“Just like EKGs!” Should EEGs undergo a confirmatory interpretation by a clinical neurophysiologist?

The misdiagnosis of epilepsy is common and has serious consequences. A major contributor to the misdiagnosis of epilepsy is the tendency to overread normal EEGs as abnormal. In fact, the wrong diagnosis of seizures is sometimes based solely on the "abnormal" EEG. Reasons for the common overinterpretation of normal EEGs are mostly related to the lack of standards or mandatory training in EEG, and the erroneous assumption that all neurologists are trained to read EEGs. The most common overread pattern consists of benign, nonspecific, sharply contoured temporal transients. In particular, there is a common misconception that "phase reversals" are indicative of abnormality. Potential solutions include defining and ensuring EEG competency of neurologists who read EEGs, and perhaps providing a confirmatory reading by an electroencephalographer, as is done for EKGs.