What can we expect from EEG after a first unprovoked seizure in children? Volume 18, issue 2, Avril-Mai-Juin 2006

Laboratoire d’explorations neurologiques fonctionnelles pédiatriques, service d’explorations fonctionnelles Groupe hospitalier Cochin-Saint Vincent de Paul, avenue Denfert Rochereau, 75014 Paris

Routine EEG is recommanded after a first unprovoked seizure in children as part of diagnostic evaluation. When the EEG is used as one of several variables, it can identify children with high and low recurrence risks. The EEG is not used solely to determine recurrence, but also helps differenciate a seizure from other events, it is essential to the diagnosis of a syndrome, and provides information on long-term prognosis. Furthermore it influences the decison to perform subsequent neuroimaging studies. When clinical data are not contributive, EEG alone does not provide sufficient information to predict the risk of recurrence. The EEG abnormalities should not contribute to a fals diagnosis of epilepsy only because of a single and uncertain paroxysmal event. It will cause unnecessary use of anticonvulsant drugs, increase stigma and result in social and occupational limitation. The seizure recurrence presents little risks as a child doesn’t drive any vehicle and mostly doesn’t stay alone. Rather than to conclude to quickly, one should take the time to wait for a second seizure. Indeed in most cases the first seizure is also the last one.