Rashmi Virmani MD, Presenter: Nothing to Disclose

Sumeet Virmani MD, Abstract Co-Author: Nothing to Disclose

Seizures are common in children and about 5-10% of all pediatric admissions are related to seizures. The purpose of our study was to determine the incidence and type of various neuroimaging abnormalities in children presenting with a seizure.

This one year prospective study enrolled 120 consecutive children (69 male, 51 female) with seizure disorders in a tertiary care teaching hospital in northern India. All children presenting with seizures (generalized or focal) and in whom no clinical diagnosis was possible after clinical examination or routine lab investigations were included in the study. Children were initially screened with a detailed history, clinical examination and routine lab investigations as well as a radiograph of the skull. Observations were then made on the clinical type of seizures, duration of each episode and their correlation with computerized tomography (CT).

CT imaging was successfully performed on all 120 children with seizure disorders. Imaging results on CT were positive in 81/120 (67.5%; 95% CI, 58.26%-75.6%). Most common CT diagnosis was tuberculoma (25 patients), Neurocysticercosis (13 patients), and calcification (11 patients). 68/120 children had focal seizures, 50/120 children had generalized seizures and 2/120 children had recurrent febrile seizures. The CT positivity in children with focal seizures was 83.8% (95% CI, 73.3%-90.7%), while for children with generalized seizures it was only 48% (95% CI, 34.8%-61.4%). Also, children with prolonged duration of seizures (>10 min) or post-ictal weakness or abnormal neurological signs showed positive CT scans. Almost one third of total cases in our study required specific therapeutic interventions in addition to anticonvulsant which as compared to 0-3% quoted in western literature is very significant.

Children with seizure disorder with negative routine investigations were found to have a significantly high incidence of abnormalities when screened by CT scan reclassifying them into the proper etiological group and in turn affected their management.

We highly recommended that in all developing countries, CT scan if available must be performed in children with first afebrile seizure presenting with focal seizures or abnormal neurological finding.

Virmani, R, Virmani, S, Computed Tomography Imaging in Children with Seizures: Recommendations Based on a One-year Prospective Study in a Developing Country.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11034240.html