In a simple febrile seizure, EEG is not routinely indicated; under which circumstances might EEG be ordered?

• A. Seizures afebrile, prolonged, focal, or there is a family history of epilepsy.
• B. Seizures occur only during sleep.
• C. Seizures happen after a head injury.
• D. EEG is always indicated after febrile seizures.

Answer: (A)

When evaluating a child after a febrile seizure, EEG is not done routinely. It is most appropriate to order an EEG when features suggest a higher risk of epilepsy or a diagnosis beyond a simple febrile seizure. Specifically, if seizures are afebrile, prolonged, or have focal onset, or if there is a family history of epilepsy, these red flags raise concern for an underlying epileptic tendency and EEG can provide useful information. In typical, uncomplicated febrile seizures, EEG usually does not change management and is not indicated.

Seizures occurring only during sleep don’t by themselves define a febrile seizure and are not the classic trigger for an EEG in this context, and a seizure after head injury points to a different scenario that might warrant evaluation, but the combination of afebrile, prolonged, focal features, or a family history best captures the standard indications. Saying EEG is always indicated after febrile seizures is not correct.