Neuroimaging Evaluation for First Attack of Unprovoked Nonfebrile Seizure in Pediatrics: When to Order?

Objective: To assess the value of neuroimaging studies in evaluating pediatric patients presenting with a first attack of nonfebrile seizure. Method: We reviewed the medical records of pediatric patients aged 28 days to 12 years who were admitted between 1 January and 31 December 2013 with a first attack of unprovoked, afebrile seizure. These patients had undergone neuroimaging studies. The exclusion criterion was patients with known predisposing conditions for seizure. The computed tomography (CT) scan and magnetic resonance imaging (MRI) results were either normal or abnormal, and the abnormal ones were further classified into clinically insignificant or significant. Descriptive analysis was performed to summarize the data. Result: Fifty children were identified with a mean age of 5.2 ± 3.8 years. Of the 50 subjects, 29 (58.0%) were males and 21 (42.0%) were females. Sixteen patients (32.0%) had abnormal neuroimaging studies (CT scan, MRI or both); however, only 1 was considered to have a clinically significant abnormality, later diagnosed as Moyamoya disease. Conclusion: In this study, the neuroimaging studies were found not to be useful in evaluating pediatric patients presenting with a first attack of unprovoked, nonfebrile seizures.