Role of Electroencephalography and Neuroimaging in Children with First Unprovoked Seizure

Background: A first unprovoked seizure in children is a critical event that requires comprehensive evaluation todetermine its cause and risk of recurrence. EEG and MRI are key diagnostic tools, though their combined utilityin resource-limited settings is less well studied.Objective: To evaluate the diagnostic yield and correlation of EEG and MRI in children with a first unprovokedseizure and describe their clinical-etiological profile.Methods: This observational study enrolled 100 children aged 1–16 years presenting with a first unprovokedseizure at JK Lon Hospital, Kota (October 2023–December 2024). EEG was performed within one week, andMRI was obtained using a 1.5T scanner. Statistical analysis used Chi-square and Fisher’s exact tests.Results: GTCS were most frequent (89%), while partial seizures occurred in 11%. EEG abnormalities werepresent in 15%, significantly more in partial seizures (45.5%) than GTCS (11.2%, P=0.002). MRI revealedabnormalities in 42%, most commonly hypoxic-ischemic encephalopathy (59.5%). In partial seizures, abnormalEEG and MRI were always concordant (100%, P=0.001). Developmental delay was strongly associated withabnormal MRI (85.7% vs. 38.7%, P<0.001).Conclusion: EEG and MRI provide complementary insights in the evaluation of first unprovoked seizures. EEGis useful for seizure classification, while MRI identifies structural causes, particularly hypoxic-ischemic injury.Routine EEG with selective MRI (for partial seizures, abnormal EEG, or developmental delay) is recommendedin resource-limited settings