EEG Abnormalities in Children with a First Unprovoked Seizure

Authors

  • Shlomo Shinnar,

    Corresponding author
    1. Department of Neurology, Montefiore/Einstein Epilepsy Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
    2. Department of Pediatrics, Montefiore/Einstein Epilepsy Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
    3. Sergievsky Center, Columbia College of Physicians and Surgeons, New York, NY, U.S.A.
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  • Harriet Kang,

    1. Department of Neurology, Montefiore/Einstein Epilepsy Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
    2. Department of Pediatrics, Montefiore/Einstein Epilepsy Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
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  • Anne T. Berg,

    1. Department of Pediatrics, Yale University School of Medicine, New Haven, CT
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  • Eli S. Goldensohn,

    1. Department of Neurology, Montefiore/Einstein Epilepsy Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
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  • W. Allen Hauser,

    1. Sergievsky Center, Columbia College of Physicians and Surgeons, New York, NY, U.S.A.
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  • Solomon L. Moshé

    1. Department of Neurology, Montefiore/Einstein Epilepsy Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
    2. Department of Pediatrics, Montefiore/Einstein Epilepsy Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
    3. Department of Neuroscience, Montefiore/Einstein Epilepsy Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
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  • Presented in part at the American Epilepsy Society Meetings, San Diego, California; November 1990 and published in abstract form in Epilepsia 1990;Vol. 31, page 653.

Address correspondence and reprint requests to Dr. S. Shinnar at Epilepsy Management Center, Montefiore Medical Center, 111 E. 210th St., Bronx, NY 10467, U.S.A.

Abstract

Summary: We examined EEG findings from an ongoing study of 347 children with a first unprovoked seizure. EEGs were available in 321 (93%), and 135 (42%) had an abnormal EEG. EEG abnormalities included focal spikes (n = 77), generalized spike and wave discharges (n = 28), slowing (n = 43), and nonspecific abnormalities (n = 7). Abnormal EEGs were more common in children with remote symptomatic seizures (60%) than in those with idiopathic seizures (38%) (p < 0.003), more common in partial seizures (56%) than in generalized seizures (35%) (p < 0.001), and more common in children age >3 years (52%) than in younger children (12%) (p < 0.001). Records including both awake and sleep tracings were available in 148 (46%) cases. For 122 (38%) only awake tracings and for 51 (16%) only sleep tracings were available. Fifty-nine (40%) of the 148 patients with both an awake and asleep tracing had abnormal EEGs. Of 50 such EEGs with epileptiform abnormalities, 15 (30%) demonstrated the abnormality either only while awake (n = 8) or only while asleep (n = 7). Of 17 patients with EEG slowing, 8 showed slowing only in the awake tracing and 9 showed slowing in both the awake and asleep tracing. Children with even a single unprovoked seizure have a high incidence of EEG abnormalities. Obtaining a combined awake and sleep EEG significantly increases the yield of EEG abnormalities. In children with an idiopathic first seizure, EEG abnormalities are associated with an increased risk of seizure recurrence.

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