The presence of an interictal spike helps to confirm a clinical diagnosis of epilepsy, aids in defining the epilepsy syndrome, provides information that assists in planning drug management, and helps to assess candidacy for epilepsy surgery. The interictal spike remains the hallmark of epilepsy, vividly demonstrating cortical hyperexcitability and hypersynchrony, and is present in the “normal” interictal state. While advances in neurological knowledge and neurodiagnostic testing have vastly improved the diagnostic process, EEG continues to play a pivotal role. Since Gibbs and colleagues ( 1) discovered spike and wave discharges in epilepsy in 1935, the EEG has been used to diagnose and manage epilepsy.
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