Seizures in Adults and Children: Evidence-Based Emergency Imaging

  • Diana M. Gomez-HassanEmail author
  • Aine Marie Kelly
  • Daniela N. Minecan
  • Bruno P. Soares
Part of the Evidence-Based Imaging book series (Evidence-Based Imag.)


Neuroimaging is required for any patient presenting with seizures. In the acute setting, imaging is necessary to exclude a space-occupying or life-threatening process. The evidence regarding the type of imaging that should be performed in the acute setting is strong but dependent on the clinical presentation, risk factors, and epileptogenic triggers including provoked or unprovoked seizures and also whether the seizures occur in children or adults. Based on the evidence, an algorithm is presented to guide providers in managing patients presenting with acute seizures. Epileptic seizure refers to a paroxysmal but transient alteration of neurologic function secondary to abnormal excessive or hypersynchronous neuronal activity in the brain. Epilepsy is a clinical condition of recurrent, unprovoked seizures. In the emergent setting, the role of neuroimaging is to exclude life-threatening pathology. MRI is reserved for patients with symptoms suggestive of encephalitis in which CT has been negative. Children with one episode of febrile seizure do not require neuroimaging. Advanced imaging methods including PET and SPECT are rarely required in the emergent setting.


Epilepsy imaging Seizures Temporal lobe epilepsy Provoked seizures Unprovoked seizures Adult Children Emergent imaging Magnetic resonance imaging Computed tomography Evidence-based imaging Emergency imaging 



The authors would like to acknowledge the work of Drs. Byron Bernal, Nolan Altman, and Elysa Widjaja. This current chapter draws upon their chapters (on Seizure Disorders in Evidence-Based Neuroimaging, Evidence-Based Imaging in Pediatrics, and Evidence-Based Imaging, three volumes all published by Springer Science, edited by L.S. Medina et al. and published in 2013, 2010, and 2011, respectively) in the process of presenting thoroughly updated and significantly revised coverage of this subject for emergency imaging.


