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Epilepsy

Value of an EEG


An EEG (electroencephalogram) is a recording of the surface charges of the brain using small surface electrodes applied to the scalp with a special conductive paste. Normal brain waves consist of a number of defined rhythms at different frequencies, amplitude and distribution. With altered brain function such as epilepsy these rhythms may alter showing waveforms of a specific type.
 

Value of an EEGThe indications for an EEG are:

  • To define seizure type – absence episodes, generalised epilepsy or partial seizures.  This may affect drug therapy and management.
  • To define a focal abnormality in the brain where epileptic events may arise. This allows a more focused review of CT or MRI scans.
  • To help in the assessment of attacks of altered awareness eg possible epileptic aura such as déjà vu phenomenon.
  • Unexplained fluctuating or altered consciousness/awareness.  This can be seen in non convulsive seizures. Presentation includes slow mentation and slow speech. Precipitants include withdrawal of benzodiazepine medication. Such altered behaviour can also be seen as a manifestation of epilepsy after cerebral injury e.g. from stroke.
  • To confirm non epileptic stress attacks with frequent events allowing capture of an episode on EEG.  A normal EEG in a typical attack would not support epilepsy.
  • To assess specific EEG changes in a rapid onset decline in cognitive function. This may show changes suggestive of a specific diagnosis.
 
Note: A normal EEG does not exclude epilepsy.
 
If treatment is begun for epilepsy, ideally an EEG should be done before the patient takes medication if information about a focal abnormality or seizure type is required. Sleep deprivation is also used to increase the possibility of recording epileptiform activity.
 

Where an EEG is not indicated:

  • EEG should not be used to diagnose epilepsy per se.  This is primarily a clinical diagnosis. 
  • EEG is not necessarily of use in refractory epilepsy, unless this is to review seizure type or to define a seizure focus.
  • EEG is not helpful in decisions as to whether to discontinue medication, having been seizure free – unless there are absence attacks.  Such decisions are driven more by clinical concerns and the consequences of a further seizure.
  • EEG is generally not helpful in addressing the question of loss of consciousness – query faint or epilepsy. Epilepsy is a clinical diagnosis but an EEG may be useful if uncertainty exists after a full clinical assessment.
 
Compiled by Stuart Mossman Neurologist FRACP MD