The Value of Early Postictal EEG in Children with Complex Febrile Seizures

Abstract

Summary:Purpose: To assess the usefulness of an early postictal EEG in neurologically normal children with complex febrile seizures.Methods: We conducted a retrospective chart review of all neurologically normal children who were hospitalized over a period of 2.5 years after complex febrile seizures, and had an EEG up to 1 week after the seizure.Results: Thirty-three patients (mean age, 17.8 months) qualified for inclusion into the study. Twenty-four patients were qualified as complex cases based on one factor (prolonged in 9, repetitive in 13, and focal in 2). Nine other patients had two complex factors: in six patients, the seizures were long and repetitive; in two patients, the seizures were focal and repetitive; and in one patient, the seizures were long, focal, and repetitive. Thirteen (39%) patients experienced prior febrile seizures. All 33 patients had a normal postictal sleep EEG. Our results indicate with a 95% probability that the true rate of abnormalities in an early postictal EEG performed on otherwise normal children with complex febrile seizures is 8.6% or less.Conclusions: The yield of abnormalities of an early postictal EEG in this population is low and similar to the reported rate of abnormalities in children with simple febrile seizures. The routine practice of obtaining an early EEG in neurologically normal children with complex febrile seizures is not justified.

Predictive value of paroxysmal EEG abnormalities for future epilepsy in focal febrile seizures

“…Studies vary in many parameters and overall design, so they cannot be compared directly and their results are confusing. Maytal concluded that EEG findings lack any predictive value for the later occurrence of epilepsy [19]. Yü cel, on the contrary, reported that many of his patients with complex FS and EEG abnormalities presented later with epilepsy [20].…”

Origins of Temporal Lobe Epilepsy: Febrile Seizures and Febrile Status Epilepticus

“…However, it is part of the diagnostic evaluation of children with status epilepticus of all causes including FSE [112]. In cases of complex febrile seizures, EEG abnormalities are more common but their significance remains unclear [113][114][115][116]. A limitation of the prior studies is that they lacked imaging data to correlate with the EEG findings.…”

Febrile seizures: an update

“…Recurrent simple or complex FS also do not justify an EEG, as it is of no use in identifying a structural abnormality or in predicting recurrent FS or the development of epilepsy. 99 Neuroimaging is not indicated in a child with a simple FS, 83 93 and not every child with a complex FS requires a brain scan, although this will clearly depend on the clinical situation. Neuroimaging should be considered in children with FS who are also found to have the following: N Micro/macrocephaly, a neurocutaneous syndrome or preexisting neurological deficit N Post-ictal neurological deficit persisting for more than a few hours following the FS N Recurrent complex febrile seizures and particularly where there was any doubt whether the seizures were febrile in origin.…”