Factors Associated with Neuroimaging Abnormalities in Children with Afebrile Seizure: A Retrospective Multicenter Study

Overview

Journal West J Emerg Med

Specialty Emergency Medicine

Date 2023 Mar 28

PMID 36976593

Authors

Seungho Woo

Sangun Nah

Minsol Kim

Sangil Kim

Dongwook Lee

Jaewook Lee

Jieun Moon

Sangsoo Han

Affiliations

Soon will be listed here.

Abstract

Introduction: Neuroimaging is recommended for patients with seizures to identify intracranial pathology. However, emergency physicians should consider the risks and benefits of neuroimaging in pediatric patients because of their need for sedation and greater sensitivity to radiation than adults. The purpose of this study was to identify associated factors of neuroimaging abnormalities in pediatric patients experiencing their first afebrile seizure.

Methods: This was a retrospective, multicenter study that included children who presented to the emergency departments (ED) of three hospitals due to afebrile seizures between January 2018-December 2020. We excluded children with a history of seizure or acute trauma and those with incomplete medical records. A single protocol was followed in the three EDs for all pediatric patients experiencing their first afebrile seizure. We performed multivariable logistic regression analysis to identify factors associated with neuroimaging abnormalities.

Results: In total, 323 pediatric patients fulfilled the study criteria, and neuroimaging abnormalities were observed in 95 patients (29.4%). Multivariable logistic regression analysis showed that Todd's paralysis (odds ratio [OR] 3.72, 95% confidence interval [CI] 1.03-13.36; P=0.04), absence of poor oral intake (POI) (OR 0.21, 95% CI 0.05-0.98; P=0.05), lactic acidosis (OR 1.16, 95% CI 1.04-1.30; P=0.01), and higher level of bilirubin (OR 3.33, 95% CI 1.11-9.95; P=0.03) were significantly associated with neuroimaging abnormalities. Based on these results, we constructed a nomogram to predict the probability of brain imaging abnormalities.

Conclusion: Todd's paralysis, absence of POI, and higher levels of lactic acid and bilirubin were associated factors of neuroimaging abnormalities in pediatric patients with afebrile seizure.

References

Huff J, Morris D, Kothari R, Gibbs M . Emergency department management of patients with seizures: a multicenter study. Acad Emerg Med. 2001; 8(6):622-8. DOI: 10.1111/j.1553-2712.2001.tb00175.x. View

Luat A, Coyle L, Kamat D . The Ketogenic Diet: A Practical Guide for Pediatricians. Pediatr Ann. 2016; 45(12):e446-e450. DOI: 10.3928/19382359-20161109-01. View

Magnusson C, Herlitz J, Hoglind R, Wennberg P, Edelvik Tranberg A, Axelsson C . Prehospital lactate levels in blood as a seizure biomarker: A multi-center observational study. Epilepsia. 2021; 62(2):408-415. PMC: 7898511. DOI: 10.1111/epi.16806. View

Worster A, Bledsoe R, Cleve P, Fernandes C, Upadhye S, Eva K . Reassessing the methods of medical record review studies in emergency medicine research. Ann Emerg Med. 2005; 45(4):448-51. DOI: 10.1016/j.annemergmed.2004.11.021. View

Hsieh D, Chang T, Tsuchida T, Vezina L, Vanderver A, Siedel J . New-onset afebrile seizures in infants: role of neuroimaging. Neurology. 2010; 74(2):150-6. PMC: 2809027. DOI: 10.1212/WNL.0b013e3181c91847. View

Tharp B . An overview of pediatric seizure disorders and epileptic syndromes. Epilepsia. 1987; 28 Suppl 1:S36-45. DOI: 10.1111/j.1528-1157.1987.tb05755.x. View

Shinnar S, Berg A, Moshe S, ODell C, Alemany M, Newstein D . The risk of seizure recurrence after a first unprovoked afebrile seizure in childhood: an extended follow-up. Pediatrics. 1996; 98(2 Pt 1):216-25. View

Raschle N, Zuk J, Ortiz-Mantilla S, Sliva D, Franceschi A, Grant P . Pediatric neuroimaging in early childhood and infancy: challenges and practical guidelines. Ann N Y Acad Sci. 2012; 1252:43-50. PMC: 3499030. DOI: 10.1111/j.1749-6632.2012.06457.x. View

Sharma S, Riviello J, Harper M, Baskin M . The role of emergent neuroimaging in children with new-onset afebrile seizures. Pediatrics. 2003; 111(1):1-5. DOI: 10.1542/peds.111.1.1. View

10.

. Neurodiagnostic evaluation of the child with a simple febrile seizure. Pediatrics. 2011; 127(2):389-94. DOI: 10.1542/peds.2010-3318. View

11.

Lee J, Ryu J, Lee J, Ko T, Yum M . Clinical Implications of Ketosis in Children with Benign Convulsions with Mild Gastroenteritis. J Clin Neurol. 2020; 16(1):96-101. PMC: 6974832. DOI: 10.3988/jcn.2020.16.1.96. View

12.

Yigit O, Eray O, Mihci E, Yilmaz D, Arslan S, Eray B . The utility of EEG in the emergency department. Emerg Med J. 2011; 29(4):301-5. DOI: 10.1136/emj.2011.112888. View

13.

Berg A, Levy S, Novotny E, Shinnar S . Predictors of intractable epilepsy in childhood: a case-control study. Epilepsia. 1996; 37(1):24-30. DOI: 10.1111/j.1528-1157.1996.tb00507.x. View

14.

Symonds J, Zuberi S, Stewart K, McLellan A, ORegan M, MacLeod S . Incidence and phenotypes of childhood-onset genetic epilepsies: a prospective population-based national cohort. Brain. 2019; 142(8):2303-2318. PMC: 6658850. DOI: 10.1093/brain/awz195. View

15.

Amagasa S, Uematsu S, Tsuji S, Nagai A, Abe Y, Kubota M . Identification of children with first afebrile seizure for whom neuroimaging is unnecessary. Seizure. 2021; 93:140-144. DOI: 10.1016/j.seizure.2021.10.022. View

16.

Aprahamian N, Harper M, Prabhu S, Monuteaux M, Sadiq Z, Torres A . Pediatric first time non-febrile seizure with focal manifestations: is emergent imaging indicated?. Seizure. 2014; 23(9):740-5. DOI: 10.1016/j.seizure.2014.06.003. View

17.

Panayiotopoulos C . Significance of the EEG after the first afebrile seizure. Arch Dis Child. 1998; 78(6):575-6; discussion 576-7. PMC: 1717611. DOI: 10.1136/adc.78.6.575. View

18.

Hirtz D, Ashwal S, Berg A, Bettis D, Camfield C, Camfield P . Practice parameter: evaluating a first nonfebrile seizure in children: report of the quality standards subcommittee of the American Academy of Neurology, The Child Neurology Society, and The American Epilepsy Society. Neurology. 2000; 55(5):616-23. DOI: 10.1212/wnl.55.5.616. View

19.

Russ S, Larson K, Halfon N . A national profile of childhood epilepsy and seizure disorder. Pediatrics. 2012; 129(2):256-64. DOI: 10.1542/peds.2010-1371. View

20.

Shapiro S . Bilirubin toxicity in the developing nervous system. Pediatr Neurol. 2003; 29(5):410-21. DOI: 10.1016/j.pediatrneurol.2003.09.011. View