Background: Epilepsy is a common problem throughout sub-Saharan Africa, including Ethiopia. Electroencephalography (EEG) is useful for the diagnosis and proper treatment of this condition. However, the literature is scanty of reports describing EEG patterns in Ethiopian patients with epilepsy. This study attempts to bridge that gap and provide a baseline for further research into the etiological basis of specific epileptiform abnormalities.Objective: To review EEG patterns in Ethiopian patients with epilepsy.Methods: We retrospectively reviewed EEG records of patients with epilepsy presenting to a specialized referral hospital (Addis Ababa University Tikur Anbessa Teaching Hospital) and a private clinic (Yehuleshet Higher Clinic) between September 2008 and August 2010.Results: Two hundred and fifty one patients with mean age of 26 years (SD 14.8) and 1.2:1 male: female ratio was included in the study. One hundred and forty nine patients (59.4%) harbored EEG abnormalities. The majority of these abnormalities 61.1% were epileptiform discharges; the remainder 38.9% being nonspecific patterns. The most common epileptiform discharges were focal, with or without secondary generalization in 63.7%. These focal discharges originated from the left cerebral hemisphere in 43.1% cases and the right in 39.7%; 17.2% were bilateral. Multifocal cerebral and temporal lobe discharges accounted for 43.1% and 39.7% of all focal discharges, respectively.Conclusion: The most common EEG abnormalities in Ethiopian patients with epilepsy are focal interictal epileptiform discharges, typically originating from multifocal cerebral loci and the temporal lobe, without hemispheric lateralization. It provides a foundation for prospective studies to address the etiological basis of focal abnormalities