Electroencephalogram and first episode afebrile seizure in children

Aniruddha Ghosh, Maya Mukhopadhyay, Swapan Mukhopadhyay


Electroencephalogram has long been an integral part of evaluation of a child with first episode of afebrile seizure. Several studies have backed up its routine use in pediatric neurology till date and management guidelines also have adopted it. But as evidences are accumulating, it has been shown that some researchers are opining against its routine use due to reasons like need for sedation in uncooperative smaller children, inter-observer variability, abnormal tracings found in normal children, normal tracings observed in epileptic children etc. In this article authors have tried to discuss evidences showing different aspects of the debates in support and against the use of electroencephalogram in first afebrile seizure episode in children.


Children, EEG, Electroencephalogram, Epilepsy, First Seizure

Full Text:



Ghosh A, Mukhopadhyay M, Mukhopadhyay S. Magnetic Resonance Imaging in First Episode of Afebrile Seizures in Children: To Do or Not To Do That is the Question. J Med Res Prac. 2017;6(1):4-8.

Fein JA, Lavelle JM, Clancy RR. Using age-appropriate prolactin levels to diagnose children with seizures in the emergency department. Acad Emerg Med. 1997;4:202-5.

Pohlman-Eden B, Newton M. First seizure: EEG and neuroimaging following an epileptic seizure. Epilepsia. 2008;49(Suppl.1):19-25.

Peterson I, Eeg-Olofsson O. The development of the electroencephalogram in normal children from the age of 1 through 15 years. Non-paroxysmal activity. Neuropadiatrie. 1971;2:247-04.

Drury I. Epileptiform patterns of children. J Clin Neurophysiol. 1989;6:1-39.

Binnie CD. Neurophysiological investigations of epilepsy in children. In: Ross EM, Woody RC, eds. Epilepsy. Bailliere's dinical paediatrics. International practice and research. London: Bailliere Tindall. 1994:2(3):585-604.

Jallon P, Loiseau P, Loiseau J, on behalf of CAROLE study. Newly diagnosed unrpovoked epileptic seizures. Presentation at diagnosis in CAROLE study. Epilepsia. 2001;42:464-75.

Gowers WR. Epilepsy and other chronic convulsive diseases: their causes, symptoms and treatment. London: J & A Churchill. 1881:242.

Goddard GV, Mc Intyre DC, Leech CK. A permanent change in brain function resulting from daily electrical stimulation. Exp Neurol. 1969;25:295-330.

Berg AT, Shinnar S. Do seizures beget seizures? An assessment of the clinical evidence in humans. J Clin Neurophysiol. 1997;14:102-10.

Maytal J, Shinnar S, Moshé SL, Alvarez LA. Low morbidity and mortality of status epilepticus in children. Pediatrics. 1989;83:323-31.

Annegers JF, Shirts SB, Hauser WA, Kurland LT. Risk of recurrence after an initial unprovoked seizure. Epilepsia. 1986;27:43-50.

Hart YM, Sander JWAS, Johnson AL, Shorvon SD. National general practice study of epilepsy: recurrence after a first seizure. Lancet. 1990;336:1271-4.

Martinovic Z, Jovic N. Seizure recurrence after a first generalized tonic clonic seizure in children, adolescents and young adults. Seizure. 1997;6:461-5.

van Donselaar CA, Schimsheimer RJ, Geerts AT, Declerck AC. Value of the electroencephalogram in adult patients with untreated idiopathic first seizures. Arch Neurol .1992;49:231-7.

Camfield PR, Camfield CS, Dooley JM, Tibbles JA, Fung T, Garner B. Epilepsy after a first unprovoked seizure in childhood. Neurology. 1985;35:1657-60.

Berg AT, Shinnar S. The risk of seizure recurrence following a first unprovoked seizure: a quantitative review. Neurology. 1991;41:965-72.

Hopkins A, Garman A, Clarke C. The first seizure in adult life. Value of clinical features, electroencephalography and computerised tomographic scanning in prediction of seizure recurrence. Lancet. 1988;1:721-6.

Hauser WA, Rich SS, Annegers JF, Anderson VE. Seizure recurrence after a 1st unprovoked seizure: an extended follow-up. Neurology. 1990;40:1163-70.

Gilad R, Lampl Y, Gabbay U, Eshel Y, Sarova-Pinhas I. Early treatment of a single generalized tonic- clonic seizure to prevent recurrence. Arch Neurol. 1996;53:1149-52.

Das CP, Sawhney IM, Lal V, Prabhakar S. Risk of recurrence of seizures following single unprovoked idiopathic seizure. Neurol India. 2000;48:357-60.

Wiebe S, Tellez-Zenteno JF, Shapiro M. An evidence-based approach to the first seizure. Epilepsia. 2008;49(Suppl. 1):50-7.

Hirtz D, Ashwal S, Berg A. Practice parameter: Evaluating a first nonfebrile seizure in children: Report of the Quality Standards Subcommittee of the American Academy of Neurology, the Child Neurology Society, and the American Epilepsy Society. Neurology. 2000;55:616.