  1. 1.
    Fisher RS, Acevedo C, Arzimanoglou A, et al. Lancet Neurol. 2015;14(6):615–24.CrossRefGoogle Scholar
  2. 2.
    Krumholz A, Wiebe S, Gronseth GS, et al. Neurology. 2015;84(16):1705–13.PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    Hess CP, Barkovich AJ. Neuroimaging Clin N Am. 2010;20(4):619–37.PubMedCrossRefGoogle Scholar
  4. 4.
    Winkler AS, Schaffert M, Schmutzhard E. Epilepsia. 2007;48(5):1029–30.PubMedCrossRefGoogle Scholar
  5. 5.
    Helmers SL, Thurman DJ, Durgin TL, et al. Epilepsia. 2015;56(6):942–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Bell GS, Sander JW. Seizure. 2001;10(4):306–14; quiz 15–6.Google Scholar
  7. 7.
    Bell GS, Neligan A, Sander JW. Epilepsia. 2014;55(7):958–62.PubMedCrossRefGoogle Scholar
  8. 8.
    Sharieff GQ, Hendry PL. Emerg Med Clin North Am. 2011;29(1):95–108.PubMedCrossRefGoogle Scholar
  9. 9.
    Knudsen FU. Arch Dis Child. 1985;60(11):1045–9.PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Murray MI, Halpern MT, Leppik IE. Epilepsy Res. 1996;23(2):139–48.PubMedCrossRefGoogle Scholar
  11. 11.
    Ho SS, Kuzniecky RI. J Neuroimaging. 1997;7(4):236–41.PubMedCrossRefGoogle Scholar
  12. 12.
    Yoon D, Frick KD, Carr DA, et al. Epilepsia. 2009;50(10):2186–91.PubMedCrossRefGoogle Scholar
  13. 13.
    Caron E, Wheless CE, Patters AB, et al. Pediatr Neurol. 2015;52(5):517–20.PubMedCrossRefGoogle Scholar
  14. 14.
    Offringa M, Bossuyt PM, Lubsen J, et al. J Pediatr. 1994;124(4):574–84.PubMedCrossRefGoogle Scholar
  15. 15.
    American Academy of Pediatrics. Pediatrics. 1996;97:769Y772; discussion 765Y773.Google Scholar
  16. 16.
    Teng D, Dayan P, Tyler S, et al. Pediatrics. 2006;117(2):304–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Kimia AA, Ben-Joseph E, Prabhu S, et al. Pediatr Emerg Care. 2012;28(4):316–21.PubMedCrossRefGoogle Scholar
  18. 18.
    Lewis DV, Shinnar S, Hesdorffer DC, et al. Ann Neurol. 2014;75(2):178–85.PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Scott RC. Curr Opin Pediatr. 2014;26(6):662–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Boyle DA, Sturm JJ. Pediatr Emerg Care. 2013;29(4):430–4.PubMedCrossRefGoogle Scholar
  21. 21.
    Shinnar S, O’Dell C, Mitnick R, et al. Epilepsy Res. 2001;43(3):261–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Dayan PS, Lillis K, Bennett J, et al. Pediatrics. 2015;136(2):e351–60.PubMedCrossRefPubMedCentralGoogle Scholar
  23. 23.
    Berg AT, Testa FM, Levy SR, et al. Pediatrics. 2000;106(3):527–32.PubMedCrossRefGoogle Scholar
  24. 24.
    Khodapanahandeh F, Hadizadeh H. Arch Iran Med. 2006;9(2):156–8.PubMedGoogle Scholar
  25. 25.
    Byars AW, deGrauw TJ, Johnson CS, et al. Epilepsia. 2007;48(6):1067–74.PubMedCrossRefPubMedCentralGoogle Scholar
  26. 26.
    King MA, Newton MR, Jackson GD, et al. Lancet. 1998;352(9133):1007–11.PubMedCrossRefGoogle Scholar
  27. 27.
    Hopkins A, Garman A, Clarke C. Lancet. 1988;1(8588):721–6.PubMedCrossRefGoogle Scholar
  28. 28.
    Schoenenberger RA, Heim SM. BMJ. 1994;309(6960):986–9.PubMedCrossRefPubMedCentralGoogle Scholar
  29. 29.
    Henneman PL, DeRoos F, Lewis RJ. Ann Emerg Med. 1994;24(6):1108–14.PubMedCrossRefGoogle Scholar
  30. 30.
    Maytal J, Krauss JM, Novak G, et al. Epilepsia. 2000;41(8):950–4.PubMedCrossRefGoogle Scholar
  31. 31.
    Garvey MA, Gaillard WD, Rusin JA, et al. J Pediatr. 1998;133(5):664–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Sadeq H, Karim J, Marwan Y, et al. Med Princ Pract. 2016;25(1):56–60.PubMedCrossRefGoogle Scholar
  33. 33.
    Bautovich T, Numa A. Emerg Med Australas. 2012;24(3):313–20.PubMedCrossRefGoogle Scholar
  34. 34.
    Pathan SA, Abosalah S, Nadeem S, et al. Acad Emerg Med. 2014;21(11):1264–8.PubMedCrossRefGoogle Scholar
  35. 35.
    Molla Mohammadi M, Tonekaboni SH, et al. Iran J Child Neurol. 2013;7(4):24–31.PubMedPubMedCentralGoogle Scholar
  36. 36.
    Hakami T, McIntosh A, Todaro M, et al. Neurology. 2013;81(10):920–7.PubMedCrossRefGoogle Scholar
  37. 37.
    Sahu PS, Seepana J, Padela S, et al. Rev Inst Med Trop Sao Paulo. 2014;56(3):253–8.PubMedCrossRefPubMedCentralGoogle Scholar
  38. 38.
    Jayaraman T, Prabhakaran V, Babu P, et al. Trans R Soc Trop Med Hyg. 2011;105(3):153–9.PubMedCrossRefGoogle Scholar
  39. 39.
