REEG can repeatedly fail to reveal IIEAs in some people with epilepsy. However, the diagnostic yield of rEEG varies considerably according to the population studied and most published data pertains to highly selected groups, such as people with a suspected first seizure or with drug-resistant temporal lobe epilepsy. If a single rEEG is normal, a sleep-deprived EEG may increase the yield of IIEAs by an additional 30% or more 5-7. It is reported that IIEAs are present in 30-50% of rEEG recordings and that the cumulative yield increases on serial testing to 80-90% by the third rEEG 1-4. It is typically carried out over 20-30 minutes on an outpatient basis and primarily aims to detect IIEAs, which are strongly associated with epilepsy. REEG is regarded as an important initial investigation in suspected epilepsy. It is resource intensive and access is limited in most regions of the UK and Ireland. It captures both ictal and interictal activity for diagnostic clarification, seizure classification and the identification of epileptogenic cortex in focal epilepsy. Prolonged vEEG, usually performed as an inpatient on an epilepsy monitoring unit (EMU) over a period of days, is widely considered the ‘gold standard’ investigation in intractable seizures 1. The diagnosis of epilepsy is generally established on clinical grounds but may be supported by EEG findings.
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