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March 1992

Value of the Electroencephalogram in Adult Patients With Untreated Idiopathic First Seizures

Author Affiliations

From the Department of Neurology and Clinical Neurophysiology, University Hospital Rotterdam-Dijkzigt, Rotterdam, the Netherlands (Dr van Donselaar and Schimsheimer); Department of Neurology, St Clara Hospital, Rotterdam (Dr van Donselaar); Department of Public Health and Social Medicine, Erasmus University, Rotterdam (Ms Geerts); and Epilepsy-centre "Kempenhaeghe," Heeze, the Netherlands (Dr Declerck).

Arch Neurol. 1992;49(3):231-237. doi:10.1001/archneur.1992.00530270045017

• We prospectively studied the reliability and accuracy of the electroencephalogram as a predictor of the risk of recurrence within 2 years in 157 patients with untreated idiopathic first seizures. In all patients, a standard electroencephalogram and, if necessary, an electroencephalogram after partial sleep deprivation were obtained. All electroencephalograms were scored by one observer according to a fixed protocol. The finding of epileptic discharges was associated with a risk of recurrence of 83% (95% confidence interval, 69% to 97%) vs 41% (95% confidence interval, 29% to 53%) in patients with nonepileptic abnormalities and 12% (95% confidence interval, 3% to 21%) in patients in whom both electroencephalograms were normal. The sensitivity proved to be 48%. Interobserver agreement among four neurologists, who independently read 50 electroencephalograms, was found to be moderate. Predictive value for each observer, however, was good. We conclude that electroencephalogram findings may play a role in the decision to initiate or delay treatment after an idiopathic first seizure.

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