Objective: To evaluate the role of computed tomography (CT) scan brain in children over the age of 1 year with generalized seizures.Design: Prospective, hospital-based study. Materials and Methods: Children of 1-12 years presenting with generalized seizuresin pediatric outpatient department and emergencies were subjected for CT scan brain with contrast along with other appropriateinvestigations after stabilization. Results: A total of 101 cases of children with generalized seizures underwent CT scan brain, 36 cases(35.64%) were found to have CT brain abnormalities. Conclusion: CT brain should be considered in children with generalized seizuresin health care settings where magnetic resonance imaging is either unavailable or unaffordable

Chaudhary, G S

Chaudhary, V

English

Atharva Scientific Publications (E-Jounals)

Chaudhary and Chaudhary CT Brain in children with generalized seizures
Vol 3 | Issue 1 | Jan - Mar 2016 Indian J Child Health 36
Original Article
Evaluation of role of computed tomography scan brain in children with 
generalized seizures
G S Chaudhary1, V Chaudhary2
From 1Departments of Pediatrics, and 2Gynecology and Obstetrics, M.L.B. Medical College, Jhansi, Uttar Pradesh, India
Correspondence to: Dr. G S Chaudhary, PR 4, Medical Campus, M.L.B. Medical College, Jhansi, Uttar Pradesh, India. 
Phone: +91-9793311400/9410859860. E-mail: drgschaudhary@rediffmail.com
Received – 21 November 2015 Initial Review – 09 December 2015 Published Online – 12 February 2016
Abstract
Objective: To evaluate the role of computed tomography (CT) scan brain in children over the age of 1 year with generalized seizures. 
Design: Prospective, hospital-based study. Materials and Methods: Children of 1-12 years presenting with generalized seizures 
in pediatric outpatient department and emergencies were subjected for CT scan brain with contrast along with other appropriate 
investigations after stabilization. Results: A total of 101 cases of children with generalized seizures underwent CT scan brain, 36 cases 
(35.64%) were found to have CT brain abnormalities. Conclusion: CT brain should be considered in children with generalized seizures 
in health care settings where magnetic resonance imaging is either unavailable or unaffordable.
Key words: Computed tomography scan, Generalized seizures, Brain imaging, children
Seizures are common in children and seen in approximately 10% of the children [1]. Approximately 4-6% of children have a single seizure during their 
childhood, and approximately 1% has two or more episodes. 
There are two places Jocote and Quesada, these are not authors 
name. Please change it as The crude prevalence of epilepsy 
was estimated to be around 28 cases /1000 in El Jocote and 
29 cases/1000 in Quesada [2] The majority of epilepsy has 
its onset in childhood [3]. The majority of epilepsy has its 
onset in childhood. Appropriate diagnosis and management 
of childhood epilepsy are essential to improve quality of life 
in these children [4]. A seizure occurring within a week of 
an acute brain insult (trauma, infection, toxic, metabolic, or 
vascular insult) is called an acute symptomatic seizure. Future 
risk of unprovoked seizures is around 3-10% [5].
Electroencephalography (EEG) is recommended as a part 
of initial evaluation in all children presenting with an episodic 
event. Epileptiform abnormalities in the EEG support a clinical 
diagnosis of seizure, help in the diagnosis of specific syndromes, 
and predict seizure recurrence [3]. Imaging provides important 
contributions in establishing etiology, providing prognostic 
information, and directing treatment in children with recently 
diagnosed epilepsy [6]. A computed tomography (CT) scan 
is now widely available with a low marginal cost in private 
and public sector hospitals [7]. A plain CT scan is indicated 
in traumatic brain injury and a contrast enhanced CT scan is 
indicated in children above 2 years, especially those presenting 
with convulsive seizures, focal seizures, and clusters of 
seizure [8].
For neuroimaging, magnetic resonance imaging (MRI) 
is more sensitive than CT and is the modality of choice. MRI 
protocol should be adapted to the age of the child and the type of 
epilepsy syndrome [9]. CT retains a role in detecting calcification 
and in acute situations such as head trauma, status epilepticus, 
and epilepsy, where granulomas are a possibility. A considerable 
treatment gap exists in developing countries due to poverty, 
stigmatization, and lack of trained manpower [10]. New-onset 
partial or generalized convulsive seizures occurring in clusters 
in an otherwise normal child is the most common presentation 
of single small contrast enhancing CT lesion; necessitating 
neuroimaging, except when an idiopathic epilepsy syndrome is 
established with EEG [11]. CT scan brain is indicated in children 
with partial seizures but its role in children with generalized 
seizure is doubtful. There is paucity of studies evaluating the 
role of cranial imaging in the children with generalized seizures. 
Considering above facts, the present study was done to evaluate 
the role of CT scan brain in children with generalized seizures.
MATERIALS AND METHODS
This study was prospective and hospital-based study conducted 
in a tertiary care teaching hospital in North India. The study 
was conducted over a span of 1 year from August 1st, 2013 to 
July 31st, 2014. Ethical clearance was obtained from Ethical 
Committee of the College. Children between 1 and 12 years 
presenting with generalized seizures or status epilepticus in 
outpatient department (OPD) and emergencies were included 
in the study. Written consent was taken from the parents 
before recruiting the patients. Children with acute brain insult, 
Chaudhary and Chaudhary CT Brain in children with generalized seizures
Vol 3 | Issue 1 | Jan - Mar 2016 Indian J Child Health 37
traumatic causes, and metabolic causes of seizures were 
excluded from study. Children with febrile seizure were also 
excluded from study.
All children were initially stabilized and seizures were 
controlled with appropriate medications. After taking detailed 
clinical history and physical examination, these children were 
subjected to CT scan brain with contrast along with other 
