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This study characterized structural abnormalities associated with onset of seizures in children using MRI and a standardized classification system in a large prospective cohort. A total of 281 children aged 6 to 14 years completed an MRI within six months of their first recognized seizure. Most MRI examinations were performed with a standardized, dedicated seizure protocol, and all were scored using a standard scoring system. At least one MRI abnormality was identified in 87 of the 281 (31%) of children with first recognized seizure. Two or more abnormalities were identified in 34 (12%). The most common abnormalities were ventricular enlargement (51%), leukomalacia/gliosis (23%), gray matter lesions such as heterotopias and cortical dysplasia (12%), volume loss (12%), various other white matter lesions (9%), and encephalomalacia (6%). Abnormalities defined as significant, or potentially related to seizures, occurred in 40 (14%). Temporal lobe and hippocampal abnormalities were detected at a higher frequency than in previous studies (13/87). Use of MRI and a standardized reliable and valid scoring system demonstrated a higher rate of abnormal findings than previous investigations, including findings that might have been considered incidental in the past. Practice parameters may need to be revised to expand the definition of significant abnormalities and to support wider use of MRI in children with newly diagnosed seizures.

Findings of MR Imaging and it's necessity in Children with First Recognized Seizure: A Tertiary Center Based prospective Cohort Study