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To the Editor:
Gilbert and Buncher1 use linear information theory2 to analyze selected findings on seizure recurrence in childhood. They conclude that the information regarding recurrence risk contained in the EEG is insufficient to justify its routine use after a first seizure in children. We note several objections.
The authors begin with a false premise that the only utility of the EEG is to ascertain recurrence risk. In reality: 1) when the diagnosis is unclear, the EEG may differentiate seizures from other nonepileptic events; 2) the EEG may distinguish a first seizure from epilepsy newly presented to medical attention; e.g., the child with a tonic-clonic seizure whose EEG demonstrates a 3 Hz generalized spike and wave pattern with staring spells. (such children are excluded from the first seizure studies Gilbert and Buncher analyzed); 3) the EEG is critical for syndrome diagnosis; 4) the determination of the syndrome strongly influences use of subsequent neuro-imaging,3 and treatment decisions independent of recurrence risk as demonstrated in a recent French study.4 It also provides crucial information about long-term prognosis; 5) a syndromic diagnosis may influence advice about other restrictions, e.g., photo-sensitivity has implications for exposure to TV, computers, and strobe lights.
The paper that Gilbert and Buncher base their analysis clearly states that testing is justified when the results alter treatment or management or provide prognostic information. “Patients may be interested in prognostic information that testing provides even if it is not used to guide treatment.”2 Fundamental to information theory is the notion that the cost …
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