NEUROLOGY JOURNAL

Predictive Value of EEG for Febrile

Seizure Recurrence
Alberta MC, Carolina B, Marta BM, Giuseppe B, Federica V, Alessia R, et al
5 December 2017, The Japanese Society of Child Neurology

Fitriani Ikhsaniatun
Supervisor
dr. Mustarsid, Sp.A (K)
dr. Fadhilah Tia Nur, Sp.A (K), M.Kes

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 PICO
• Children with first simple or complex FS who
P underwent EEG

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I

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C

• EEG can predict recurrence of FS after the first FS

O

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Introduction
Febrile seizures (FS) are the most
common type of seizure in
childhood

25-35% : complex FS
65-75% : simple FS

Longstanding debate on the

usefulness of EEG in FS children
to predict long term outcome

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Introduction

Abnormal EEG increasing risk of

unprovoked seizure

no corelation EEG
abnormality to reccurence of
FS or development of
epilepsy

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Objective
To evaluate possible role of EEG in predicting
recurrence of FS in children after a first FS, during
at least three years of follow up

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 Methods
• Retrospective study, consecutive
Study design sampling

• Children aged 6-72 months who

Population underwent EEG and had follow up
for at least three years

• Hospital of Degli University, Milan

Place Italy

Time • January 2007 –January 2013

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 Exclussion criteria

Children with previous unprovoked seizure or

known neurological disorders

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Methods
• FS : seizures occurs in body
temperature ≥ 38o C, no infection
of CNS, no metabolic
disturbance or electrolyte
imbalance
• Simple FS : generalized, < 15
mins, not recurrent within 24 h
Definition • Complex FS : focal or repetitive
within 24 h or >15 min
• Recurrent FS: seizure occurring
in new episode of fever, already
experienced at least one
previous FS
• Epilepsy : 2 or more unprovoked
seizures occuring > 24h apart
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Methods
• EEG obtained without
pharmacological sedation
• Included wake and sleep stages
• Interpreted by pediatric neurologist
Procedure and neurophysiologist
• Classified in three groups: (1) normal
(2) abnormal : focal or generalized
slow activity or epileptiform
discharges (3) PPMD pattern

Information FS recurrence obtained by telephone interview,

during follow up at least 3 years

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Methods
• Main outcome: recurrence of
outcome febrile seizures (FS) in children
with a first FS

• Chi square for categorical

variables
Statistical • Wilcoxon –mann whitney for
continuous variable
analysis • Univariate and multiple Poisson
regression models  calculate RR

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Results

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Results

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Results

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 Discussion
PPMD is paroxysmal discharge consisting
In 1964, Gibbs and generalized or nearly generalized high
Gibbs voltage 3-4 /sec wave with poorly
developed spike occured in drowsiness
only

in 1983, alvarez at Hypnagogic paroxysmal spike and wave

al activity (the similiar pattern)

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Discussion

Clinical predictor of FS : young age at onset,

family history of FS, low degree of fever, short
interval between fever onset and initial seizure
PPMD pattern and abnormal EEG should be
considered as another independent risk factor for
FS recurrence

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 Limitation

•Retrospective study
•sort duration of follow up
• various timing of EEG

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Conclusion
EEG may have a role in predicting FS recurrence in
children after first FS
The practice of EEG examination after first FS needs
better clarification with prospective studies

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Critical Appraisal

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Validity
1. Was the defined representative sample of patients assembled
at the common point (usually early) in the course of their
disease?
• Yes
• Patient recruited with retrospective cohort, with consecutive
sampling , child with a first febrile seizure who underwent
EEG from Jan 2007 – Jan 2013

2. Was patient folllow up sufficiently long and complete?

• No, the patient follow up for three years only

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Validity
3. Were outcome criteria either objective or applied in a ‘blind’
fashion?
• it isn’t clearly stated in journal that outcome criteria applied
in a ‘blind’ fashion

4. If subgroup with different prognoses are identified, did

adjustment for important prognostic factors take place?
• Yes, each variables adjusted to others (table 2)

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Importance
How likely are the outcomes over time?

• This study just record the recurrence of FS in three years

follow up, so that we can’t define how the outcome over
time

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 Importance

How precise are the prognostic estimates?

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Applicability
Is my patient so different to those in the study that the
results cannot apply?
• No, our patient has same characteristic with the
population study

Will this evidence make a clinically important impact on my

conclusion about what to offer or to tell my patients?

• Yes, we can educate patient about possibility of FS

recurrence when there is abnormality in EEG after first
FS, especially when we find PPMD in EEG

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 important

LoE
2B
Valid applicable

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Level of Evidence Prognostic
Studies

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