I think yor question is too general. May be a specific case would
clarify the question better. The reason I say this is that I do NOT
believe every new afebrile seizure deserves expensive neuroimaging as
the group suggest.
It is well known that less than half of new onset generalized afebrile
seizures do not have any recurrences. I believe that an elective
referral to NEUROLOGY (no, my spouse is not a neurologist!!!!) with
another detailed exam including fundoscopy and an initial EEG looking
for focality or typical patterns suggestive of epilepsy etc is a more
appropriate and COST EFFECTIVE start.
I think imaging a new afebrile tonic clonic seizure is justified only if
there is (a)clear evidence of a focality in the description of the
seizure or a description consistent with a partial seizure (b)focality
on exam or on EEG (c)evidence of raised ICP (d)neurocutaneous stigmata
(e)neurodevelopmental delay (f) antecedent risk factors like trauma,
coagulapathy or shunt.
If their description fits an absence seizure clinically & on EEG say, it
is a waste to get an MRI or CT because they are going to be normal. I
am presuming your question centers around the "Tonic Clonic" seizure
If raised ICP is not a concern and an elective imaging is planned, an
MRI is the popular first step with our neurologists to look for small
cortical lesions or subtle neuronal migration defects etc.
Hope that helps
> -----Original Message-----
> From: steven szabo [SMTP:[log in to unmask]]
> Sent: Wednesday, February 11, 1998 9:21 PM
> To: Multiple recipients of list PED-EM-L
> Subject: seizures/head ct
> What is this group's opinion on head CT's for first-time, non-febrile
> seizures? I know the literature is somewhat ambigous but I would like
> get some consensus on what people are currently practicing.
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