Prevalence of epileptiform electroencephalographic abnormalities in people without a history of seizures: A systematic review and meta‐analysis

Abstract

Abnormal patterns identified on electroencephalogram (EEG) are one of the primary diagnostic tests for epilepsy. However, epidemiological studies have established that both benign and epileptiform abnormalities (EA), occur in the EEG of non‐epileptic, seizure‐free people as well. The reported rates of EAs in non‐epileptic, seizure‐free populations vary, and the true prevalence is unknown. The primary objective of this systematic review and meta‐analysis was to estimate the overall prevalence of EAs in the EEG of people without a history of seizures. Secondary aims were to characterize i) the cortical localization of focal abnormalities; ii) the proportion of findings that occurred during standard EEG stimulation protocols; and iii) the persistence and implications of abnormalities at follow‐up. A comprehensive electronic search of six bibliographic databases was completed: EMBASE, MEDLINE, PsycINFO, Cumulated Index of Nursing and Allied Health Literature, The Cochrane Central Register for Controlled Trials, and Web of Science. No search date restrictions were applied. Overall effect size was calculated using a generalized linear mixed‐effects model. Fifty‐three studies, totalling 73,990 individuals, met our inclusion criteria. The overall point prevalence of EAs was 1.74% (95% CI: 1.13‐2.67). Due to the risk of bias in the literature, especially from participant selection, we believe this to be an overestimate of the true prevalence. Prevalence of EAs was greater in children (2.45%, 1.41‐4.21) and the elderly (5.96%, 1.39‐22.13) compared with adults (0.93%, 0.48‐1.80). Reports of developing epilepsy after an EA‐positive EEG were rare. The likelihood of subsequent positive findings on follow‐up EEG may be as high as 50%. Our study has limitations in that males were overrepresented in the study samples, there is substantial heterogeneity among studies, and many studies provided insufficient detail about their exclusion criteria. Nonetheless, our estimates provide benchmark data for future studies examining EAs in clinical populations, particularly behavioural and psychiatric populations.