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Routine emergency neuroimaging may be unnecessary for most children after first complex febrile seizures, according to a study performed by researchers at Columbia University's Mailman School of Public Health and the Morgan Stanley Children's Hospital of NewYork-Presbyterian. Children with a first complex febrile seizure who otherwise appear well and who have normal neurological examinations are at low risk of structural abnormalities that require emergency interventions.

The practice guidelines of the American Academy of Pediatrics recommend against the use of emergency neuroimaging for pediatric patients with simple febrile seizures, but no guidelines exist for complex febrile seizures. The new study, published in the February issue of the journal Pediatrics, provides data to potentially extend these practice guideline recommendations to children who experience complex febrile seizures.

The study's senior author is Dr. Dale Hesdorffer, assistant professor of epidemiology at the Mailman School of Public Health and the Gertrude H. Sergievsky Center at Columbia University Medical Center. The other principal authors are Dr. Peter Dayan, acting associate director of Pediatric Emergency Medicine at Morgan Stanley Children's Hospital and assistant clinical professor of Pediatrics at Columbia University College of Physicians and Surgeons and Dr. David Teng, assistant attending physician at Morgan Stanley Children's Hospital and assistant clinical professor of Pediatrics at Columbia University College of Physicians and Surgeons.

"Each year in the United States, between 130,000 and 340,000 children under five years of age will experience a first complex febrile seizure," said Dr. Hesdorffer.

"Our study suggests that for children who have first complex febrile seizures whose history and physical exam are otherwise unremarkable, routine neuroimaging may not be necessary," said Dr. Dayan. "These patients have a low risk of structural abnormalities requiring emergency surgery or medical intervention."

Febrile seizures are common convulsions that occur with fever in infants and toddlers. They are generally not harmful to the child, but are frightening for the parents. Children with febrile seizures typically have rectal temperatures greater than 101 degrees Fahrenheit. Most febrile seizures occur during the first day or two of a child's fever.

Simple febrile seizures are single, brief and uncomplicated seizures. Complex febrile seizures may last longer than 15 minutes, occur more than once during the same illness, or include a brief period of transient abnormal neurological signs on physical examination.

The study evaluated 71 children who came to the emergency room of Morgan Stanley Children's Hospital with a first complex febrile seizure. The patients were identified by emergency department physicians and trained research assistants.

The research assistants obtained detailed information from the parents on the nature of the seizure and the information was reviewed by two epileptologists to classify the seizure as simple or complex. Neuroimaging studies were performed at the discretion of the emergency physician or as part of a study of MRI in febrile seizures led by Dr. Hesdorffer.

Follow-up assessments were performed in order to determine the presence or absence of conditions that required emergent intervention, including but not limited to mass lesion, hemorrhage, hydrocephalus, abscess or cerebral edema. None of the patients demonstrated a condition requiring emergency intervention.

"Although this is the largest study of its kind, more study needs to be done to determine which children presenting with first complex febrile seizures are at risk of pathologic conditions requiring neuroimaging and emergency intervention measures," said Dr. Teng.

The study was supported in part by a grant from the National Institute of Child Health and Human Development.

Columbia University's Mailman School of Public Health

The only accredited school of public health in New York City, and among the first in the nation Columbia University's Mailman School of Public Health provides instruction and research opportunities to more than 950 graduate students in pursuit of masters and doctoral degrees. Its students and more than 270 multi-disciplinary faculty engage in research and service in the city, nation, and around the world, concentrating on biostatistics, environmental health sciences, epidemiology, health policy and management, population and family health, and sociomedical sciences.

Morgan Stanley Children's Hospital of NewYork-Presbyterian

Ranked by U.S.News & World Report as one of the top five children's hospitals in the country, Morgan Stanley Children's Hospital of NewYork-Presbyterian offers the best available care in every area of pediatrics including the most complex neonatal and critical care, and all areas of pediatric subspecialties in a family-friendly and technologically advanced setting. Building a reputation for more than a century as one of the nation's premier children's hospitals, Morgan Stanley Children's Hospital of NewYork-Presbyterian is affiliated with Columbia University College of Physicians and Surgeons, and is New York City's only hospital dedicated solely to the care of children and the largest provider of children's health services in the tri-state area with a long-standing commitment to its community. Morgan Stanley Children's Hospital of NewYork-Presbyterian is also a major international referral center, meeting the special needs of children from infancy through adolescence worldwide.