King MA, Newton MR, Jackson GD, Fitt GJ, Mitchell LA, Silvapulle MJ, et al. Epileptology of the first-seizure presentation: a clinical, electroencephalographic, and magnetic resonance imaging study of 300 consecutive patients. Lancet. 1998;352:1007-11.

Michoulas A, Farrell K, Connolly M: Approach to a child with a first afebrile seizure. BCMJ. 2011;53:274-7.

Berg AT. Risk of recurrence after a first unprovoked seizure. Epilepsia. 2008;49 Suppl 1:13-8.

Vining EP, Freeman JM. Management of nonfebrile seizures. Pediatr Rev. 1986;8:185-90.

Holmes GL. How to evaluate the patient after a first seizure. Postgrad Med. 1988;83:199-209.

Shafer S, Shafer W, Hauser WA, Annegers JF, Klass DW. EEG and other early predictors of epilepsy remission. Epilepsia. 1988;29:590-600.

Fountain NB, Freeman JM. EEG is an essential clinical tool. Pro and con. Epilepsia. 2006;47:23-5.

Neufeld MY, Chistik V, Vishne TH, Korczyn AD. The diagnostic aid of routine EEG findings in patients with a presumed first-ever provoked seizure. Epilepsy Res. 2000;42:197-202.

Schreiner A, Pohlmann-Eden B. Value of the early electroencephalogram after a first unprovoked seizure. Clin Electroencephalogr. 2003;34:140-4.

Pohlmann-Eden B, Beghi E, Camfield C, Camfield P. The first seizure and its management in adults and children. BMJ. 2006;332:339-42.

Stroink H, Brouwer OF, Arts WF, Geerts AT, Peters AC, van Donselaar CA. The first unprovoked, untreated seizure in childhood: a hospital based study of the accuracy of the diagnosis, rate of recurrence, and long term outcome after recurrence. Dutch Study of Epilepsy in Childhood. J Neurol Neurosurg Psychiatry. 1998;64:595-600.

O'Donohoe NV. Classification of epilepsies in infancy, childhood and adolescence. In: Ross EM, Woody RC, eds. Epilepsy. Bailliere's dinical paediatrics. International practice and research. London: Bailliere Tindall. 1994;2(3):471-84.

Roger J, Bureau M, Dravet C, Driefuss FE, Perret A, Wolf P. Epileptic syndromes in infancy, childhood and adolescence. 2nd Ed. London, Paris: John Libbey. 1992.

Panayiotopoulos CP. Benign childhood partial epilepsies: benign childhood seizure susceptibility syndromes. J Neuro, Neurosurg Psychiatry. 1993;56:2-5.

Tan M, Appleton R, Tedman B. Paediatric EEGs: what NICE didn't say. Arch Dis Child. 2008;93:366-8.

Snead OC, Hosey LC. Exacerbation of seizures in children by carbamazepine. N Engl J Med. 1985;313:916-21.

Williams J, Grant M, Jackson M. Behavioral descriptors that differentiate between seizure and nonseizure events in a pediatric population. Clin Pediatr. 1996;35:243-9.

Appleton RE. Significance of the EEG after the first afebrile seizure. Arch Dis Child. 1990;80:100-1.

Gilbert DL, Buncher RC. An EEG should not be obtained routinely after first unprovoked seizure in childhood. Neurology. 2000;54:635-41.

Shinnar S, Berg AT, Moshe SL. The risk of seizure recurrence after a first unprovoked febrile seizure in childhood: an extended followup. Pediatrics. 1996;98:216-25.

Boulloche J, Leloup P, Mallet E, Parain D, Tron P. Risk of recurrence after a single, unprovoked, generalized tonic-clonic seizure. Dev Med Child Neurol. 1989;31:626-32.

Shinnar S, Kang H, Berg AT, Goldensohn ES, Hauser WA, Moshe SL. EEG abnormalities in children with a first unprovoked seizure. Epilepsia. 1994;35:471-6.

Carpay JA, de Weerd AW, Schimsheimer RJ. The diagnostic yield of a second EEG after partial sleep deprivation: a prospective study in children with newly diagnosed seizures. Epilepsia. 1997;38:595-9.

Shinnar S, Berg AT, Ptachewich Y, Alemany M. Sleep state and the risk of seizure recurrence following a first unprovoked seizure in childhood. Neurology. 1993;43:701-6.

Commission on Neuroimaging of the International League Against Epilepsy. Recommendations for neuroimaging of patients with epilepsy. Epilepsia. 1997;38:1255-6.

Panayiotopoulos CP. Significance of the EEG after the first afebrile seizure. Arch Dis Child. 1998;78:575-7.

Cavazzuti GB, Capella L, Nalin A. Longitudinal study of epileptiform EEG patterns in normal children. Epilepsia. 1980;21:43-55.