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Aim
To look at the outcome of the routine video EEG (vEEG) wake and sleep records on children referred following a single unprovoked afebrile seizure.
Methods
We examined all the vEEGs that were undertaken in a regional paediatric neurophysiology department in Oxford, following a single unprovoked seizure over a 1-year period (2008–2009), several years after National Institute for Health and Clinical Excellence (NICE)1 guidelines for the management of epilepsy in children became available.
Results
A total of 998 vEEGs were undertaken during the study period. Of these, 128 were following a first afebrile seizure: 119/128 were referred by general paediatricians and the remaining 9 by paediatric neurologists. The mean age group was 6.5 years (range 1 month to 17 years). Thirty-four of 128 children had an underlying neurodevelopmental problem. In 11 children, there was a family history of epilepsy and in 13 a past history of febrile convulsions.
The seizure semiology included generalised tonic clonic seizure (n=50), focal (n=25), atonic (n=4), myoclonic (n=2) and uncertain (n=47).
The vEEG outcomes were normal (n=75), non-epileptic events recorded (n=8) and suggestive of an epilepsy syndrome (n=45). The breakdown of the 45 patients with an epilepsy syndrome was idiopathic generalised epilepsy (n=14), focal epilepsies (n=29) and generalised epilepsy with febrile seizures+ (n=2). The syndromes suggested in the 14 patients with idiopathic generalised epilepsy were juvenile absence epilepsy (n=1), juvenile myoclonic epilepsy (n=1) and idiopathic generalised epilepsy not otherwise specified (n=12). Of the 29 with EEGs suggestive of focal epilepsies, focal idiopathic epilepsy accounted for 25/29 (benign rolandic (n=10), late-onset occipital epilepsy (n=2), early-onset occipital epilepsy (n=2) and others (n=11)) and focal symptomatic epilepsy accounted for 4/29.
Conclusion
We are unaware whether a similar study has been done in the UK after NICE guidelines for the management of epilepsy became available. vEEG following a single unprovoked seizure2 accounted for 12.8% of our total referrals. Our study shows that in a substantial number of children we can obtain a result suggestive of an epileptic syndromic diagnosis even after a single seizure. Although this will not alter the decision to treat, it can be valuable information when counselling the families of these children.
References
Footnotes
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Competing interests None.
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Provenance and peer review Not commissioned; internally peer reviewed.