What question did this study set out to answer?

The study aims to evaluate the diagnostic yield of EEG and MRI in children experiencing their first unprovoked seizure and describe their clinical-etiological profiles.

January 17, 2026Open Access

Role of Electroencephalography and Neuroimaging in Children with First Unprovoked Seizure

Key Points

The study aims to evaluate the diagnostic yield of EEG and MRI in children experiencing their first unprovoked seizure and describe their clinical-etiological profiles.
Observed 100 children aged 1–16 years presenting with a first unprovoked seizure.
Conducted EEG within one week of the seizure occurrence.
Performed MRI scans using a 1.5T scanner.
Applied Chi-square and Fisher’s exact tests for statistical analysis.
Generalized tonic-clonic seizures (GTCS) accounted for 89% of cases, while partial seizures were 11%.
EEG abnormalities were found in 15% of cases, significantly higher in partial seizures (45.5%) compared to GTCS (11.2%).
MRI abnormalities were detected in 42%, with hypoxic-ischemic encephalopathy being the most common (59.5%).
In partial seizures, EEG and MRI results were always concordant (100%).
Developmental delay was linked to abnormal MRI findings (85.7% vs. 38.7%).

Abstract

Background: A first unprovoked seizure in children is a critical event that requires comprehensive evaluation todetermine its cause and risk of recurrence. EEG and MRI are key diagnostic tools, though their combined utilityin resource-limited settings is less well studied.Objective: To evaluate the diagnostic yield and correlation of EEG and MRI in children with a first unprovokedseizure and describe their clinical-etiological profile.Methods: This observational study enrolled 100 children aged 1–16 years presenting with a first unprovokedseizure at JK Lon Hospital, Kota (October 2023–December 2024). EEG was performed within one week, andMRI was obtained using a 1.5T scanner. Statistical analysis used Chi-square and Fisher’s exact tests.Results: GTCS were most frequent (89%), while partial seizures occurred in 11%. EEG abnormalities werepresent in 15%, significantly more in partial seizures (45.5%) than GTCS (11.2%, P=0.002). MRI revealedabnormalities in 42%, most commonly hypoxic-ischemic encephalopathy (59.5%). In partial seizures, abnormalEEG and MRI were always concordant (100%, P=0.001). Developmental delay was strongly associated withabnormal MRI (85.7% vs. 38.7%, P<0.001).Conclusion: EEG and MRI provide complementary insights in the evaluation of first unprovoked seizures. EEGis useful for seizure classification, while MRI identifies structural causes, particularly hypoxic-ischemic injury.Routine EEG with selective MRI (for partial seizures, abnormal EEG, or developmental delay) is recommendedin resource-limited settings

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