Abstracts

Rationale: First unprovoked seizure in children often results in emergency room admission. The American Academy of Neurology has proposed guidelines for management of these patients. However the management strategies vary widely depending upon the severity of symptoms, condition of the patient at the time of ER visit, parent s level of anxiety, experience and decision making ability of the ER physician, and the availability of resources at the time of presentation. Questions that need answers include Is this really a seizure? What are the chances of recurrence? What is the etiology? and Is any treatment required or not? A detailed clinical evaluation of EEG findings and neuroimaging is used to answer these questions. An abnormal EEG is associated with higher rate of recurrence and is recommended in all patients. However the timing and length of EEG is not standardized and varies in previous studies.Often the patients are discharged with many unanswered questions and unresolved anxiety. We decided to look at the predictive value and diagnostic yield of Long term VEEG done on the day of ER visit in children with first unprovoked seizure. Methods: From Jan.2008 to Dec. 2009 all patients with ages between 4 months to 20 years with first unprovoked seizure and were admitted for a 24-48 hour VEEG are included in the study. Findings of EEG are described as no epileptiform discharge found versus epileptiform discharge which is focal, generalized or consistent with an epilepsy syndrome . Neuroimaging when available is described as normal or abnormal . Treatment with daily AED is described as treated versus not treated. Recurrence of seizure is established by checking medical records and following up until December 2012.Results: A total of 53 patients are included in the study.40 patients (75.4%) had an abnormal VEEG. Recurrence of seizures within the first 2 years following the first seizure was established in 33 patients (62.2%) and 26(78.7%) of these patients had abnormal VEEG s. 7/9 patients (77.7%) with no recurrence of seizures had a normal VEEG. 11 patients (20.7%) were lost to follow up and 8(72.7%) of them had abnormal VEEG s. 9/53 patients (16.9%) were diagnosed with an epilepsy syndrome and 14 Patients (26.4%) were initially treated with daily AED and all of them had abnormal VEEG. No daily treatment was prescribed in 15/53 patients (28.3%).Conclusions: In the past, LTM-VEEG was not readily available for use in diagnosis of epilepsy. However, improvements in technology have led to more widespread use of VEEG. Our study shows that VEEG can be a very helpful tool in assessing carefully selected patients with first unprovoked seizure. The longer duration of record and inclusion of sleep state increases the yield of this test significantly in terms of finding abnormal epileptiform discharges and predicting recurrence of seizures. More importantly, in some cases it helps in making a diagnosis of an epilepsy syndrome at the time of first encounter. Overall this gives the physicians the opportunity and ability to educate and counsel the patients and their families and to formulate a management plan.