Relationship of Clinical Profile with Neuroimaging and Electroencephalogram Changes in First Unprovoked Seizure in Children: A Cross-sectional Study

Abstract

Introduction: Unprovoked seizures are common events in children, occurring as single episodes or recurring, as seen in epilepsy. The First Unprovoked Seizure (FUS) poses diagnostic challenges and raises concerns about aetiology, the initiation of anti-seizure medication and prognosis. The roles of Electroencephalogram (EEG) and neuroimaging in the diagnosis and management of FUS are debated. While EEGs play a crucial role in identifying seizure onset and epilepsy syndromes, neuroimaging aids in diagnosing underlying pathologies. Despite recommendations for routine EEGs in evaluating FUS, the role of neuroimaging remains less defined. Aim: To characterise the clinical profile of children presenting with FUS and investigate the relationship between clinical features, EEG findings and neuroimaging findings. Additionally, it explores the aetiology of FUS based on patterns of neuroradiological abnormalities and EEG changes. Materials and Methods: A cross-sectional study was conducted from April 2021 to July 2022 in the Paediatric Intensive Care Unit (PICU) and Paediatric Ward at Government TD Medical College, Alappuzha, Kerala, India. A total of 72 children aged beyond the neonatal period up to 12 years who were admitted with FUS at a tertiary care centre over an 18-month period were included in the study. Clinical data were recorded and standard techniques were used to perform EEGs and Magnetic Resonance Imaging (MRI) on all subjects. Results: The minimum age of participants in the study was two months, with a median age of 3.9 years. Among the 72 participants, most were in the infantile age group, with 23 (31.94%) falling into this category. The most frequently observed seizure type was generalised onset, with 47 (65.28%) cases. EEG irregularities were noted in 25 (34.72%) subjects, while 21 (29.16%) showed MRI abnormalities. Most frequent EEG abnormalities included generalised spike-and-wave discharges in 7 (28%) cases and modified hypsarrhythmia in 6 (24%) cases. The MRI scans revealed ischaemic changes and cerebral dysgenesis, each occurring in 7 out of 21 cases. A considerable proportion of children with abnormal EEGs had abnormal neuroimaging findings. Conclusion: The study recommends that both EEG and MRI should be included as part of the routine evaluation for children presenting with FUS. In cases with abnormalities in EEG, the detection rate of abnormalities through MRI was statistically significant. Additionally, MRI should be performed even when the EEG results are normal.

Keywords

• epilepsy
• epileptic syndromes
• magnetic resonance imaging
• seizures aetiology
• seizures classification