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Seizures are a common and concerning new symptom in pediatric patients. Epilepsy incidence rates in pediatric patients range from 0.5-8 per 1,000 person years with 0.5-1% of children having 1 or more afebrile seizures by adolescence. They may be the result of immune, infectious, genetic, structural, metabolic and/or idiopathic causes.
Differentiating between epileptic and non-epileptic symptoms is key to making the diagnosis of seizure disorders. Although there are many exceptions to typical findings, most true seizures follow stereotypical patterns.
Most children with a first-time seizure do not require emergent neuroimaging. A prospective multicenter study showed a rate of an emergent/urgent finding in only 0.8% of patients. In certain subsets of patients however, emergent neuroimaging may be necessary.
MRI is the preferred method of neuroimaging for patients with new onset seizures. It is more sensitive than CT for many of the findings considered after a new seizure.