{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T00:32:12Z","timestamp":1793320332344,"version":"4.5.0"},"reference-count":97,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T00:00:00Z","timestamp":1745452800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurology International"],"abstract":"<jats:p>Background\/Objectives: In a patient suspected of having epilepsy, routine EEG primarily contributes to the recording of interictal epileptiform discharges (IEDs). Similarly, magnetic resonance imaging (MRI) has become the gold standard imaging technique for identifying epileptogenic structural brain abnormalities. Various EEG and MRI tools to improve epilepsy diagnosis will be presented. Methods: When the initial EEG fails to record IEDs, various EEG measures that can improve EEG performance are presented; a comprehensive epilepsy-targeted MRI protocol to identify, localize, and characterize an epileptogenic lesion will also be described. Results: Studies show that the initial routine EEG fails to record IEDs in approximately 47\u201350% of epileptic patients. To improve the yield of EEG, subsequent EEG recording should include sleep deprivation, sleep recording, prolonged hyperventilation, optimized light stimulation, addition of an inferior temporal electrode chain, extended EEG duration, and continuous video-EEG monitoring, all measures known to activate IEDs. Furthermore, MRI is interpreted as \u201cnormal\u201d in many epilepsy patients, even when performed according to an epilepsy-specific protocol and evaluated by a specialized MRI reader. In such case, the use of the Harmonized Epilepsy Structural Sequence Imaging (HARNESS-MRI) protocol and other imaging tools will improve the detection of potential epileptic lesions, as described in this study. Conclusions: In a patient with a clinical diagnosis of epilepsy but a normal EEG and brain MRI, several options can improve the performance of subsequent EEG and MRI examinations, the subjects of this review.<\/jats:p>","DOI":"10.3390\/neurolint17050066","type":"journal-article","created":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T06:18:02Z","timestamp":1745475482000},"page":"66","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Epilepsy Diagnosis When the Routine Ancillary Tests Are Normal"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8625-7365","authenticated-orcid":false,"given":"Boulenouar","family":"Mesraoua","sequence":"first","affiliation":[{"name":"Neurosciences Department, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar"},{"name":"Weill Cornell Medical College, Doha P.O. Box 3050, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6559-1329","authenticated-orcid":false,"given":"Bassel","family":"Abou-Khalil","sequence":"additional","affiliation":[{"name":"Department of Neurology, Vanderbilt University, Nashville, TN 2301, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Schuknecht","sequence":"additional","affiliation":[{"name":"Medical Radiological Institute, 8001 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hassan","family":"Al Hail","sequence":"additional","affiliation":[{"name":"Neurosciences Department, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar"},{"name":"Weill Cornell Medical College, Doha P.O. Box 3050, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2340-3553","authenticated-orcid":false,"given":"Musab","family":"Ali","sequence":"additional","affiliation":[{"name":"Neurosciences Department, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9707-9266","authenticated-orcid":false,"given":"Majd A.","family":"AbuAlrob","sequence":"additional","affiliation":[{"name":"Neurosciences Department, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5530-1136","authenticated-orcid":false,"given":"Khaled","family":"Zammar","sequence":"additional","affiliation":[{"name":"Neurosciences Department, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2598-7601","authenticated-orcid":false,"given":"Ali A.","family":"Asadi-Pooya","sequence":"additional","affiliation":[{"name":"Department of Neurology, Shiraz University of Medical Sciences, Shiraz P.O. Box 71348-14336, Iran"},{"name":"Department of Neurology, Thomas Jefferson University, Philadelphia, PA 4201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1056","DOI":"10.1016\/j.clinph.2018.01.019","article-title":"Clinical utility of EEG in diagnosing and monitoring epilepsy in adults","volume":"129","author":"Tatum","year":"2018","journal-title":"Clin. 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