American Epilepsy Society

View all recommendations from this society

August 15, 2018

Do not routinely order electroencephalogram (EEG) as part of initial syncope work-up.

EEG will be negative in a large portion of patients with epilepsy, and may be positive in patients without epilepsy. False positive EEG findings commonly lead to unnecessary use of antiepileptic drugs and may delay the syncope diagnosis and treatment. EEGs are most helpful in specific situations when there is high pre-test probability for epilepsy based on history and exam, and clinical presentation.


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American Epilepsy Society (AES) and the AES Practice Management Committee (PMC) worked together to prepare the five statements from 2016–2018. The PMC met in person in December 2016 to use the ABIM Foundation’s Operating Principles for Clinician Organizations’ Participation in the Choosing Wisely Campaign to discuss and propose topics for further development. The PMC ultimately proposed seven potential topics for further discussion and tasked a subgroup of seven committee members to draft seven Choosing Wisely statements. Once drafted, each item was voted upon by the PMC subgroup for further inclusion.

Voters were provided additional instructions to select the item for further inclusion if it had (1) clinical relevance, (2) clinical validity, and (3) clarity of concept. Voting occurred electronically. Two items were eliminated, and five items were selected for further and final development. The final five items were completed by individual PMC subgroup members. The entire PMC subgroup then reviewed each statement for final editing and final vote for submission to Choosing Wisely, based on the same criteria mentioned above. Items receiving at least six “yes” votes (among seven voters) were advanced and reformatted and edited by the Practice Committee Chair, Dr. Gabriel Martz, to adhere to the ABIM Foundation’s Choosing Wisely submission specifications. The PMC subgroup then re-evaluated items to ensure consistency of message after re-formatting, and again voted on each item individually for or against advancement for review and consideration of approval by the AES Council on Clinical Activities, AES Executive Committee, AES Board of Directors. The AES Board of Directors provided feedback and final approval of the five statements for submission to the ABIM Foundation for consideration of inclusion in the Choosing Wisely Campaign. The PMC will review the statements on an annual basis to ensure adherence to the Foundation’s Operating Principles and that the statements continue to be supported by generally accepted evidence and are applicable to current clinical practice.

Sources

https://www.nice.org.uk/donotdo/do-not-routinely-use-electroencephalogram-eeg-in-the-investigation-of-transient-loss-of-consciousness-tloc

Angus-Leppan. Diagnosing epilepsy in neurology clinics: a prospective study. Seizure 2008; 17 (5): 431-6.

Josephson CB, Rahey S, Sadler RM. Neurocardiogenic Syncope: Frequency and consequences of its misdiagnosis as epilepsy. Canadian Journal of Neurological
Sciences. 2007; 34 (2): 221-224.

Chowdhury FA, Nashef L, Elwes RDC. Misdiagnosis in epilepsy: A review and recognition of diagnostic uncertainty. Eur J Neurol 2008; 15(10): 1034-1042.

Fowle AJ, Binnie CD. Uses and abuses of the EEG in epilepsy. Epilepsia 2000; 41 Suppl 3: 10-18.

Van Donselaar CA, Stroink H, Arts WF; Dutch Study Group of Epilepsy in Childhood. How confident are we of the diagnosis of epilepsy? Epilepsia. 2006; 47 Suppl 1:9-13.