What follow-up actions should I take if an EEG shows non-specific abnormalities in a patient with unexplained neurological symptoms?

If an electroencephalogram (EEG) shows non-specific abnormalities in a patient presenting with unexplained neurological symptoms, the following follow-up actions are recommended:

• Consider further EEG testing: If the routine EEG is non-diagnostic or shows non-specific abnormalities, a sleep-deprived EEG may be considered after discussing benefits and risks with the patient and their family or carers.
• If uncertainty persists: Consider ambulatory EEG monitoring for up to 48 hours to capture more data and clarify diagnosis.
• Neuroimaging: Offer an MRI scan to investigate structural causes, unless the clinical context suggests idiopathic generalised epilepsy or self-limited epilepsy with centrotemporal spikes. MRI should be performed within 6 weeks of referral using regionally agreed epilepsy protocols.
• If MRI is contraindicated: Consider a CT scan as an alternative.
• Specialist review: Ensure MRI scans are reported by neuroradiologists with appropriate expertise. If seizures or symptoms persist and diagnosis remains unclear, consider referral for specialist review and possibly repeat imaging.
• Referral and further assessment: Refer the patient to a neurologist or specialist for comprehensive assessment, including consideration of genetic testing if epilepsy is suspected.
• Information and support: Provide the patient with information about their condition, implications for activities such as driving, and support options.

These steps aim to clarify the diagnosis, identify underlying causes, and guide appropriate management.

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