Abstract
Background/Objectives: Electroencephalography (EEG) has been widely used to differentiate individuals with autism spectrum disorder (ASD) and co-occurring conditions, particularly epilepsy. However, the relationship between EEG abnormalities and core features of ASD remains unclear. This study reviews the potential impact of EEG findings on the development, behavior, sleep, and seizure occurrence in ASD patients. Additionally, it evaluates whether routine EEG testing is warranted for all ASD patients, particularly in the absence of clinical seizures. Methods: A systematic review was conducted that covered literature published between 2014 and 2024. The review focused on EEG abnormalities, both epileptiform and non-epileptiform, in individuals with ASD. Studies were selected based on predefined inclusion criteria, emphasizing the prevalence, type, and clinical relevance of EEG findings. The analysis also included a critical assessment of whether EEG abnormalities correlate with specific ASD symptoms, such as cognitive impairment, speech delay, or behavioral issues. Results: EEG abnormalities were reported in 23-80% of ASD patients, indicating a broad range of findings. Despite their frequent occurrence, the evidence linking these abnormalities to specific clinical symptoms remains inconclusive. Some studies suggest an association between epileptiform patterns and more severe ASD traits, while others do not confirm this. Furthermore, the effectiveness of anticonvulsant treatment in children with EEG abnormalities and no seizures remains uncertain, with limited supporting data. Conclusions: Given the uncertain relationship between EEG findings and ASD symptoms, routine EEG testing for all children with ASD appears unnecessary. EEG should be considered primarily when epilepsy is clinically suspected.