ORCID
- Rohit Shankar: 0000-0002-1183-6933
- John Terry: 0000-0002-6829-5736
Abstract
Lengthy waits for follow-up testing are common for people with suspected epilepsy. This delays diagnosis, prolongs uncertainty and increases seizure risk. Initial EEGs are frequently inconclusive, yet follow-ups are often dictated by referral date, and there is no established method for risk-based prioritisation. Here, we tested whether an established digital EEG biomarker could help prioritise those most likely to have epilepsy for expedited follow-up EEG testing. We analysed 196 normal non-contributory (non-diagnostic) initial EEGs collected from six National Health Service (NHS) sites in England. From these recordings, we extracted eight previously validated computational features that quantify the likelihood that the EEG was recorded from someone with active epilepsy. We then used this information to reorder follow-up lists and compared outcomes against standard referral-based scheduling.We found that ordering for follow-up testing based upon the digital biomarker consistently prioritised people subsequently diagnosed with epilepsy; for a waitlist of 40 patients, the median number of follow-up EEGs needed to see 50% of true epilepsy patients was decreased by 6 (95% CI 4–7). The EEG diagnostic yield for epilepsy of follow-ups was increased relative to orderings based on time of referral (median increase in yield for epilepsy at 50% follow-up EEGs was 5%; 95 CI 4.9%-10%). Our study indicates that a routine EEG may furnish an objective risk metric that could accelerate second-line investigations and so reduce diagnostic delay whilst improving resource allocation in clinical practice.
DOI Link
Publication Date
2026-02-16
Publication Title
Epilepsy and Behavior
Volume
177
ISSN
1525-5050
Acceptance Date
2026-01-28
Deposit Date
2026-02-17
Funding
Funding was provided by Innovate UK, National Institute for Health and Care Research, Engineering and Physical Sciences Research Council, and Epilepsy Research UK.
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Recommended Citation
Shankar, R., & Terry, J. (2026) 'Prioritising follow-up for people with suspected epilepsy using a digital EEG biomarker', Epilepsy and Behavior, 177. Available at: 10.1016/j.yebeh.2026.110925
