The yield from neuroimaging of children presenting with new onset afebrile seizures is typically low, with one study finding that it led to a change in clinical management for only four percent of patients. As there are already a well-tested set of indicators for determining the likelihood of intracranial abnormalities in children with new onset unprovoked seizures, a combination of clinical history, examination, and electroencephalograph (where relevant) should first be used to determine whether the condition warrants neuroimaging. Clinical indicators for intracranial abnormalities, which are likely to change initial patient management, include (i) a focal seizure in children aged less than three years, (ii) abnormal neurological examination, (iii) Todd’s post-ictal paresis, or (iv) presence of a condition predisposing to seizures.
In children where an intracranial abnormality is considered likely, and neuroimaging is indicated, magnetic resonance imaging (MRI) is recommended over computed tomography (CT) because (i) there is superior anatomic resolution and characterisation of pathologic processes from using MRI, and (ii) there is radiation exposure and escalated future cancer risk associated with CT.
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