Neuroimaging in children with first afebrile seizures: to order or not to order?

Seizures are common in children and 5% of all medical attendances to accident and emergency departments are related to seizures. The role of emergent neuroimaging for those children with first afebrile seizure is, however, not well-defined. We reviewed medical charts of 125 children who were admitted with a new-onset afebrile seizure to the Pediatric Ward of Rasool Akram Hospital and underwent CT scan or MRI of the brain. Neuroimaging was performed for 95% (119/125) of these children over the first few hours of their arrival to the Emergency Department. In 90% (107/119) of them, the result was normal. There was a significant relationship between abnormal neuroimaging and focal seizure (P < 0.001), and with age under 2 years (P < 0.002). Therefore, it is recommended that CT scan or MRI to be performed in children with first afebrile seizure who present with focal seizures, abnormal neurologic findings, or age under 2 years.