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An electroencephalogram (EEG) records tiny voltage differences detected by electrodes on the scalp over time. It is not a picture of the brain or a direct readout of thoughts. A technologist sets up and checks the recording; a trained clinician reviews its patterns, recording conditions and any captured events alongside the person’s symptoms and medical history.
What an EEG records
Scalp electrodes detect voltage differences associated with electrical activity. The recording system amplifies and digitizes those differences, then displays them as changing traces. Because the electrodes are on the scalp, an EEG measures electrical patterns at the head’s surface; it does not show brain anatomy the way an imaging scan does.
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Each displayed channel compares signals from selected electrodes. The arrangement of those comparisons is called a montage. Readers may reformat a digital recording into different montages to examine how a waveform appears across channels and where it is distributed. Calibration and acquisition settings also affect the scale and frequency content visible in the trace.
How a clinical EEG is recorded
1. The team records the clinical context
The technologist documents the reason for the test, relevant event history, the person’s state during recording and other context such as medications. These details help the clinician interpret the trace rather than treating it as an isolated signal.
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2. Electrodes are placed in a standardized array
Electrodes are positioned at measured scalp locations. The conventional international 10–20 system provides a standardized layout. Joint International Federation of Clinical Neurophysiology (IFCN) and International League Against Epilepsy (ILAE) minimum recording standards, published in 2023, suggest a 25-electrode IFCN array whenever feasible; they consider the 10–20 array acceptable when that is not practical. The choice is made by the clinical team, not the patient.
3. Connections and signal quality are checked
Clinical recordings commonly use electrodes secured with paste or gel, or an appropriate cap. The technologist checks electrode contact, connections and signal quality before and during acquisition. The 2023 IFCN-ILAE standards suggest electrode impedance below 5 kΩ and regard below 10 kΩ as acceptable, while emphasizing balanced impedance and noting limitations in evidence about perceived signal quality at different levels. These are professional technical recommendations, not instructions for home use.
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4. The system acquires and displays the signal
The equipment amplifies and digitizes the voltage differences. The 2023 IFCN-ILAE standards propose a minimum sampling rate of 256 Hz for routine EEG. This is a recording recommendation, not a universal guarantee of quality: electrode contact, calibration, filtering, acquisition settings and later review all matter. The American Clinical Neurophysiology Society’s technical guideline was revised in August 2016; its recommendations should be understood in light of that date and local practice.
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Depending on the clinical question, the team may record wakefulness, sleep, or both, and may use procedures such as eye opening and closure, photic stimulation or hyperventilation under an appropriate clinical protocol. Video, ECG, EMG or eye-movement channels may also be recorded to help relate the EEG trace to events or other signals. These procedures are performed as part of supervised clinical testing; do not try to provoke symptoms at home.
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How clinicians interpret the tracing
A trained reader first considers whether the recording is technically reliable, then examines waveform shape, distribution and changes over time. The reader takes account of whether the person was awake or asleep and, when available, compares trace changes with video and auxiliary channels. Reviewing more than one montage can help determine whether a suspicious pattern is consistent across different electrode comparisons.
An EEG finding is not a diagnosis by itself. Its significance depends on the clinical question and the person’s symptoms, state, medications and other relevant information. The report describes what was seen in that recording and how the clinician interprets it in context.
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Why artifacts matter
Not every waveform on an EEG comes from cerebral activity. Blinking and eye movement, muscle activity, movement, sweat, electrode problems and electrical equipment can create signals that obscure or resemble brain-derived patterns. The EEG atlas groups artifacts broadly into biological and nonbiological sources and emphasizes that they are pervasive.
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What a normal routine EEG does—and does not—mean
A normal routine EEG means that the recording did not show a particular abnormality during that session. It does not, by itself, prove that a person never has seizures or settle every clinical question. A routine recording samples a limited period and state; a finding may not appear while someone is awake but may be seen during sleep or on another recording.
The 2023 IFCN-ILAE standards report that epileptiform discharges are more frequent during NREM sleep than wakefulness and that sensitivity for detecting them increases with repeated EEG recordings. For a second study, the group recommends a sleep EEG. Whether another or different recording is appropriate depends on the clinical situation and is a decision for the treating team.
Which EEG recording approach is used?
Recording choices answer different clinical questions; they are not interchangeable consumer products. The team selects the arrangement, state and event-capture approach that fit the reason for testing.
| Choice | What it changes | How it is selected |
|---|---|---|
| 10–20 array or 25-electrode IFCN array | Scalp electrode coverage and the activity sampled across locations. | The 10–20 system is the conventional standard; 2023 IFCN-ILAE standards suggest the 25-electrode array when feasible and accept 10–20 otherwise. |
| Awake or sleep recording | The brain state represented in the trace; sleep can reveal findings not seen during wakefulness. | Chosen according to the clinical question and protocol. |
| Routine, ambulatory or continuous monitoring | Recording duration and opportunity to capture events. | Chosen by the clinical team for the clinical situation; specific durations are not stated in the cited standards summarized here. |
| EEG alone or with video and auxiliary channels | Whether movements or events can be compared with the EEG and other recorded signals. | Video, ECG, EMG or eye-movement channels may be included when relevant to the question. |
What standards can—and cannot—tell you
The ACNS document Minimum Technical Requirements for Performing Clinical EEG, Guideline 1, was revised in August 2016. The ACNS guideline index lists a November 2025 update to guideline materials. The separate IFCN-ILAE standards for routine and sleep EEG were published in 2023; their authors characterize overall evidence quality as low and recommendations as conditional and consensus-based. These documents provide professional guidance, not a promise that every clinic uses an identical protocol or that a technically compliant recording answers every diagnostic question.
This overview explains the recording and interpretation process; it cannot diagnose a condition or replace a clinician’s reading of an EEG in clinical context.
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