To EEG or not EEG

NICE guidelines emphasise the importance of not relying on EEG in isolation for diagnosis, the main indication for EEG, to define the seizure type and syndrome to guide treatment and prognosis. EEG is also essential when non convulsive status sate or the development of Continuous Spike Wave in Slow Wave Sleep (CSWS) is suspected, but should not be requested in children with autistic regression. EEG should not be included in work up of developmentally/neurologically normal children with simple or complex febrile seizures, and repeat EEG's once the epilepsy seizure type/syndrome has been diagnosed, are of limited value for monitoring treatment or deciding drug withdrawal. The value of a routine EEG can be enhanced by the paediatrician closely liaising with the EEG department to try and record episodes if there are known triggers for the episodes under investigation. This article describes the value of EEG interictal in children and offers advice to those requesting this important investigation.