    American College of Emergency Physicians, American Academy of Neurology, American Association of Neurological Surgeons, American Society of Neuroradiology. Ann Emerg Med. 1996;28(1):114–8.CrossRefGoogle Scholar
  40. 40.
    Hirtz D, Ashwal S, Berg A, et al. Neurology. 2000;55(5):616–23.PubMedCrossRefGoogle Scholar
  41. 41.
    Harden CL, Huff JS, Schwartz TH, et al. Neurology. 2007;69(18):1772–80.PubMedCrossRefGoogle Scholar
  42. 42.
    Turner S, Benger J, for the College of Emergency Medicine (UK). Guideline for the Management of First Seizure in the Emergency Department. Available at: file:///D:/ainekell/Downloads/CEM5073-GEMNet---Guideline-for-the-management-of-first-seizure-in-the-ED---Dec-2009.pdf.
  43. 43.
    Gaillard WD, Chiron C, Cross JH, et al. Epilepsia. 2009;50(9):2147–53.PubMedCrossRefGoogle Scholar
  44. 44.
    Sharma S, Riviello JJ, Harper MB, et al. Pediatrics. 2003;111(1):1–5.PubMedCrossRefGoogle Scholar
  45. 45.
    Hsieh DT, Chang T, Tsuchida TN, et al. Neurology. 2010;74(2):150–6.PubMedCrossRefPubMedCentralGoogle Scholar
  46. 46.
    Weeke LC, Van Rooij LG, Toet MC, et al. Epileptic Disord. 2015;17(1):1–11; quiz.Google Scholar
  47. 47.
    Glass HC, Shellhaas RA, Wusthoff CJ, et al. J Pediatr. 2016;174:98–103.e1.Google Scholar
  48. 48.
    Sinclair DB, Wheatley M, Aronyk K, et al. Pediatr Neurosurg. 2001;35(5):239–46.PubMedCrossRefGoogle Scholar
  49. 49.
    Harvey AS, Berkovic SF, Wrennall JA, et al. Neurology. 1997;49(4):960–8.PubMedCrossRefGoogle Scholar
  50. 50.
    Shinnar S, Bello JA, Chan S, et al. Neurology. 2012;79(9):871–7.PubMedCrossRefPubMedCentralGoogle Scholar
  51. 51.
    Sztriha L, Gururaj AK, Bener A, et al. Epilepsia. 2002;43(1):75–80.PubMedCrossRefGoogle Scholar
  52. 52.
    Spooner CG, Berkovic SF, Mitchell LA, et al. Neurology. 2006;67(12):2147–53.PubMedCrossRefGoogle Scholar
  53. 53.
    Eisner RF, Turnbull TL, Howes DS, et al. Ann Emerg Med. 1986;15(1):33–9.PubMedCrossRefGoogle Scholar
  54. 54.
    Earnest MP, Feldman H, Marx JA, et al. Neurology. 1988;38(10):1561–5.PubMedCrossRefGoogle Scholar
  55. 55.
    Feussner JR, Linfors EW, Blessing CL, et al. Ann Intern Med. 1981;94(4 pt 1):519–22.PubMedCrossRefGoogle Scholar
  56. 56.
    Reinus WR, Wippold FJ 2nd, Erickson KK. Ann Emerg Med. 1993;22(8):1298–303.PubMedCrossRefGoogle Scholar
  57. 57.
    Pesola GR, Westfal RE. Acad Emerg Med. 1998;5(9):905–11.PubMedCrossRefGoogle Scholar
  58. 58.
    American College of Emergency Physicians. Ann Emerg Med. 1997;29(5):706–24.CrossRefGoogle Scholar
  59. 59.
    Aprahamian N, Harper MB, Prabhu SP, et al. Seizure. 2014;23(9):740–5.PubMedCrossRefGoogle Scholar
  60. 60.
    Bradford JC, Kyriakedes CG. Emerg Med Clin North Am. 1999;17(1):203–20, ix–x.Google Scholar
  61. 61.
    Wilden JA, Cohen-Gadol AA. Am Fam Physician. 2012;86(4):334–40.PubMedGoogle Scholar
  62. 62.
    National Institute for Clinical Excellence. Epilepsies: diagnosis and management. Accessed at:
  63. 63.
    Scottish Intercollegiate Guidelines Network. Diagnosis and management of epilepsy in adults. Guideline 143. Accessed at:
  64. 64.
    First Seizure Trial Group (FIR.S.T. Group). Neurology. 1993;43(3 Pt 1):478–83.Google Scholar
  65. 65.
    Marson A, Jacoby A, Johnson A, et al. Lancet. 2005;365(9476):2007–13.PubMedCrossRefGoogle Scholar
  66. 66.
    Wiebe S, Tellez-Zenteno JF, Shapiro M. Epilepsia. 2008;49(Suppl 1):50–7.PubMedCrossRefGoogle Scholar
  67. 67.
    Berg AT. Epilepsia. 2008;49(Suppl 1):13–8.PubMedCrossRefGoogle Scholar
  68. 68.
    Phabphal K, Geater A, Limapichat K, et al. Seizure. 2013;22(7):577–80.PubMedCrossRefGoogle Scholar
  69. 69.
    Dhamija R, Moseley BD, Cascino GD, et al. Epilepsia. 2011;52(8):1522–6.PubMedCrossRefPubMedCentralGoogle Scholar
  70. 70.
    Tekgul H, Gauvreau K, Soul J, et al. Pediatrics. 2006;117(4):1270–80.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Diana M. Gomez-Hassan
    • 1
    Email author
  • Aine Marie Kelly
    • 2
  • Daniela N. Minecan
    • 3
  • Bruno P. Soares
    • 4
  1. 1.Neuroradiology Division, Department of Radiology, Michigan MedicineUniversity of Michigan HospitalsAnn ArborUSA
  2. 2.Department of Radiology, Division of Cardio-Thoracic RadiologyMichigan MedicineAnn ArborUSA
  3. 3.Department of NeurologyMichigan MedicineAnn ArborUSA
  4. 4.Russell H. Morgan Department of Radiology and Radiological ScienceThe Johns Hopkins HospitalBaltimoreUSA

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