EEG
A pediatric EEG reading curriculum: twelve self-paced modules from electrodes and montages to reading a neonatal or PICU record and writing the report, with decision questions, quizzes and faculty sign-offs.
- Work through Modules 1 to 5 in order.
- Take the neonatal pair (6 and 7) and the abnormal-EEG sequence (8 to 10) in either order, then finish with Module 11.
- Module 12 runs alongside everything: pre-read real studies from the first week and compare each read with the attending's.
Each module takes roughly 2 to 4 hours of self-study, plus reading real records. These are estimates, not tested times. Every module has the same parts: objectives, teaching sections with key points and a decision question each, a quiz, what to read and watch, and what a faculty reader checks before the module counts as done.
Modules 1 to 5, in order. Signal, montage, the reading routine, artifacts, and what is normal for age.
Where the scalp signal comes from, how a montage turns it into channels, and how filters and time base change what you see.
When an EEG is indicated, a fixed order for reading every record, and a report that keeps description, impression and clinical correlation apart.
The physiologic and non-physiologic artifacts of childhood, the rhythmic artifacts of the NICU and PICU, and a method for proving that a waveform is not cerebral.
When each normal feature appears and disappears, from the posterior dominant rhythm and sleep spindles to the drowsy patterns that get over-read.
The benign variants by age, the IFCN rule for calling a transient epileptiform, and why a discharge alone does not make epilepsy.
Modules 6 and 7. Maturation by postmenstrual age, then abnormal backgrounds and neonatal seizures.
Postmenstrual age as the reading age, and what continuity, synchrony, graphoelements and sleep states should look like at each week.
Grading a neonatal background in ACNS terms, defining a neonatal seizure and status epilepticus, and knowing when and how long to monitor.
Modules 8 to 10. Interictal findings, the syndromes, and seizures and status on EEG.
How to describe an epileptiform discharge precisely, and how to separate it from slowing, rhythmic delta and asymmetries, each of which points to a different set of causes.
The EEG features that define, support or argue against the common infant and childhood epilepsy syndromes under the ILAE 2022 definitions, and which study to order for each question.
How a seizure is recognized on EEG by evolution, how the ACNS 2021 definitions turn that into thresholds for seizures and status epilepticus, and which seizures the scalp EEG can miss.
Module 11. ACNS terminology, the ictal-interictal continuum, and seizure burden in the PICU.
Module 12 runs alongside everything: pre-read real studies from the first week.
| Level | Wording (ACGME child neurology milestones, 2020) | Modules |
|---|---|---|
| Level 1 | Describes general indications for an EEG | |
| Level 2 | Describes normal EEG features using correct terminology, including common artifacts, across the lifespan | |
| Level 3 | Describes patterns of status epilepticus, normal EEG variants and common abnormalities, across the lifespan | |
| Level 4 | Interprets common EEG abnormalities and creates a report | |
| Level 5 | Interprets uncommon EEG abnormalities |
In a 2024 survey of US and Canadian child neurology program directors, 62% used no objective EEG competency measure and 93% set no minimum number of reads (Katyal 2024). The ILAE competency roadmap puts the same skills at its Level 2 (Blümcke 2019).
- 01The resident localizes five discharges on real records, in both bipolar and referential montages, with a faculty reader.
- 02The resident writes five full reports that a faculty reader accepts with minor edits.
- 03The resident correctly labels ten artifacts on real records, including at least three from infants or the ICU.
- 04The resident reads ten normal records spanning infancy to adolescence and states the expected posterior rhythm for each age before looking.
- 05On ten sharp transients chosen by faculty, the resident scores each against the six IFCN criteria and agrees with the faculty call on at least eight.
- 06The resident reads five neonatal records of different postmenstrual ages and estimates the age from the tracing to within 2 weeks.
- 07The resident grades five neonatal backgrounds and identifies seizures on two continuous EEG studies, agreeing with the faculty read.
- 08The resident describes ten abnormal records in full, with each finding placed correctly as epileptiform or non-epileptiform.
- 09The resident identifies the syndrome-defining features in at least one record each of IESS, an absence epilepsy and SeLECTS.
- 10The resident identifies onset, evolution and offset in five recorded seizures, including at least one generalized and one focal.
- 11The resident passes the ACNS CCEMRC certification test and reviews two pediatric cEEG days with faculty, naming every pattern.
- 12The resident completes the local reading target and all six EEGmaster competency tests, and every module's sign-off has been verified by a faculty reader.
A suggested local reading mix, offered as a suggestion rather than a standard: 60 routine studies, at least 20 of them in children under 2. 10 neonatal studies across a range of postmenstrual ages. 10 days of pediatric or neonatal continuous EEG. At least one recorded example each of IESS, an absence epilepsy and SeLECTS. Sign-offs here are self-reported; the faculty log in Module 12 is the record that counts.
All three core sites are free, but each has a different strength: Learning EEG for pediatric and neonatal content, eeg-training.com for interactive technical and ICU drills, and EEGmaster for tracked testing. None grants a reuse licence, so this curriculum links to their pages rather than copying figures.
- Libenson MH. Practical Approach to Electroencephalography. 2nd ed. Elsevier; 2024.
- Mizrahi EM, Hrachovy RA. Atlas of Neonatal Electroencephalography. 4th ed. Demos/Springer Publishing; 2015.
- Sansevere AJ, Harrar DB, eds. Pediatric Neurocritical Care EEG. Springer Publishing; 2020.
- Tatum WO. Handbook of EEG Interpretation. 3rd ed. Springer Publishing; 2021.
For education. Not for clinical decision-making. Content follows the ACNS, IFCN and ILAE terminology named in each module, with every PubMed citation checked before publication.