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.