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A first single unprovoked seizure (FSUS) is one of the most terrifying life events a person can experience. Beyond immediate impairment of normal activities in daily life crippling, its quality and safety risks include potential morbidity and mortality affecting physical, mental, and emotional health regardless of age, sex, ethnicity, and cultural background.1 Routine EEG (rEEG) is a well-known, established, and essential tool used to diagnose people with epilepsy.2 There is high specificity for an epilepsy diagnosis when interictal epileptiform discharges (IEDs) are identified on EEG.2-4 Six essential criteria to define IEDs have been established by the International Federation of Clinical Neurophysiology (IFCN) to serve as a benchmark.3 Epilepsy is defined by the International League Against Epilepsy (ILAE) and includes a FSUS with at least a 60% chance of recurrence within the next 10 years.5 Despite common practice, diagnostic accuracy of rEEG after a FSUS has low sensitivity.4 The impact of an abnormal EEG containing IEDs after a FSUS imparts a high likelihood of recurrent seizures6 which in turn prompts consideration of chronic treatment with antiseizure medication (ASM) known to limit recurrence.
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Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.
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