Epilepsy Sparks

Not Everyone With Epilepsy Has An Abnormal EEG!

Not Everyone With Epilepsy Has An Abnormal EEG!

I'm Marcin Kopka MDa Neurologist at the Military Institute of Aviation Medicine1 (Warsaw, Poland).

I’m particularly interested in the treatment of people with both epilepsy and migraines.


Favourite bands: Depeche Mode2ABBA3

Favourite food:    Bacon and eggs

Favourite film:     12 Angry Men4

An Electroencephalography (EEG) is an important test during which the bioelectrical activity of the brain is recorded5. EEGs are most commonly carried out in people either with or suspected of having epilepsy. But, are EEG recordings always “abnormal” in those with epilepsy?

When a person has an unprovoked seizure, a diagnosis of epilepsy may be suspected, and an EEG requested. It is estimated that upon an initial EEG; approximately 50% of patients will have an abnormal EEG. When the recording process is repeated two or more times, disturbances in EEG recording are found in 70-80% of recordings6. This means that 20-30% of patients with epilepsy have no pathological abnormalities in an EEG recording. You could ask: “How is this possible?” It should be noted that EEGs are only able to record the bioelectrical activity in the peripheral layers of the brain (the cerebral cortex). When a person’s seizure focus is located deep inside their brain, an EEG is unable to pick up the abnormal activity.

EEGs are useful in a clinical diagnosis of epilepsy and can also often help with the diagnosis of specific types of seizures and the identification of epileptic focus localisation.7

Remember that a person may have a diagnosis of epilepsy without any abnormalities showing in their EEG recordings.

Marcin Kopka MD

Neurologist, Military Institute of Aviation Medicine   


1.Military Institute of Aviation Medicine: http://www.wiml.waw.pl/?q=en

2. Depeche Mode: http://www.depechemode.com/

3. ABBA: https://abbasite.com/

4. IMDb: https://www.imdb.com/title/tt0050083/ 

5. Pierre Gloor, OCLC World Cat: Electroencephalography and Clinical Neurophysiology. Supplement no. 28Hans BERGER, Professor an der UniversitaÌ?t Jena.ISBN: 0444407391 9780444407399

6.W. B. Mathews, Practical Neurology. Blackwell 1963, ASIN: B0000CLW12

7. P.E.M. Smith & S.J. Wallace: Clinicians Guide to Epilepsy. Hodder Education Publishers; 1 edition 2001. ISBN-10 0340762934, ISBN-13: 978-0340762936


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Thank you for the valuable information. Would love to learn more about surface EEG.

Hi Dr.Kopka I'm one of those people with seizures where nothing abnormal shows so they get treated like pseudo seizures. I live with depression, ADHD and Tourettes syndrome and I find living with mental health issues gets in the way when you are doing with a medical issue. Things get placed under stress and anxiety. I'm constantly get asked and checked to see if I'm a substance abuser. I never have been. I had a nearly two year break but now it's back. I have not had the greatest treatment since 2009, in regards to this issue. I'm almost scared to go back. Tonight, I spent at least a minute of just my head twitching and my left arm. I couldn't speak, I had no control. I then briefly passed out and very shortly after had a grand mal. I feel quite tired and am having loose bowels now. Despite them being pseudo, in nature,if they truly were, I had a relief from seizure medications in the past. I don't want to have to go through the not so nice treatment I went through before. I wish it would not have come back though I'm not so sure they truly left. I get odd sensations, like I'm sinking through the floor. Any bad accident I had when I was younger, everything went black before it happened. I have gaps in what happened. Any advice. Thanks for your time Tammy.

That's interesting. Would you say that is the same case even after a video eeg produces an abnormal eeg?

Dear Dr. Kopka, I received this link to you today: "We bridge the gap between those in the medical profession and patients! To share your story message us/check out: https://www.epilepsysparks.com/Not-Everyone-With-Epilepsy-Has-An-Abnormal-EEG- … ????????????#scicomm #neurology #Epilepsy #epilepsyresearch" I raise epilepsy awareness with my medical mystery novel, DINGS and my monthly epilepsy blogs (101 monthly educational blogs, to date). I shall be in Warsaw 12-14 June 2019 as part of a vacation tour. I would be happy to meet you during that time. Having a local contact in Warsaw would enrich my experience. My website: LanceFogan.com tells my story. Lance Fogan, MD, MPH, FAAN Clinical Professor of Neurology at UCLA. Email: Lance@lancefogan.com

My kiddo struggles with what has been diagnosed nonepileptic seizures. She's had 2 veegs. Many abnormalities but nothing lasting long enough to call epilepsy. She has a pineal cyst .6mm. Tricuspid valve leaking, low iron, a low case of Von Willebrand disease, blood in urine. We're presently seeking follow up with tricuspid valve, mri, sleep study, hematologist and urine analysis. She has struggled with FND..wheelchair bound after released from the hospital with a sprain only to find out later it was broke. She's presently mobile and even dancing. She has struggled with significant depression since around Sept. Initially we believe prednisone was a trigger to the start of self harm and suicidal ideations. She struggles with ptsd I believe medically and quite likely past traumas. She did not have significant depression and or ptsd until after her fall on 2-1-18 in ballet class. Her ability to process stress seemed doable until the fall. Now it seems we may be discovering the physiological triggers to nonepileptic seizures. She has been attaining tools in grounding. Thanks for listening/reading.