Electroencephalogram after first unprovoked seizure in children: Routine, unnecessary or case specific

A child is brought into a paediatric emergency unit with an unprovoked, afebrile first seizure. We conduct a clinical assessment of the child and rule out any acute metabolic, traumatic or infectious causes and consequently, make the diagnosis of an epileptic seizure. The International League against Epilepsy (ILAE) suggests that following such a diagnosis, the next step should be the appropriate classification of the seizure type, after which an appropriate syndrome diagnosis should be made. (1) Should an EEG be arranged for this child and if so, should it be arranged within 24 hours or within the next week? If we decide not to arrange an EEG this time and to do so if any further seizures occur, are we practicing evidence based medicine? A recent guideline published by the Royal College of paediatrics and child health (RCPCH) asserted: “There is no need for an EEG following a first simple afebrile seizure”. (2) This is a very bold and clear statement but what evidence and what quality of evidence is this statement based upon? This review analyses and discusses prominent literature regarding this widely-discussed topic.