Role of MRI in Assessment of First Seizures in Pediatric Patients

Rahul Gangwar; Rashmi Singh; Anjali Singh Raghav; Shivam Babu Gautam; Karan Goswami; Sandeep Yadav

doi:10.69980/ajpr.v28i5.335

Authors

Rahul Gangwar
Rashmi Singh
Anjali Singh Raghav
Shivam Babu Gautam
Karan Goswami
Sandeep Yadav

DOI:

https://doi.org/10.69980/ajpr.v28i5.335

Keywords:

Pediatric Seizures; First-Time Seizure; MRI; Neuroimaging; Epilepsy; Brain Imaging, Children; Diagnostic Evaluation; Structural Abnormalities.

Abstract

Background: When a Pediatric patient has their first seizure, it's a medical emergency that calls for immediate answers about what's causing it. MRI shines as the go-to apparatus for spotting brain anomalies linked to these episodes.

Objective: This review digs into when doctors should order an MRI, the best timing for it, what it typically reveals, and why it matters for pediatric having their first seizure, whether triggered or not.

Methods: The scoured studies from 2015 to 2025, zeroing in on research about MRI findings in Pediatric patient aged 1 month to 18 years who had a first-time seizure.

Results: Doctors often turn to MRI when seizures start in one part of the brain, when neurological exams raise red flags, or when recovery takes too long. It frequently uncovers issues like malformed brain tissue, tumors, scarring in the temporal lobe, or damage from lack of oxygen. These discoveries guide decisions about surgery or diagnosing epilepsy.

Conclusion: MRI is a game-changer for figuring out what’s behind a pediatric’s first seizure, especially when signs point to something serious. Smart imaging strategies and pediatric-friendly sedation make it both effective and safe.

Author Biographies

Rahul Gangwar

Assistant Professor, Department of Radiological Imaging Techniques, SRMS Institute of Paramedical Sciences, Bareilly (U.P).

Rashmi Singh

Research Fellow, Department of Radiological Imaging Techniques, Teerthankar Mahaveer University, Moradabad (U.P).

Anjali Singh Raghav

Assistant Professor, Department of Radiological Imaging Techniques, GD Goenka Health Care Acedamy, Bareilly (U.P).

Shivam Babu Gautam

Assistant Professor, Department of Radiological Imaging Techniques, SRMS Institute of Paramedical Sciences, Bareilly (U.P).

Karan Goswami

Research Fellow, Department of Radiological Imaging Techniques, SRMS Institute of Paramedical Sciences, Bareilly (U.P).

Sandeep Yadav

Research Fellow, Department of Radiological Imaging Techniques, Vivekananda Global University, Jaipur (Rajasthan).

References

1. Camfield P, Camfield C. Incidence, prevalence and aetiology of seizures and epilepsy in children. Epileptic Disord. 2015;17(2):117-123. doi:10.1684/epd.2015.0736

2. Gaillard WD, Chiron C, Cross JH, et al. Guidelines for imaging infants and children with recent-onset epilepsy. Epilepsia. 2009;50(9):2147-2153. doi:10.1111/j.1528-1167.2009.02075.x

3. Pearce MS, Salotti JA, Little MP, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet. 2012;380(9840):499-505. doi:10.1016/S0140-6736(12)60815-0

4. Berg AT, Berkovic SF, Brodie MJ, et al. Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology, 2005–2009. Epilepsia. 2010;51(4):676-685. doi:10.1111/j.1528-1167.2010.02522.x

5. Scheffer IE, Berkovic S, Capovilla G, et al. ILAE classification of the epilepsies: position paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017;58(4):512-521. doi:10.1111/epi.13709

6. Widjaja E, Raybaud C. Imaging of pediatric epilepsy. Neuroimaging Clin N Am. 2017;27(4):611-626. doi:10.1016/j.nic.2017.06.004

7. Shinnar S, Bello JA, Chan S, et al. MRI abnormalities following febrile status epilepticus in children: the FEBSTAT study. Neurology. 2012;79(9):871-877. doi:10.1212/WNL.0b013e318266fcc5

