title: The diagnostic accuracy of routine electroencephalography after a first unprovoked seizure.
abstract: The clinical utility of routine electroencephalography (EEG) after a first unprovoked seizure remains uncertain. Its diagnostic accuracy in identifying adults and children with new onset epilepsy was examined. A systematic review and meta-analysis of studies examining individuals who underwent routine EEG after a first unprovoked seizure and were followed for seizure recurrence for at least 1 year was performed. A 'positive' test was defined by the presence of epileptiform discharges (ED). Pooled sensitivity and specificity estimates were calculated using a bivariate random effects regression model. In all, 3096 records were reviewed, from which 15 studies were extracted with a total of 1799 participants. Amongst adult studies, the sensitivity and specificity (95% confidence interval) of routine EEG were 17.3% (7.9, 33.8) and 94.7% (73.7, 99.1), respectively. Amongst child studies, the pooled sensitivity and specificity were 57.8% (49.7, 65.6) and 69.6% (57.5, 79.5), respectively. Based upon our positive likelihood ratios, and assuming a pre-test probability of 50%, an adult with ED on routine EEG after a first unprovoked seizure has a 77% probability of having a second seizure, whilst a child with similar findings has a 66% probability. Further studies are required to examine the impact of patient characteristics and EEG features on the diagnostic accuracy of routine EEG for new onset epilepsy.
authors.affiliation: Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada.|Neuroepidemiology Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
authors.forename: H K
authors.initials: HK
authors.lastname: Bouma
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.|Division of Cardiology, McGill University, Montreal, QC, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Labos
authors.affiliation: Life Sciences Library, McGill University, Montreal, QC, Canada.
authors.forename: G C
authors.initials: GC
authors.lastname: Gore
authors.affiliation: Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada.|Neuroepidemiology Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.|Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.|Department of Medicine, McGill University, Montreal, QC, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Wolfson
authors.affiliation: Neuroepidemiology Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.|Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
authors.forename: M R
authors.initials: MR
authors.lastname: Keezer
mesh_terms: D000328:Adult; D002648:Child; D004569:Electroencephalography / Q000592:standards*; D006801:Humans; D012640:Seizures / Q000175:diagnosis*; D012680:Sensitivity and Specificity
keywords: clinical neurophysiology; electroencephalography; epilepsy; sensitivity; specificity