Do not routinely perform electroencephalographs (EEGs) for children presenting with febrile seizures.
Febrile seizures are seizures associated with fever, but without evidence of central nervous system infection. There is no evidence that epileptiform discharges (i.e. distinctive electroencephalograph patterns associated with epileptic disorders) in children with febrile seizures have any diagnostic or prognostic implications.
For instance, even among otherwise neurodevelopmentally normal children with a first complex febrile seizure (febrile seizures which are prolonged or occur multiple times within 24 hours or are confined to one side of the body) these EEG patterns are a poor predictor for epilepsy. Therefore, an EEG test should not be a routine investigation for these and other patients presenting with febrile seizures.
- Harini C, Nagarajan E, Kimia AA, et al. Utility of initial EEG in first complex febrile seizure. Epilepsy Behav 2015; 52(Pt A):200-4.
- Kuturec M, Emoto SE, Sofijanov N, et al. Febrile seizures: is the EEG a useful predictor of recurrences? Clin Pediatr (Phila) 1997; 36(1):31-6.
- Sadleir LG, Scheffer IE. Febrile seizures. BMJ 2007; 334(7588):307-11.
- Shah PB, James S, Elayaraja S. EEG for children with complex febrile seizures. Cochrane Database Syst Rev 2015; 8(12):CD009196.
Following deliberations, the ANZCNS Board determined to investigate the evidence for nine priority recommendations regarding low-value clinical practices in paediatric neurology. An evidence review was developed for these recommendations and served as the basis for an online survey sent to all ANZCNS members asking respondents if they agreed, disagreed or were unsure if these recommendations were evidence based, undertaken in significant numbers, and important in terms of reducing patient harm and unnecessary healthcare expenditure. Based on survey responses, each of the nine was assigned a score and ranked accordingly. Based on this information and a final evidence review, these top 5 recommendations were chosen.
- 1 Do not routinely perform electroencephalographs (EEGs) for children presenting with febrile seizures.
- 2 Do not routinely perform computed tomography (CT) scanning of children presenting with new onset seizures.
- 3 Do not routinely undertake repeat blood level monitoring of antiepileptic drug (AED) treatments.
- 4 Do not routinely undertake neuroimaging for new onset primary headache without first examining for neurological abnormality.
- 5 Do not routinely perform electroencephalographs (EEGs) for children presenting with syncope (fainting).