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EEG pre-referral guidelines

  • Routine outpatient EEGs are performed in Specialist Clinics A3, during weekdays between 9 am and 5 pm. EEGs are performed by paediatric neurophysiology scientists, with activation procedures (hyperventilation and photic stimulation) and attempts to record EEG during the state in which seizures occurred (e.g. sleep, arousal, startle).  Sleep deprivation is used to facilitate sleep recording, if this is required and requested; sedation is not employed in outpatient EEGs. It should be noted that an EEG recording is a time-consuming, costly and often technically-challenging investigation that does not always provide clear answers to the clinical question.

    COVID-19 pandemic outpatient EEG service provision

    Our normal practice is to limit EEG to patients with appropriate clinical indications, given the complexities of EEG recording and the potential for findings to lead to erroneous diagnoses and management. In the context of the COVID-19 pandemic, we are further limiting outpatient EEGs to patients for whom the result will significantly impact on management.

    • EEG referrals are currently accepted for patients with a clinical diagnosis of seizures, where the result will assist in seizure or syndrome diagnosis and may determine the need for further investigation and/or anticonvulsant medication.
    • EEG referrals will be considered for patients with possible seizures only in exceptional circumstances, eg. suspected infantile spasms, or with compelling history or home video of other events. However, these referrals should be discussed by telephone with an RCH neurologist or fellow. Please indicate this on the referral.

    Indications for routine EEG

    Routine outpatient EEG recording is indicated in a child who has had an unprovoked epileptic seizure or is having recurrent episodes suspicious for seizures following:

    • clinical assessment (history, examination, review of home video recordings)
    • consideration of non-epileptic episodes (e.g. breath-holding spells, syncope, inattention etc)
    • exclusion of acute symptomatic causes for seizures (CNS infection, head trauma, metabolic disturbance etc)

    The clinical utility of routine outpatient EEG in children with seizure disorders includes:

    • confirmation of a clinical suspicion of epileptic seizures
    • prediction of seizure recurrence risk after a first unprovoked seizure
    • determination of the type of seizure, typically focal versus generalised seizures
    • determination of the type of epilepsy, and sometimes a specific epileptic syndrome
    • determination of the need for brain imaging and other specialised investigations
    • decision about whether to treat and the choice of antiepileptic medication
    • occasionally, monitoring of treatment of epilepsy

      EEG is not indicated in children with

      • febrile seizures, including when focal, prolonged or recurrent
      • other provoked seizures, e.g. concussive, hypoglycaemic, diarrhoea-associated
      • headache, migraine and tics
      • autism, learning difficulties, language delay, attention deficits or intellectual impairment without a history of seizures
      • psychiatric symptoms or episodic behaviour disturbance
      • syncope and breath-holding spells, including with convulsive features (consider the need for ECG instead)
      • to "exclude" epilepsy or neurological basis or underlying lesion

      There are additional roles and indications for specialised EEG recordings in acute inpatient and chronic epilepsy settings. These are undertaken after formal neurological consultation.

      For advice about whether to request a routine EEG, please discuss the clinical issue with the neurologist or the neurology fellow on-call if urgent (via switchboard operator 9345 5522) or email neurology.department@rch.org.au if not urgent.

      For booking inquiries and questions, please call Specialist Clinics A3 on 9345 3901

      For outstanding results, please call the Neurology Department on 9345 5661


      Patient information about EEG

      https://www.rch.org.au/neurology/patient_information/routine_EEG/#what-is-an-eeg

      https://www.rch.org.au/kidsinfo/fact_sheets/Electroencephalography_EEG/

      Links

      RACP EVOLVE top 5 recommendations for paediatric neurology