Overinterpretation of EEG is a major contributor to misdiagnosis 2, 6, 7: 25%–30% of patients seen at epilepsy centers for drug-resistant seizures do not have epilepsy. 5 The body of knowledge is passed down by word of mouth from teacher to student, and EEG training is like an extensive process of probabilistic classification learning, where teachers provide reinforcement for the visually identified patterns. 1, 3, –, 5 However, interpreting EEG is based on pattern recognition, and reading EEG is still more an art than a science. Interictal epileptiform discharges (IEDs) are typically found in patients with epilepsy. 1 However, most recordings are interpreted by neurologists without expert certification. Visual analysis is still the gold standard in clinical EEG. Glossary AC1 = Gwet agreement coefficients IED = interictal epileptiform discharge IFCN = International Federation of Clinical Neurophysiology IRA = interrater agreement LTM = long-term video-EEG monitoring ROC = receiver operating characteristic
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