Can anyone read an electroencephalogram (EEG)?

EEG Interpretation Requires Specialized Training and Expertise

EEG interpretation requires specialized training and cannot be performed by anyone without proper education and experience. 1, 2

Training Requirements for EEG Interpretation

• Standard diagnostic EEG interpretation requires specific expertise that develops through dedicated training and experience 2
• Neurologists typically need at least 8 weeks of specialized EEG training to reach accuracy comparable to clinical neurophysiologists 3
• Most child neurologists and neurodevelopmental disability specialists who read EEGs in clinical practice receive their primary training during residency, with an average of 7.3 weeks dedicated to EEG training 4
• Accuracy in EEG interpretation improves from 67% (with no prior EEG training) to 77% (with >12 weeks of EEG training) 3

Technical Aspects of EEG Recording

• Standard EEG recording should include 19 electrodes placed according to the 10-20 International System 5, 1
• A typical diagnostic EEG lasts 20-30 minutes, though monitoring may be longer in specific clinical scenarios 6, 1
• EEG recordings should capture variations in vigilance levels, including both eyes-closed and eyes-open states when possible 5, 1
• EEG has high temporal resolution (<1 ms) but relatively low to moderate spatial resolution (few centimeters) compared to neuroimaging techniques 5

Interpretation Challenges and Expertise

• Interpreting EEG is primarily based on qualitative review, making the accuracy dependent on the interpreter's training, experience, and exposure to various waveforms 2
• Potential pitfalls include misinterpreting normal variants and artifacts as epileptiform patterns, particularly for inexperienced interpreters 2
• Nearly one-third of graduating child neurology residents do not feel confident interpreting EEGs independently 4
• Neurologic consultation before obtaining an EEG is reasonable given the specialized nature of EEG interpretation 1

Emerging Technologies and Access

• New technologies like Rapid Response EEG systems may allow faster acquisition of EEG data in emergency situations, but interpretation still requires expertise 7
• Continuous EEG monitoring combined with quantitative analysis and machine learning may help identify changes in real time, but human expertise remains essential for final interpretation 8
• Online, competency-based EEG examination tools are being developed to improve resident EEG education worldwide 3

Clinical Applications of EEG

• EEG is the definitive test for detecting ongoing electrical seizure activity, particularly when clinical manifestations are subtle or absent 1
• EEG can detect changes in cortical cerebral activity across the spectrum of hepatic encephalopathy without patient cooperation 5
• In post-cardiac arrest patients, EEG patterns can help predict neurological outcomes 5
• EEG is invaluable for confirming or excluding non-convulsive seizures or status epilepticus, particularly in critically ill patients 8

Limitations and Considerations

• A normal EEG does not exclude certain neurological conditions, such as autoimmune encephalitis 1
• Environmental electrical noise and levels of anesthesia may sometimes completely obscure the EEG in intensive care unit environments 5
• The optimal montage and number of electrodes for recording EEG in specific clinical scenarios remains uncertain in some cases 1

In conclusion, while EEG is a valuable diagnostic tool in neurology, its interpretation requires specialized training and expertise that develops through dedicated education and clinical experience. General clinicians should consult with neurologists or clinical neurophysiologists for proper interpretation of EEG findings.