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A practical guide for routine EEG studies in epilepsy.

J Engel

    Journal of Clinical Neurophysiology : Official Publication of the American Electroencephalographic Society
    |April 1, 1984
    PubMed
    Summary
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    The electroencephalogram (EEG) is a valuable tool for diagnosing epilepsy, but it should not be overinterpreted. Proper EEG use aids in differentiating seizure types and guiding treatment decisions for better patient outcomes.

    Area of Science:

    • Neurology
    • Clinical Neurophysiology

    Background:

    • Epilepsy diagnosis is clinical, not solely based on electroencephalogram (EEG) findings.
    • Overinterpretation of EEG tracings can lead to diagnostic errors.
    • Appropriate EEG utilization significantly aids in the epilepsy diagnostic process.

    Purpose of the Study:

    • To highlight the appropriate use of EEG in epilepsy diagnosis and management.
    • To emphasize the diagnostic and prognostic implications of EEG findings.
    • To guide the selection of patients for surgical interventions.

    Main Methods:

    • Utilizing activating techniques like hyperventilation, photic stimulation, and natural sleep.
    • Leveraging in-laboratory seizures for diagnostic opportunities.
    • Differentiating generalized and partial epileptic conditions using EEG.

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  • Identifying benign epileptic syndromes.
  • Assessing patient deterioration (undermedication vs. side effects) via EEG.
  • Distinguishing postictal slowing from other EEG changes.
  • Evaluating EEG characteristics for surgical candidacy.

    • Main Results:

    • EEG aids in differentiating seizure types and identifying specific epileptic syndromes.
    • EEG helps in managing medication adjustments by assessing seizure activity versus side effects.
    • Specific EEG patterns (e.g., anterior temporal spikes) identify candidates for resective surgery.
    • Certain EEG findings (multifocal spikes, bilateral synchrony with mental retardation) suggest limited benefit from resective surgery.

    Conclusions:

    • Epilepsy is a clinical diagnosis, with EEG serving as an adjunctive tool.
    • Appropriate EEG interpretation, including the use of activation techniques and seizure observation, is crucial.
    • EEG findings have significant prognostic value and guide therapeutic strategies, including surgical options.