Evolving clinical utility of long-term electroencephalography in pediatric epilepsy: diagnostic and therapeutic trends between 2019 and 2024

Introduction
Epilepsy is a chronic neurological disorder marked by recurrent, unprovoked seizures. Electroencephalography (EEG) is crucial for diagnosing and managing epilepsy. Recently, the use of long-term EEG has expanded beyond clear epilepsy suspicion, raising concerns about overinterpretation and diagnostic overuse. This study analyzes long-term EEGs in pediatric patients, assessing whether broader application reflects genuine clinical need or excessive use.

Material and methods
A retrospective analysis was conducted and included 59 long-term video EEG recordings from 54 children (mean age 7.78 years) in 2019, and 96 EEGs from 94 children (mean age 8.92 years) in 2024. All patients were hospitalized for evaluation of confirmed or suspected epilepsy. Daytime and combined day-and-night recordings were analyzed by certified pediatric neurophysiologists. Patients were grouped based on diagnosis status, EEG findings, and correlation with clinical symptoms.

Results
In 2019, the majority of patients had previously confirmed epilepsy, with antiepileptic treatment changes made in 44% of cases based on EEG findings. In 2024, there was a noticeable increase in referrals for suspected epilepsy, particularly among children with developmental concerns. Electroencephalography-seizure correlation was significantly higher in 2019 (65%) compared to 2024 (31%). Eye deviation during seizures consistently matched EEG findings across both years, serving as a clinical clue.

Conclusions
The use of long-term EEG monitoring increased between 2019 and 2024, with a shift toward evaluating diagnostically complex and behaviorally diverse cases. Long-term monitoring continues to improve diagnostic accuracy and inform treatment decisions, but the lower EEG-seizure correlation observed in 2024 indi- cates that broader indications may reduce diagnostic yield. Eye deviation remained a reliable electroclinical marker of seizures. Long-term EEG remains a valuable tool for distinguishing epileptic from non-epileptic events; its use should be guided by careful patient selection to avoid overinterpretation, unnecessary testing, and misdiagnosis, particularly in children with developmental and behavioral disorders.