ABSTRACT.This study examined the clinical presentation and electrographic features of 34 children with positive polarity epileptiform activity in routine EEG recordings, in an attempt to determine the clinical significance of these discharges. Positive discharges when seen in the neonatal period were broad sharp waves always located along the rolandic strip. In older children the discharges were much sharper and involved the rolandic region or occasionally the frontal or occipital area.Clinically, a large percentage of neonates and children with positive discharges presented with significant neurological impairment. The impairment included congenital anomalies, chronic neurological deficits, and concomitant structural lesions. The exception to this finding was seen in four children who, in addition to their positive discharges, had independent dipole spike discharges. These children had a lower degree of neurological impairment.