Retrospective evaluation of cranial imaging and EEG results in children presenting to the pediatric emergency department with first-time afebrile seizures

In this study, 227 children aged 1 months to 18 years who presented to Pamukkale University Pediatric Emergency Department with their first afebrile (non-febrile) seizure between January 2019 and December 2024 were retrospectively analyzed. Of the patients, 52% were male and 48% were female, with a mean age of 6.91 years. Seizures were classified as generalized in 82.8% and focal in 17.2% of cases. 21.1% of the patients experienced seizure recurrence in the emergency department, and 83.3% of these patients had another seizure on the same day (p=0.0001). MRI findings were abnormal in 39.8% of cases, with hydrocephalus (60.2%) and cortical developmental anomalies (24.4%) being the most common findings. EEG findings were abnormal in 23.8% of cases, with focal abnormalities (74.1%) being more frequent. Patients with abnormal MRI findings had a higher rate of EEG abnormalities (p=0.014). A borderline significance was found between seizure recurrence and a family history of seizures (p=0.054). Abnormal EEG findings (p=0.001) and neurodevelopmental delay (p=0.001) were identified as significant factors in the decision to initiate antiepileptic drug (AED) therapy. Additionally, the rate of AED initiation was higher in children over 12 years of age (p=0.003). In conclusion, this study highlights the importance of neuroimaging and EEG findings in the diagnostic and therapeutic management of children presenting with their first afebrile seizure. The higher rate of AED initiation in patients with abnormal EEG findings underscores the role of EEG as a critical marker in treatment decisions. The lack of a significant association between MRI/CT findings and seizure recurrence suggests that the development of epilepsy cannot be explained solely by structural brain anomalies. These findings emphasize the need for a multimodal approach in managing children with their first afebrile seizure. Keywords: Afebrile seizure, epilepsy, neuroimaging, EEG, antiepileptic drugs, childhood seizures.