent intracranial pathology. Absence of secondary generalization and multiple seizures on presentation were not predictive.
  
  
  CONCLUSIONS
  Four percent of children imaged with first time, afebrile focal seizures have findings important to initial management. Children younger than ≤ 18 months are at increased risk.
authors: Boston Children's Hospital, Department of Medicine, Division of Emergency Medicine, 300 Longwood Avenue, Boston, MA 02115, United States. Electronic address: Nadine.aprahamian@childrens.harvard.edu.
authors: N
authors: N
authors: Aprahamian
authors: Boston Children's Hospital, Department of Medicine, Division of Emergency Medicine, 300 Longwood Avenue, Boston, MA 02115, United States. Electronic address: Marvin.Harper@childrens.harvard.edu.
authors: M B
authors: MB
authors: Harper
authors: Boston Children's Hospital, Department of Neurology, Neuro-Radiology Unit, 300 Longwood Avenue, Boston, MA 02115, United States. Electronic address: Sanjay.prabhu@childrens.harvard.edu.
authors: S P
authors: SP
authors: Prabhu
authors: Boston Children's Hospital, Department of Medicine, Division of Emergency Medicine, 300 Longwood Avenue, Boston, MA 02115, United States. Electronic address: michael.monuteaux@childrens.harvard.edu.
authors: M C
authors: MC
authors: Monuteaux
authors: Boston Children's Hospital, Department of Medicine, Division of Emergency Medicine, 300 Longwood Avenue, Boston, MA 02115, United States. Electronic address: Zujajas@hotmail.com.
authors: Z
authors: Z
authors: Sadiq
authors: Boston Medical Center, Department of Neurology, One Boston Medical Center Place, Boston, MA 02118, United States. Electronic address: Alcy.Torres@bmc.org.
authors: A
authors: A
authors: Torres
authors: Boston Children's Hospital, Department of Medicine, Division of Emergency Medicine, 300 Longwood Avenue, Boston, MA 02115, United States. Electronic address: amir.kimia@childrens.harvard.edu.
authors: A A
authors: AA
authors: Kimia
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012640:Seizures / Q000150:complications* / Q000175:diagnosis*; D003294:Seizures, Febrile / Q000150:complications* / Q000175:diagnosis*; D018709:Statistics, Nonparametric
keywords: Focal manifestations; Imaging; Seizure