EEG Training for Neurologists Is Inadequate

In order to become a board-certified neurologist in the U.S., medical students have to complete a neurology residency and pass the Neurology Boards. The neurology residency comprises a first year of general medicine (known as the internship) followed by three years of neurology. During those three years, residents are exposed to patients with neurologic diseases, and several components are mandatory. For example, inpatient (hospital) and outpatient (clinic) experience are required, as are child neurology (three months), psychiatry (one month), and some exposure to intensive care units, emergency rooms, and neuroimaging. While there is time allotted for “elective” rotations, there is no mandatory requirement for electroencephalography, or EEG, training.

In reality, many program directors understand the importance of EEG and do require a mandatory EEG rotation (one month or so) within their own program. One month is short, but is certainly better than nothing. Unfortunately, there are also many neurology training programs that do not have such requirements and allow their residents to graduate with little or no EEG training. As a result, it is not uncommon for a neurologist to enter private practice with little or no experience in reading EEGs.

The absence of any mandatory EEG training is surprising because only neurologists read EEGs in clinical practice. EEGs are used for many areas of neurology, but nowhere are they as critical as in the diagnosis of seizures and epilepsy. In fact, EEGs are very often misinterpreted by inexperienced readers. Specifically, EEGs tend to be “over-read” as abnormal when they are normal, resulting in wrong diagnoses of seizures and epilepsy. This is rarely published or discussed because it is a politically unpleasant topic, but it is a real tragedy for those who are misdiagnosed based on an over-read EEG.

Other specialties, such as cardiology, have established standards for competency on reading EKGs. Our professional organizations, such as the American Academy of Neurology, the American Epilepsy Society, and the American Clinical Neurophysiology Society, should work together to establish similar minimum requirements.

To read more:

• Benbadis SR. The tragedy of over-read EEGs and wrong diagnoses of epilepsy. Expert Rev Neurother 2010;10:343.
• Benbadis SR, Lin K. Errors in EEG interpretation and misdiagnosis of epilepsy. Which EEG Patterns Are Overread? Eur Neurol 2008;59(5):267-271.
• Benbadis SR. Just like EKGs! Should EEGs undergo a confirmatory interpretation by a clinical neurophysiologist? Neurology 2013;80(Suppl 1):S47-51.
• Benbadis SR, Tatum WO. Over-intepretation of EEGs and misdiagnosis of epilepsy. J Clin Neurophysiology 2003;20:42-44.