Quality statement 3: Magnetic resonance imaging

Quality statement

Children and young people who meet the criteria for neuroimaging for epilepsy have magnetic resonance imaging.

Rationale

Magnetic resonance imaging (MRI) is shown by evidence to be the most sensitive and specific neuroimaging option in terms of identifying structural abnormalities in the brain, but access to MRI scanning and reporting facilities varies across the country.

Quality measure

Structure:

a) Evidence of local arrangements for children and young people who meet the criteria for neuroimaging for epilepsy to have MRI.

b) Evidence of local arrangements for children and young people with learning disabilities who meet the criteria for neuroimaging for epilepsy to have MRI.

Process: Proportion of children and young people who meet the criteria for neuroimaging for epilepsy who have MRI.

Numerator – the number of people in the denominator who have MRI.

Denominator – the number of children and young people who meet the criteria for neuroimaging for epilepsy.

What the quality statement means for each audience

Service providers ensure systems are in place for children and young people who meet the criteria for neuroimaging for epilepsy to have MRI.

Healthcare professionals ensure that children and young people who meet the criteria for neuroimaging for epilepsy have MRI.

Commissioners ensure they commission services for children and young people who meet the criteria for neuroimaging for epilepsy to have MRI.

Children and young people who are having neuroimaging (taking pictures of the brain) for epilepsy have magnetic resonance imaging (a type of neuroimaging that uses magnetic fields to produce a picture of the brain; often shortened to MRI).

Source guidance

NICE clinical guideline 137 recommendation 1.6.20.

Data source

Structure: a) and b) Local data collection.

Process: Local data collection. Organisations can collect data on the percentage of children with defined indications for MRI who had MRI within 1 year using the Epilepsy12 national audit, section 9a.

Definitions

Neuroimaging should be used to identify structural abnormalities that cause certain epilepsies. People diagnosed with idiopathic generalised epilepsy or benign epilepsy with centrotemporal spikes are unlikely to have any aetiologically relevant structural abnormalities and should not therefore undergo neuroimaging.

The criteria for MRI in children and young people are newly diagnosed epilepsy in a child aged under 2 years, epilepsy with focal onset (unless there is evidence of benign epilepsy with centrotemporal spikes) and failure of first-line medication.

In acute situations computed tomography may be used to determine whether a seizure has been caused by an acute neurological lesion or illness. Computed tomography should be used for children and young people for whom a general anaesthetic or sedation would be needed for MRI but would not be needed for computed tomography.

Equality and diversity considerations

The same services, investigations and therapies should be offered to children and young people with learning disabilities or challenging behaviour as are offered to the general population.

Children and young people with learning disabilities or challenging behaviour might need particular care and attention to help them tolerate investigations. Reasonable adjustments, such as offering open-bed scanners, sedation or general anaesthesia, should be made if necessary to ensure all children and young people who need MRI have access to it.

Good communication and a supportive environment are important in helping children to undergo investigative tests. Play therapy may also have a role in supporting children having neuroimaging for epilepsy.