Is Cranial Imaging Necessary in Children with First-Time Focal Seizures?

Objective: Seizures in children represent a common cause of admission to the emergency department. This study aimed to determine clinically significant intracranial abnormalities in children presenting to the pediatric emergency department with first-time focal seizures. Methods: Patients aged 1 month-18 years, who presented to the pediatric emergency department with first-time focal seizures between 2009 and 2019, were retrospectively screened. Patients with a history of trauma, cases in which focal neurological signs could not be assessed, and patients with pre-existing structural brain or neurological abnormalities, and metabolic disorders were excluded from the study. Cranial computed tomography findings were re-evaluated by a pediatric radiologist. The fourth and fifth-level according to the classification of the International League Against Epilepsy were interpreted as urgent intracranial pathologies requiring medical or surgical intervention. The univariate analysis was performed using the chi-square test for categorical data and the Mann-Whitney U test for continuous data. Results: The mean age of the 121 patients was 46.8±44.4 months, and 52.9% were male. Clinically significant emergency intracranial pathologies were detected in the neuroimaging of eight patients. Intracranial masses, bleeding, and hematomas were the most common pathologies. The presence of focal neurologic findings and an age below six months were clinically determined as predictors of an urgent intracranial pathology. Conclusion: We found the rate of urgent cranial pathologies to be 6.6% in patients presenting to the emergency department following the first focal seizure. Children younger than six months with focal neurological signs should be evaluated for emergency neuroimaging.