EEG for children (electroencephalography)

• A first seizure without fever — according to the international practice standard, an EEG is a standard part of the workup
• Confirming the diagnosis of epilepsy and determining the seizure type and syndrome
• Recurrent “zoning out” episodes (suspected absence seizures)
• Unusual episodes of movement during sleep
• Monitoring treatment and deciding whether to stop medication
• When it is hard to tell a non-epileptic event from epilepsy (video EEG)
• Sudden loss of speech and skills (regression)

• A simple febrile seizure — according to the American Academy of Pediatrics, an EEG is not needed in an otherwise healthy child
• Typical migraine and tension-type headache
• ADHD, tics, stuttering, developmental delay (if seizures are not suspected)
• Fainting, night terrors, shuddering attacks, sleep myoclonus — when typical

Why this matters: even healthy children can have small changes on an EEG. In a large cohort study, one in three diagnoses recorded as “epilepsy” turned out to be wrong, and among them were diagnoses based on EEGs done for another reason. A normal EEG does not rule out epilepsy, and an EEG “with changes” does not by itself mean epilepsy; the diagnosis rests on the clinical picture.

Routine (awake) EEG: 20–30 minutes; your child sits or lies down, opens and closes their eyes, breathes deeply (hyperventilation), and light stimulation is performed.

Sleep EEG: in many childhood epilepsies, changes show up only during sleep, so a recording during sleep is more informative. In small children, the test is often done while they sleep.

Prolonged and video EEG: several hours or longer to capture the episodes themselves; it determines whether a seizure is epileptic.

• Hair should be clean and dry; no gel, spray, oil or braids
• For a sleep EEG, it is recommended to put your child to bed later than usual the night before and wake them early in the morning (following the doctor's instructions); they should arrive sleepy
• Your child should not be hungry; for babies, feeding is planned a little before the test
• Medications your child takes are not stopped unless the doctor says otherwise
• Bring a favorite toy or book; explain to your child, “they'll put a cap on your head like a hat, it doesn't hurt”

The electrodes are placed with a mesh cap or adhesive paste; your child lies down and the recording is made. There is no pain and no electric current, the test is safe, and it can be repeated at any age. The result describes whether the rhythms fit the child's age, any asymmetry, and whether epileptiform activity is present and where. The interpretation is always made together with the clinical information: the same EEG means different things in different children. That is why it is important to discuss the result with the neurologist who did the EEG and examined your child.