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Significance of the EEG after the first afebrile seizure
  1. C P Panayiotopoulos
  1. Department of Clinical Neurophysiology and Epilepsies, St Thomas’s Hospital, London SE1 7EH, UK
  1. Dr Panayiotopoulos.

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The EEG, entirely harmless and relatively inexpensive, is the most important investigation in the diagnosis and management of epilepsies, providing it is properly performed and carefully interpreted in the context of a well described clinical setting.1 2

The current practice in paediatrics of not requesting an EEG after the “first afebrile seizure”2 may need revision. An epileptiform EEG abnormality is one of the most significant predictors of recurrence,3-7 but more importantly it may be indispensable for a specific seizure and syndrome diagnosis.8-10

Although not a substitute for the clinical examination, the EEG is an integral part of the diagnostic process in epilepsies. In this sense, there is more than enough justification to have an EEG after the first seizure. The fact that the patient may not be treated2 is not a convincing argument against such a practice; the prime aim in medicine is the diagnosis that determines prognosis and treatment strategies. The EEG may be the only means of an incontrovertible syndromic diagnosis in cases with a single fit such as in benign partial or video game induced seizures. This may also have genetic implications9 10 that will not be addressed if an EEG is not obtained after the first seizure.

Syndromic diagnosis of epilepsies

The most important milestone in epilepsies has been the recognition of epileptic syndromes and diseases, most of which are well defined and easy to diagnose using combined clinical and EEG evidence.9 10 Four common groups of epileptic syndromes exemplify the need for a more precise diagnosis than the inclusive term “epilepsy”. Benign childhood partial epilepsies, symptomatic generalised epilepsies, juvenile myoclonic epilepsy, and temporal lobe epilepsy comprise more than 60% of all epilepsies with onset from age 2 to 16 years. They are entirely different in presentation, cause and genetics, investigative procedures, short …

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