Feasibility and clinical utility of early electroencephalogram (EEG) in children with first seizure
Lorie Hamiwka1, Neetu Singh, Silvia Kozlik
1Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada. lhamiwka@ucalgary.ca
Insights
Early electroencephalograms (EEG) within 48 hours for pediatric first seizures are not feasible and do not increase abnormality detection. Delayed EEGs showed similar diagnostic yields, suggesting current practices may need adjustment.
Area of Science:
- Pediatric Neurology
- Clinical Neurophysiology
Background:
- Early electroencephalography (EEG) is crucial for diagnosing first-time seizures in children.
- The feasibility and diagnostic yield of early EEG (within 48 hours) in pediatric patients remain under investigation.
Purpose of the Study:
- To assess the feasibility and clinical utility of early EEG in children referred for a first seizure.
- To compare the diagnostic yield of early versus late EEG in identifying epileptiform abnormalities.
Main Methods:
- A retrospective study of 127 children (1 month-17 years) with a first seizure.
- EEG abnormalities were classified as epileptiform or nonepileptiform.
- Children were categorized based on epileptic or nonepileptic events.
Main Results:
- Only 18% of children received an EEG within 48 hours, with delays attributed to referral timing, scheduling, and logistical issues.
- Abnormalities were detected in 47% of early EEGs and 44% of late EEGs, with no significant difference in yield (P = .50).
- Epileptiform abnormalities were the most common finding in both early and late EEG groups.
Conclusions:
- Early EEG within 48 hours is often not feasible in the pediatric population presenting with a first seizure.
- There was no significant increase in the detection of EEG abnormalities with early EEG compared to later EEG.
- Findings suggest that current practices for timely EEG acquisition may require re-evaluation for pediatric first seizure evaluations.
Abstract:
The feasibility and clinical utility of early electroencephalogram (within 48 hours) was studied in 127 children (age, 1 month-17 years) referred for a "first seizure." The electroencephalogram was considered late after 48 hours. Electroencephalogram abnormalities were classified as nonepileptiform or epileptiform. Children were classified as having an "epileptic" or "nonepileptic" event. An early electroencephalogram was obtained in 23 (18%). Late referral (n = 36), weekend event (n = 23), difficulty contacting families (n = 11), parental schedules (n = 9), and laboratory scheduling (n = 11) resulted in late electroencephalograms. All 94 children with an epileptic event had an electroencephalogram, 19 (20%) within 48 hours. Results were abnormal in 9 (47%) early (7 epileptiform, 2 nonepileptiform) and 35 (44%) late (30 epileptiform, 5 nonepileptiform). Increased abnormalities were not seen with early electroencephalography (P = .50). Early electroencephalograms may not be feasible in the pediatric population and did not show a higher yield of abnormalities.
