Imaging Methods for New-Onset Seizures at Canadian Pediatric Hospitals

BACKGROUND: Seizures are common neurological events in children, with neuroimaging playing a crucial role in evaluating new-onset seizures. While magnetic resonance imaging (MRI) is often preferred over computed tomography (CT) for pediatric seizure imaging due to higher sensitivity and lack of ionizing radiation, practices regarding imaging protocols and sedation use vary. Currently, there are no published Canada-wide guidelines describing the practices for workup of pediatric seizures. METHODS: A cross-sectional survey was conducted among radiologists at 16 Canadian tertiary pediatric centers to assess neuroimaging practices for children with new-onset seizures. The survey explored the presence and content of dedicated seizure MRI protocols, sedation use, and strategies to facilitate non-sedated MRI. RESULTS: Fifteen centers (94%) responded. Only 2 (13%) reported using dedicated new-onset seizure protocols, while 10 (67%) used epilepsy-specific MRI protocols, and the others used different approaches, including variations of routine brain MRI. MRI sequences varied across institutions. Sedation use also varied, with a median sedation age range of 3 months to 6 years. Non-sedated MRI techniques such as feed-and-swaddle (93%) and natural sleep (27%) were commonly used for infants. Video goggles (67%) and child life specialist support (53%) were often used for older children. Only 2 institutions (13%) had fast MRI protocols, and virtual reality preparation was uncommon (13%). CONCLUSION: Considerable variability exists in MRI protocols and sedation practices across Canadian pediatric centers evaluating new-onset seizures. Our findings emphasize the need for national consensus guidelines to standardize imaging protocols, reduce sedation use, and optimize care for pediatric seizure patients.