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Background ICANS is a life-threatening neurological toxicity occurring in 50% of patients treated with CAR T-cell therapy. Advances in understanding its pathophysiology, recognition, and management have improved outcomes. However, in the absence of randomised controlled trials, management strategies vary across published guidelines.Methods A retrospective observational study of EEG use and utility in ICANS management at University College London Hospitals (UCLH) haemato-oncology service between May 2019 - December 2022.Results ICANS occurred in 48% patients treated(100/208), clinical seizure activity in 11%(11/100), EEG performed in 48% (48/100).Mild EEG abnormalities in 73% patients with low grade (LG) and 33% of patients with high grade (HG) ICANS. Mild to moderate EEG abnormalities in 11% with HG and 9% LG ICANS. Moderate and severe EEG abnormalities only in HG ICANS. A strong correlation between EEG abnormalities and ICANS severity (τ = 0.265, p = 0.039).10.6% of EEGs in HG ICANS were normal.EEG findings directly impacted treatment decisions in 17% patients. Escalation of anti-seizure therapy in 50% (NCSE), immunosuppression de-escalation in 37.5% (serial improvement in slow wave activity) and 12.5% treatment for viral encephalitis (EEG: features).Conclusion EEG is not a sensitive and specific diagnostic biomarker in ICANS but can guide therapeutic decision making.frederick.vonberg@nhs.net