BACKGROUND FUS (First Unprovoked Seizure) is defined as the first seizure that is not feverish and that cannot be attributed to an immediate, clear-cut cause, such as an intracranial infection or head injury. Improvements in diagnostic techniques have increased the chances of finding the unknown causes.The most crucial investigative instrument for the diagnosis and treatment of epilepsies is the EEG. Specific epilepsy disorders can be diagnosed with EEG because it can identify focal lesions that are invisible with neuroimaging and have epileptiform signs. Unlike the recommendations for adult patients undergoing neuroimaging, there is not enough data to establish a standard recommendation or guideline for regular neuroimaging for children experiencing their FUS. This study was conducted to delve into the role of neuroimaging (MRI) and EEG combined in the first episode of unprovoked seizures and to establish a correlation, if any, between EEG and MRI findings as well as between clinical features and abnormal EEG and MRI findings. MATERIALS AND METHODS This was a prospective descriptive observational study involving 50 children belonging to the age group of 3 months to 18 years admitted with their first episode of seizures. EEG recordings and findings of MRI scans were recorded and the data was analyzed using the SPSS version 21.0 software. Continuous variables were presented as mean+/-SD. Categorical variables were expressed as frequencies and percentages. The Fisher’s exact test was used to determine if there is a relationship between two variables. P<0.05 was considered statistically significant. RESULTS Generalised seizures were more common (80.8%), and focal seizures were 19.2%. Both generalised (59.5%) and focal (80%) seizures were more common in male children compared to female children, with 40.5% and 20%, respectively. The incidence was higher among the 1–5 year age group (50%). In a majority, 86.5%, the seizures were of <15 minutes duration. The seizures were multiple in a majority of 80.8% of the children. Also, both generalised and focal seizures were more commonly multiple in onset than single, with 83.3% and 70%, respectively. EEG findings were abnormal in 53.8% of the study population. Focal seizures had more abnormal EEG findings (70%) than generalised seizures. However, the difference was not statistically significant (p-value = 0.3). Only 17.3% of the study population had abnormal MRI findings. Focal seizures had more abnormal MRI findings (30%) than generalised seizures (14.3%). However, the difference was not statistically significant (p value = 0.2). EEG findings were abnormal in 24 of the study population with <15 min of duration and in 4 with >= 15 min of seizure duration. Among those who had abnormal EEG findings, 7 (25%) had a single episode and 21 (75%) had multiple episodes. The findings were abnormal in 24 with a duration <15 min, compared to 4 with a duration >=15 min. This difference had a p-value of 1, which was not statistically significant. MRI findings were abnormal in six cases with multiple episodes and in three cases with a single episode. The p-value was 0.3, which was not significant. In our study, we observed that when EEG was abnormal, there was a higher chance that MRI was also abnormal, with a p-value of 0.002, which is significant. CONCLUSION In the present study, generalised seizures were more common. EEG findings were abnormal in a greater number of cases than MRI findings, with focal seizures having more abnormal findings. There was no correlation between abnormal EEG and MRI findings and the duration or number of seizure episodes. When EEG was abnormal, there was a higher chance that MRI was also abnormal, thus indicating the importance of neuroimaging in addition to EEG.

FUS (First Unprovoked Seizure), EEG, MRI.