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EEG abnormalities in children with a first unprovoked seizure
1Department of Neurology, Montefiore/Einstein Epilepsy Center, Albert Einstein College of Medicine, Bronx, NY.
Insights
Electroencephalography (EEG) abnormalities are frequent in children after a first unprovoked seizure. A combined awake and sleep EEG is more effective in detecting these abnormalities, especially for idiopathic first seizures, indicating a higher risk of recurrence.
Area of Science:
- Pediatric Neurology
- Clinical Neurophysiology
Background:
- First unprovoked seizures in children warrant thorough investigation.
- Electroencephalography (EEG) is a key diagnostic tool in evaluating seizure disorders.
Purpose of the Study:
- To determine the incidence of EEG abnormalities in children following a first unprovoked seizure.
- To assess the diagnostic yield of combined awake and sleep EEG recordings.
- To identify factors associated with EEG abnormalities and seizure recurrence.
Main Methods:
- Analysis of EEG findings in 321 children with a first unprovoked seizure.
- Comparison of EEG abnormalities based on seizure type, etiology, and age.
- Evaluation of the effectiveness of awake versus sleep EEG recordings.
Main Results:
- 42% of children had abnormal EEGs, including focal spikes, generalized discharges, and slowing.
- Abnormal EEGs were more prevalent in symptomatic seizures, partial seizures, and children over 3 years old.
- Combined awake and sleep EEGs increased the detection rate of abnormalities compared to single-state recordings.
Conclusions:
- Children experiencing a first unprovoked seizure have a high rate of EEG abnormalities.
- Combined awake and sleep EEG recordings improve the detection of abnormalities.
- EEG abnormalities in idiopathic first seizures are linked to an increased risk of recurrence.
Abstract:
We examined EEG findings from an ongoing study of 347 children with a first unprovoked seizure. EEGs were available in 321 (93%), and 135 (42%) had an abnormal EEG. EEG abnormalities included focal spikes (n = 77), generalized spike and wave discharges (n = 28), slowing (n = 43), and nonspecific abnormalities (n = 7). Abnormal EEGs were more common in children with remote symptomatic seizures (60%) than in those with idiopathic seizures (38%) (p < 0.003), more common in partial seizures (56%) than in generalized seizures (35%) (p < 0.001), and more common in children age > 3 years (52%) than in younger children (12%) (p < 0.001). Records including both awake and sleep tracings were available in 148 (46%) cases. For 122 (38%) only awake tracings and for 51 (16%) only sleep tracings were available. Fifty-nine (40%) of the 148 patients with both an awake and asleep tracing had abnormal EEGs. Of 50 such EEGs with epileptiform abnormalities, 15 (30%) demonstrated the abnormality either only while awake (n = 8) or only while asleep (n = 7). Of 17 patients with EEG slowing, 8 showed slowing only in the awake tracing and 9 showed slowing in both the awake and asleep tracing. Children with even a single unprovoked seizure have a high incidence of EEG abnormalities. Obtaining a combined awake and sleep EEG significantly increases the yield of EEG abnormalities. In children with an idiopathic first seizure, EEG abnormalities are associated with an increased risk of seizure recurrence.