Significance of Magnetic Resonance Imaging and Electroencephalography in Evaluating Children Visiting the Emergency Department with First Afebrile Seizures

ABSTRACT

PURPOSE: The purpose of our study is to evaluate the initial diagnostic value of magnetic resonance imaging (MRI) and electroencephalogrphy (EEG) in children who visit the emergency department (ED) with first afebrile seizure attacks. METHODS: We reviewed the medical records of children who visited the emergency department of Inha University Hospital with first afebrile seizure attacks and who underwent the diagnostic procedures of MRI & EEG during their visits. The study duration was for the 72 months from January 1997 to December 2002. One year after the study, we followed up the patients by using a telephone survey and by reviewing their medical records. RESULTS: The records of 46 patients, 23 boys and 23 girls, were reviewed. Generalized tonic clonic seizures appeared in 37 (80%) of the children and focal seizures in 9 (20%) of the children. Twenty nine (63%) of the children had two or more seizures during a single episode. There were 8 (17%) cases in which the seizures lasted for over 30 minutes. MRI abnormalities were found in only a small portion (9 cases, 20%) of the patients, but all of the MRI abnormalities were significant. The MRI abnormalities were as follows brain atrophy (n=2), leptomeningeal enhancement (n=2), aneurysm (n=1), arachnoid cyst (n=1), ventriculomegaly (n=1), demyelinating disease (n=1), and hypoxic damage (n=1). Abnormal EEG findings were found in 15 (33%) of the children Eleven showed partial seizures and 4 showed cerebral dysfunctions. CONCLUSION: Even though abnormal MRI & EEG findings were revealed in only a small portion of the patients, all of the revealed abnormal findings were very serious and were associated with significant problems. In conclusion, we suggest that initial MRI & EEG evaluations are valuable diagnostic procedures for children who visit the emergency department with first attacks of afebrile seizures.