Electroencephalographic profile and its association with seizure recurrence in children with a first unprovoked seizure: a prospective observational study from Eastern India

Abstract

Background: A first unprovoked seizure is a common neurological presentation in childhood, and the electroencephalogram (EEG) is recommended as a key investigation in its evaluation. Data on the EEG profile of such children from Eastern India and its relationship with early seizure recurrence remain limited. This study aimed to evaluate the seizure semiology and EEG findings in neurologically normal children presenting with a first unprovoked seizure and to determine their association with recurrence within three months. Methods: This single-centre, prospective, observational study enrolled 176 neurologically and developmentally normal children aged 1–18 years presenting with a first unprovoked seizure to a tertiary care hospital in Kolkata between May 2022 and April 2023. All children underwent EEG within 24 hours of the seizure and magnetic resonance imaging (MRI) of the brain. Participants were followed up for three months to detect seizure recurrence. Associations were tested using the chi-square test, with p<0.05 considered significant. Results: The mean age was 6.8 (±4.9) years with a male preponderance (60.2%; M:F 1.4:1). Generalized seizures occurred in 61.4% and focal seizures in 38.6% of children. An abnormal EEG was found in 58.0%, of which 79.4% showed epileptiform discharges. Among the 160 children (90.9%) who completed follow-up, seizure recurred in 45.0%. Recurrence was significantly higher in children with an abnormal EEG (58.5% vs 25.8%; p<0.001) and with focal seizure semiology (54.8% vs 38.8%; p=0.047). Conclusion: An abnormal EEG was present in more than half of children after a first unprovoked seizure and was the strongest predictor of early recurrence. EEG, particularly when combining awake and sleep recordings, is a valuable tool for risk stratification in this population.