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. 2025 Sep;32(9):e70288.
doi: 10.1111/ene.70288.

Does the Timing of Electroencephalogram Recording After a First Unprovoked Seizure Influence Its Ability to Predict Additional Seizures?

Tal Gilboa  1   2 , Ella Rochberg Hanuka  3 , Tzlil Y Shifman  4 , Dana Ekstein  2   4
Affiliations

Does the Timing of Electroencephalogram Recording After a First Unprovoked Seizure Influence Its Ability to Predict Additional Seizures?

Tal Gilboa et al. Eur J Neurol. 2025 Sep.

Abstract

Background: Abnormal electroencephalograms (EEGs) are a known risk factor for additional seizures following a first unprovoked seizure (FUS). This study assessed whether early or late EEGs after a FUS predict subsequent seizures in pediatric and adult patients.

Methods: This retrospective study included patients who underwent EEGs after a FUS between 4/2011 and 12/2015, categorized into children (≤ 16 years) and adults. EEGs (assigned as generally abnormal or specifically epileptiform) performed early (within 2 days) or later were correlated with patient characteristics, anti-seizure medication (ASM) use, and additional seizures within 2 years.

Results: The study involved 202 participants (137 children, 65 adults) with 168 early and 127 late EEGs. Children had more abnormal early and late EEGs than adults, though early EEGs were conducted sooner in adults. More early EEGs in children showed epileptiform activity. ASMs were more frequently prescribed in adults, patients with risk factors, and those with abnormal early EEGs, but ASM use did not correlate with less abnormal late EEGs. Epileptiform activity in late EEGs (p = 0.006, OR 3.085) and ASM use (p = 0.018, OR 0.39) were significantly linked to additional seizures on multivariate analysis, with similar findings in pediatric but not adult patients.

Conclusions: Both early and late EEGs are valuable following a FUS, serving different purposes. Early EEGs are helpful for diagnosis, while late EEGs offer better prognostic value for seizure recurrence. Further research is needed to confirm these results in larger, prospective studies.

Keywords: anti‐seizure medications; early EEG; epilepsy prediction; late EEG.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Time to early EEG. The time between the FUS, or the admission to the emergency department, when the exact FUS time was not available, and performance of the early EEG is plotted separately for children and adults. In adults, the EEGs were performed significantly faster, almost all of them within the first 24 h. A, average; M, median.
FIGURE 2
FIGURE 2
Correlation between EEG results and the occurrence of a second seizure. The number of EEG studies in each category (early vs. late, in patients who did or did not have a second seizure after the FUS) is depicted separately in children (A) and in adults (B). The only significant difference was found in children between late epileptiform and non‐epileptiform EEG results.
See this image and copyright information in PMC

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