The Value of Neuroimaging Studies in Pediatric Febrile Status Epilepticus

Febrile seizures are common in children, with incidence rates up to 14% in developing countries; febrile status epilepticus accounts for roughly 5% of all febrile seizure cases. Both status epilepticus and febrile status epilepticus are life-threatening conditions that put children at risk of future epilepsy and that require timely diagnosis and care. However, there are difficulties in applying these diagnostic concepts to daily practice due to a lack of precise definitions of the disorders. In addition, there are no unified standardized neuroimaging diagnostic guidelines, and the significance of imaging findings, when observed, remains uncertain. Even though some brain MRI features occurring in the acute phase and over long-term follow-up have been studied in both children and animals, the causal relationships between these findings and risk of adverse seizure outcomes still need clarifying. Guidelines on eligibility criteria, optimal imaging modalities and protocols, timing of imaging, and the specific brain areas and structures to be evaluated and reported, along with their specific characteristics, are urgently required. This review summarizes clinical issues related to the varied definitions of febrile status epilepticus and the data regarding the acute and chronic neuroimaging changes observed in febrile status epilepticus.