8. Krumholz A, Wiebe S, Gronseth GS, et al. Evidence-based guideline: management of an unprovoked first seizure in adults. Neurology. 2015;84(16):1705-1713. doi:10.1212/WNL.0000000000001487

9. Pohlmann-Eden B, Newton M. First seizure: EEG and neuroimaging. Neurology. 2011;76(7 Suppl 2):S24-S28. doi:10.1212/WNL.0b013e31820d9668

10. Hirtz D, Ashwal S, Berg A, et al. Practice parameter: evaluating a first nonfebrile seizure in children. Neurology. 2000;55(5):616-623. doi:10.1212/WNL.55.5.616

11. Harden CL, Huff JS, Schwartz TH, et al. Reassessment: neuroimaging in the emergency patient presenting with seizure. Neurology. 2007;69(18):1772-1780. doi:10.1212/01.wnl.0000278118.00982.57

12. Wilmshurst JM, Gaillard WD, Vinayan KP, et al. Summary of recommendations for the management of infantile seizures: Task Force Report for the ILAE Commission of Pediatrics. Epilepsia. 2015;56(8):1185-1197. doi:10.1111/epi.13057

13. Ramey WL, Martirosyan NL, Lieu CM, et al. Current management and surgical outcomes of medically intractable epilepsy. Clin Neurol Neurosurg. 2013;115(12):2411-2418. doi:10.1016/j.clineuro.2013.09.008

14. Barkovich AJ, Raybaud C. Pediatric Neuroimaging. 6th ed. Wolters Kluwer; 2019.

15. Andre JB, Bresnahan BW, Mossa-Basha M, et al. Toward quantifying the prevalence, severity, and cost associated with patient motion during clinical MR examinations. J Am Coll Radiol. 2015;12(7):689-695. doi:10.1016/j.jacr.2015.03.007

16. Knake S, Triantafyllou C, Wald LL, et al. 3T phased array MRI improves the presurgical evaluation in focal epilepsies. Neurology. 2005;65(7):1026-1031. doi:10.1212/01.wnl.0000179355.04481.3c

17. Barkovich AJ, Guerrini R, Kuzniecky RI, et al. A developmental and genetic classification for malformations of cortical development: update 2012. Brain. 2012;135(Pt 5):1348-1369. doi:10.1093/brain/aws019

18. Krsek P, Maton B, Korman B, et al. Different features of histopathological subtypes of pediatric focal cortical dysplasia. Ann Neurol. 2008;63(6):758-765. doi:10.1002/ana.21398

19. Guerrini R, Dobyns WB. Malformations of cortical development: clinical features and genetic causes. Lancet Neurol. 2014;13(7):710-726. doi:10.1016/S1474-4422(14)70040-7

20. Koeller KK, Rushing EJ. From the archives of the AFIP: medulloblastoma and other cerebellar tumors in children. Radiographics. 2003;23(5):1155-1179. doi:10.1148/rg.235035047

21. Rowland NC, Englot DJ, Cage TA, et al. A meta-analysis of predictors of seizure freedom in the surgical management of focal cortical dysplasia. J Neurosurg. 201 J Neurosurg. 2012;116(5):1035-1041. doi:10.3171/2012.1.JNS111105

22. Friedlander RM. Arteriovenous malformations of the brain. N Engl J Med. 2007;356(26):2704-2712. doi:10.1056/NEJMcp067192

23. Ding D, Starke RM, Kano H, et al. International multicenter cohort study of pediatric brain arteriovenous malformations. J NeurosurgPediatr. 2017;19(2):139-148. doi:10.3171/2016.9.PEDS16283

24. Tunkel AR, Glaser CA, Bloch KC, et al. The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2008;47(3):303-327. doi:10.1086/589747

25. Whitley RJ. Herpes simplex encephalitis: adolescents and adults. Antiviral Res. 2006;71(2-3):141-148. doi:10.1016/j.antiviral.2006.04.002

26. Magnetic Resonance Imaging (MRI). (n.d.). National Institute of Biomedical Imaging and Bioengineering. Retrieved May 14, 2023, from https://www.nibib.nih.gov/science-education/science topics/magnetic-resonance-imaging-mri