Electroencephalography Practices in Epilepsy Diagnosis

Electroencephalography (EEG) remains the cornerstone of epilepsy diagnosis, providing real-time insight into cortical electrical activity. Standard clinical practice involves routine and prolonged recordings to capture interictal epileptiform discharges, seizures and normal variants. Advances in portable and ambulatory systems have broadened access, enabling long-term monitoring outside hospital settings. Computer-assisted reporting frameworks have improved consistency and data interoperability, while machine-learning algorithms now offer rapid flagging of key features. Interrater studies underscore the importance of specialist review, balancing speed with accuracy. Globally, EEG guides therapeutic decisions, from confirming diagnosis to tailoring surgical and pharmacological interventions, and supports paediatric through adult care in both resource-rich and constrained environments.

Research from Nature Portfolio

A large prospective study evaluated the agreement between EEG technologists and neurophysiologists across over 1,500 recordings. Technologists achieved very high negative predictive values for status epilepticus and seizure detection, demonstrating reliability in ruling out critical events. However, positive predictive values were moderate, emphasising the need for expert confirmation before clinical action. Interrater agreement for interictal epileptiform discharges was substantial, but variable in specific patient groups such as the elderly or those under sedation. This work highlights how tiered review pathways can streamline emergency triage while safeguarding diagnostic accuracy.

Electroencephalography Practices in Epilepsy Diagnosis publication trend

The graph below shows the total number of articles in electroencephalography practices in epilepsy diagnosis across all publications each year (not limited to Nature Index journals).

Technical terms

Electroencephalography (EEG): Non-invasive recording of the brain’s electrical activity via electrodes placed on the scalp.

Interictal epileptiform discharges (IEDs): Brief, abnormal waveforms between seizures indicating cortical hyperexcitability.

Ambulatory EEG: Extended, portable EEG monitoring conducted in everyday environments over hours or days.

Status epilepticus: Continuous or rapidly repeating seizures beyond a critical duration, detectable on EEG and requiring urgent treatment.

Standardised Computer-based Organised Reporting of EEG (SCORE): A structured reporting system that uses predefined elements to classify EEG features consistently.

References

1. Prospective evaluation of interrater agreement between EEG technologists and neurophysiologists. Scientific Reports (2021).
2. Standardized Computer‐based Organized Reporting of EEG: SCORE. Epilepsia (2013).
3. Ultrafast review of ambulatory EEGs with deep learning. Clinical Neurophysiology (2023).
4. Normal variants and artifacts: Importance in EEG interpretation. Epileptic Disorders (2023).