appropriate investigations. CT scan was obtained after 24 h 
and within 15 days of seizure in all children. Sedation was not 
required in most of the children especially older children but 
few required in form of triclofos and diazepam. CT scan was 
performed in the Department of Radiology by CT technician, 
and reporting was done by the radiologist.
RESULTS
A total of 217 cases of seizures were subjected to CT scan 
during study period. Among these, only 101 cases were 
presented with generalized seizures and included in the 
study. Out of these cases, 71 cases were initially admitted in 
emergency and 30 children were investigated from OPD. Cases 
not fitting in inclusion criteria were excluded from study. 
Other investigations like EEG, routine blood investigations 
were done in most of the cases but were not recorded in the 
study proforma. About 36% cases showed abnormal CT scan, 
of which most common abnormality was generalized cerebral 
edema (16.83%) followed by multiple lesions (7.92%) as 
shown in Table 1. Out of 101 cases, 6 were showing localized 
lesions, 30 had generalized lesions and 65 cases had normal CT 
study. The most common localizing lesion was granuloma and 
the most common generalized lesion was cerebral edema.
Clinically, 90 out of 101 cases had generalized tonic/clonic 
seizures at the time of presentation. However, only 30% cases 
had generalized lesion on CT scan and approximately 65% cases 
had normal CT brain study as shown in Table 2. Generalized 
lesions include generalized cerebral edema, atrophy, multiple 
granuloma, and calcification. Localized lesions comprised 
solitary lesions (such as granuloma/calcification/abscess/
mass), localized edema, atrophy.
DISCUSSION
Approximately 4-6% of children are expected to have a 
seizure by the age of 16 years [1]. The role of emergent 
neuroimaging for children with a new seizure, specially 
generalized seizure, is not well-understood. This is because 
the prevalence of neuroimaging abnormalities in this 
group has yet not been determined [12]. The prevalence of 
abnormalities in CT scan reported in different studies varied 
from 5% to above 50% as described in Table 3. [6,12-18]. 
In the present study, 6 cases had localized lesions in form of 
tuberculoma, neurocysticercosis, localized calcifications, and 
abscess and localized atrophic changes. They had presented 
with generalized seizures instead partial seizures which we 
were expecting in them. We also found 8 cases with multiple 
granulomas and calcifications. Etiological diagnosis and line 
of management were decided by CT brain in these cases which 
were not feasible without imaging studies.
Table 2: CT scan findings in different type of generalized seizures
Type of seizures Number of cases CT scan finding Number of cases Percentage
Generalized tonic/clonic seizures 90 Localized lesion 04 4.44
Generalized lesion 27 30.00
Normal study 59 65.56
Absence seizures 02 Localized lesion 00 00
Generalized lesion 00 00
Normal study 02 100
Myoclonic seizures 04 Localized lesion 01 25
Generalized lesion 02 50
Normal study 01 25
Tonic/clonic/atonic seizures 05 Localized lesion 01 20
Generalized lesion 01 20
Normal study 03 60
Total 101 101
CT: Computed tomography
Table 1: Type of lesion in CT scan brain of children with 
generalized seizures
Type of lesion Number 
of cases
Percentage
Single inflammatory granuloma/
calcification/localized edema/abscess
06 5.94
B/L, generalized cerebral atrophy 05 4.95
B/L, generalized cerebral edema 17 16.83
Multiple lesions/multiple calcification 08 7.92
Normal study 65 64.35
Total 101
CT: Computed tomography
Chaudhary and Chaudhary CT Brain in children with generalized seizures
Vol 3 | Issue 1 | Jan - Mar 2016 Indian J Child Health 38
The incidence of high percentage of abnormality in the 
case of generalized seizures are most probably because of the 
high prevalence of tuberculosis and neurocysticercosis in our 
locality and many of children are presenting as partial seizure 
with secondary generalization. Their histories were misleading 
because of no eye witness for history or not remembering the 
beginning of seizures correctly. Though CT scan is having 
radiation exposure risk but single exposure is not having much 
risk as compared to seizures complications. Children with 
epilepsy are frequently evaluated in the emergency department 
for breakthrough seizure activity. This population is at risk 
for undergoing repeated CT scans [19]. CT scan brain is an 
important investigation and should be used in generalized 
seizures because it is affordable and available at many smaller 
centers. Limitations of the study include small sample size, and 
lack of long-term follow-up with repeat CT scan.
CONCLUSION
The present study showing that CT brain was abnormal in more 
than 35% of cases of generalized seizures. CT scan can detect 
many of localized lesions in cases of generalized seizures. CT 
brain may also be used in cases of generalized seizures, not 
only in partial seizures especially where the MRI facility is not 
available and affordable.
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Table 3: CT scans abnormality in different studies of generalized seizures
Study Total number 
of cases
Number of cases with 
abnormal CT scan N (%)
Alawneh and Bataineh, 2008, Jordan [15] 78 05 (6.4)
Khreisat, 2006, Jordan [13] 100 50 (50)
Khodapanahandeh and Hadizadeh, 2006. Iran [12] included 
all children with afebrile seizure
119 12 (10)
Njuguna et al., 2007, Kenya [16], Included children with 
all type of neuronal abnormalities
34 16 (47)
Patel et al., 1986, Saudi Arabia [17] 57 06 (10.52)
Nair et al., India, [18] included cases of status epilepticus 44 21 (47.7)
Present study, 2014, North India 101 36 (35.64)
CT: Computed tomography, MRI: Magnetic resonance imaging
Funding: None; Conflict of Interest: None Stated
How to cite this article: Chaudhary GS, Chaudhary V. Evaluation 
of role of computed tomography scan brain in children with 
generalized seizures. Indian J Child Health. 2016;3(1):36-38.


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Evaluation of role of computed tomography scan brain in children with generalized seizures

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