Choosing Wisely:

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

Rationale and Comments: Electroencephalogram will be negative in a large portion of patients with epilepsy, and may be positive in patients without epilepsy. False positive electroencephalogram findings commonly lead to unnecessary use of antiepileptic drugs and may delay the syncope diagnosis and treatment. Electroencephalogram are most helpful in specific situations when there is high pre-test probability for epilepsy based on history and exam, and clinical presentation.
Sponsoring Organizations:
  • American Epilepsy Society
  • Sources:
  • Expert consensus
  • Disciplines:
  • Neurologic
  • Cardiovascular
  • References: • 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.

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