Electroencephalography (EEG), first recorded in 1924, has undergone a century of advancements and now plays a cornerstone role in diagnosing and researching brain disorders. It has significantly enhanced our understanding of brain function, facilitated the diagnosis of neurological conditions, and driven major advances in neuroscience.

Traditionally viewed as non-invasive and ethically straightforward, EEG has received limited attention in neuroethics discussions. However, the rapid integration of artificial intelligence (AI) into EEG technology introduces new ethical complexities that demand urgent consideration, particularly in neurological innovation and patient care.

We systematically reviewed 108 peer-reviewed articles published between 2010 and 2025 to explore these emerging challenges. Our findings highlight three major ethical concerns: algorithmic bias, the evolving challenges of informed consent, and the protection of mental privacy and neural data. While AI enhances EEG by improving the detection of abnormal brain activity and accelerating diagnostic workflows, it also introduces significant risks.

Algorithmic bias may lead to misdiagnosis or unequal treatment outcomes, particularly among underrepresented patient groups. This underscores the need for rigorous validation practices and diverse training datasets.

When AI-driven EEG assessments are used, informed consent becomes increasingly complex. Patients must understand the EEG procedure and how AI interprets their brain data, which poses particular challenges for individuals with cognitive impairments. Clear, compassionate communication strategies are essential to uphold patient autonomy and care trust.

Moreover, the rise of portable EEG devices outside clinical settings raises significant concerns regarding mental privacy. The possibility of "mind reading" through accessible brain data and inadequate regulatory oversight heightens the risk of misuse.

Alarmingly, many developers of portable EEG technologies remain unaware of existing ethical, legal, and social issues (ELSI) guidelines, highlighting a critical gap in ethical adherence.