EEG is the only means of diagnosing NCSE and ongoing electrographic seizures that are potentially detrimental to the brain and may affect prognosis. Stat EEGs are reserved for emergent situations, especially when non-convulsive status epilepticus (NCSE) is suspected. In this review, we focus on when to perform and repeat a routine EEG during the evaluation of seizures and epilepsy and other neurological disorders by posing clinically relevant questions and answers. The challenges to maintain a long-term EEG during COVID-19 have proven to facilitate usage of a routine EEG in cases where antiseizure medication (ASM) reduction and presurgical evaluation are not necessary. When used appropriately, ambulatory EEG is a valuable surrogate for inpatient video EEG monitoring without compromising the quality of the recording. During the pandemic when “lock down” forced epilepsy monitoring units to close temporarily, the gap created by a lack of monitoring was augmented in our center (and probably many others) and met with a rise in routine and ambulatory EEGs to meet the needs of the patients. The benefits of long-term EEG are well established. The primary aim of routine EEG analysis is to support the clinician’s evaluation of patients with objective data to support a clinical hypothesis for diagnoses. Video-assisted EEG is now routine and is used to correlate behavioral activity with electrocerebral activity to provide even greater yield. Today, routine EEGs are a sophisticated multi-channel microprocessor that is digitally based with sampling rates of > 200 Hz, 128 gigabytes of internal memory space, and resolution of at least 12-bits. As regions rebound, the routine use of EEG in the interictal or asymptomatic period has remained a powerful test for diagnosis and management. This was substantially reduced as COVID-19 influenced all aspects of hospital care. Normally, a comprehensive epilepsy center may perform > 4,000 EEG studies per year. Routine EEG is foundational for the diagnostic process in people with epilepsy, extracting complex brain signals and applying them to clinically relevant features using visual analysis. Routine electroencephalogram (EEG) is a common test of neurophysiologic function that is performed to diagnose and monitor several conditions affecting the brain.
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