The clinical value of EEG investigations in children with febrile seizures is reviewed from the Section of Child and Adolescent Psychiatry, Parke Hospital for Children, Old Road, Hedington, Oxford, England. Reports of EEG abnormalities in children with a history of febrile seizures include 1) ictal, generalized spiking, or lateralized spike wave discharge; 2) postictal, slow activity, spike wave or spikes; and 3) serial EEG’s showing bisynchronous theta activity, bisynchronous spike wave at rest and during over breathing, bisynchronous spike wave on photic stimulation, focal spikes or sharp waves, and hypnagogic paroxysmal spike wave. The author concludes that an early postictal standard EEG will not be helpful in: a) the distinction between clinically simple and atypical seizures, b) the identification of a cerebral infective etiology, and c) the prediction of later occurrence of either further febrile or later afebrile seizures. A limited place for EEG studies is proposed in connection with febrile seizures associated with suspect cerebral pathology. If the child showed developmental delay, if the first seizure occurred below the age of 12 months, or if the seizures are partial or focal in pattern, a possible structural brain pathology is more likely. In addition, a prolonged febrile seizure, especially if followed by residual neurologic signs or developmental regression, may be evidence of structural cerebral damage and may require further investigation. EEG can be a useful ancillary investigation suggesting a persistent brain pathology, even in the presence of a normal CT scan, if it demonstrates a slow wave abnormality with or without spike or sharp waves that is persistent. This implies the use of serial EEG recordings over a period of weeks rather than a single recording. The EEG may also be helpful in research investigations concerning genetic factors and the possible connection between febrile seizures and benign rolandic epilepsy of childhood. Also, the possibility of defining clinically important subgroups of febrile seizures might be facilitated by the use of the EEG. It is emphasized that the EEG recordings should include natural sleep and wakefulness, drowsiness, at least stages I and II of nonrapid eye movement sleep, and arousal. Failure to standardize the procedure makes comparisons between different studies very difficult. [1]

COMMENT. The author correctly emphasizes the need for standardized EEG procedures, including sleep recordings, in assessing the value of the EEG in the management of febrile seizures. The conclusion that EEG findings may lack predictive value for the later occurrence of epilepsy in children with febrile seizures has been based on longitudinal EEG investigations that were sometimes lacking in this necessary standardization and activation procedures, including sleep. Some earlier reports, omitted from the list of references cited in the present review, have demonstrated a predictive value for the EEG and later occurrence of afebrile seizures (Millichap JG. Febrile convulsions. Macmillan New York 1967). Further research would be justified.