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South African Medical Journal

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The utility of computed tomography for recent-onset partial seizures in childhood

George H Swingler, Anthony TR Westwood, Karen Iloni

Abstract


Objectives. To determine the diagnostic yield of computed tomography  (CT) of the head in children presenting for the first time with partial  seizures in a region with a high prevalence of tuberculosis and neurocysticercosis.
Design. Prospective cohort study.


Setting. The secondary-level ambulatory service of Red Cross Children's Hospital, Cape Town.


Subjects. Children aged 6 months - 12 years with a first partial seizure.


Outcome measures. Abnormal CT findings; clinically unsuspected abnormal CT findings.


Results. Of 118 enrolled children, CT findings were available for 94 (80%). Sixteen (33%) of 49 children scheduled to return later for an initial CT scan failed to do so. Thirty-two scans (34%) were reported normal, 45 (48%) showed single or multiple granulomas, and 17 (18%) showed other  findings. All 8 children with persistent specific CT findings were suspected of having the condition before CT scan. Of 68 cases with prospectively  recorded clinically expected CT findings, normal scans were expected in 2 cases (3%) and occurred in 33 cases (49%).

Conclusions. Routine CT scan for children presenting with a first partial seizure in an area with a high prevalence of neurocysticercosis failed to identify findings other than neurocysticercosis that meaningfully altered clinical management. Assuming a 70% relative reduction of seizures with albendazole treatment for neurocysticercosis, routine CT scanning in the study population would require 11 scans and 5 courses of albendazole to prevent 1 child from having seizures, compared with no CT scans and 11 courses of albendazole with blanket use of albendazole.




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