Paediatric, Seizure
Pathway Home
Population Covered By The Guidance
This pathway provides guidance on imaging children with unexplained seizures.
Date reviewed: May 2017
Date of next review: July 2023
Published: September 2017
Quick User Guide
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The relative radiation level (RRL) of each imaging investigation is displayed in the pop up box.
SYMBOL | RRL | EFFECTIVE DOSE RANGE |
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None | 0 |
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Minimal | < 1 millisieverts |
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Low | 1-5 mSv |
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Medium | 5-10 mSv |
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High | >10 mSv |
Teaching Points
Teaching Points
- A seizure is defined as “a transient episode of clinical signs and symptoms due to abnormal, synchronous and excessive neuronal discharge in the brain, particularly the cerebral cortex”
- This pathway presents an approach to the investigation and management of unexplained seizures in a paediatric population
- Seizures in younger children differ significantly from those in older children and adults. Children younger than six have less complex behaviours, particularly with focal seizures with impairment of awareness
- History, clinical examination, laboratory investigations and EEG (or Video-EEG) form very important initial steps in diagnosing epilepsy and semi-acute/chronic seizure forms
- Imaging provides further proof to suspected aetiology or its contrary, provides prognostic information, may direct the treatment being planned, helps in localization of the epileptic focus and helps in surgical planning when structural abnormalities are detected
- A significant abnormality on imaging is rare in the absence of a specific seizure pattern, abnormal neurology or an abnormal EEG finding
- Simple febrile seizures do not require imaging
- US should be the first imaging modality for evaluating neonatal seizures though MRI will often also be required
- Imaging, preferentially MRI, is indicated in partial seizures and generalized seizures accompanied by abnormal neurologic findings or other risk factors
References
References
References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document
- Fisher RS, Cross JH, French JA, Higurashi N, Hirsch E, Jansen FE, et al. Operational classification of seizure types by the International League Against Epilepsy: Position Paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017;58(4):522-30. (Guidelines). View the reference
- Seizures and epilepsy in children: Classification, etiology, and clinical features [Internet]. 2016 [cited May 04, 2017]. Available from: (Review article). View the reference
- Berg AT, Berkovic SF, Brodie MJ, Buchhalter J, Cross JH, van Emde Boas W, et al. Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology, 2005-2009. Epilepsia. 2010;51(4):676-85. (Guidelines). View the reference
- Engel J, Jr. Report of the ILAE classification core group. Epilepsia. 2006;47(9):1558-68. (Guidelines). View the reference
- National Guideline Clearinghouse (NGC). Guideline summary: ACR Appropriateness Criteria® seizures — child Rockville MD: Agency for Healthcare Research and Quality (AHRQ); 2012. Available from: (Guidelines). View the reference
- Ronen GM, Penney S, Andrews W. The epidemiology of clinical neonatal seizures in Newfoundland: a population-based study. J Pediatr. 1999;134(1):71-5. (Level III evidence). View the reference
- Lanska MJ, Lanska DJ. Neonatal seizures in the United States: results of the National Hospital Discharge Survey, 1980-1991. Neuroepidemiology. 1996;15(3):117-25. (Level III evidence). View the reference
- Seshia SS, Huntsman RJ, Lowry NJ, Seshia M, Yager JY, Sankaran K Neonatal seizures: diagnosis and management. Zhongguo Dang Dai Er Ke Za Zhi. 2011;13(2):81-100. (Review article). View the reference
- Krishnamoorthy KS, Soman TB, Takeoka M, Schaefer PW. Diffusion-Weighted Imaging in Neonatal Cerebral Infarction: Clinical Utility and Follow-Up. Journal of Child Neurology. 2000;15(9):592-602. (Level III evidence). View the reference
- Sfaihi L, Maaloul I, Kmiha S, Aloulou H, Chabchoub I, Kamoun T, et al. Febrile seizures: an epidemiological and outcome study of 482 cases. Childs Nerv Syst. 2012;28(10):1779-84. (Level III evidence). View the reference
- Oluwabusi T, Sood SK. Update on the management of simple febrile seizures: emphasis on minimal intervention. Curr Opin Pediatr. 2012;24(2):259-65. (Review article). View the reference
- Kimia AA, Bachur RG, Torres A, Harper MB. Febrile seizures: emergency medicine perspective. Curr Opin Pediatr. 2015;27(3):292-7. (Review article). View the reference
- Kimia AA, Ben-Joseph E, Prabhu S, Rudloe T, Capraro A, Sarco D, et al. Yield of emergent neuroimaging among children presenting with a first complex febrile seizure. Pediatr Emerg Care. 2012;28(4):316-21. (Level III evidence). View the reference
- Hardasmalani MD, Saber M. Yield of diagnostic studies in children presenting with complex febrile seizures. Pediatr Emerg Care. 2012;28(8):789-91. (Level III evidence). View the reference
- Hsieh DT, Chang T, Tsuchida TN, Vezina LG, Vanderver A, Siedel J, et al. New-onset afebrile seizures in infants: Role of neuroimaging. Neurology. 2010;74(2):150-6. (Level III evidence). View the reference
- Berg AT, Testa FM, Levy SR, Shinnar S. Neuroimaging in children with newly diagnosed epilepsy: A community-based study. Pediatrics. 2000;106(3):527-32. (Levl III evidence). View the reference
- Sharma S, Riviello JJ, Harper MB, Baskin MN. The role of emergent neuroimaging in children with new-onset afebrile seizures. Pediatrics. 2003;111(1):1-5. (Level II/III evidence). View the reference
- Gaillard WD, Chiron C, Cross JH, Harvey AS, Kuzniecky R, Hertz-Pannier L, et al. Guidelines for imaging infants and children with recent-onset epilepsy. Epilepsia. 2009;50(9):2147-53. (Guidelines). View the reference
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Information for Consumers
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