Classic eeg abnormalities
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Classic EEG Abnormalities. Academic Half-Day June 5th 2013. How do you read an eeg ?. How can an eeg be abnormal?. Epileptic Focal or Generalized Interictal Focal or Generalized Seizure Non-convulsive Status Periodic PLEDs/ BiPLEDs GPEDs Burst-suppression Triphasic waves

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Classic EEG Abnormalities

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Classic EEG Abnormalities

Academic Half-Day

June 5th 2013


How do you read an eeg?


How can an eeg be abnormal?


  • Epileptic

    • Focal or Generalized Interictal

    • Focal or Generalized Seizure

    • Non-convulsive Status

  • Periodic

    • PLEDs/BiPLEDs

    • GPEDs

    • Burst-suppression

    • Triphasic waves

    • Periodic complexes (CJD)

  • Background Abnormality


  • Case One


    Case One

    • How do you decide it is epileptic activity?

      (inter-ictal)

    • Sharp, asymmetrical (rapid rise)

    • Voltage maximum

    • “Field”

    • Slow wave

    • Recurs

    Fisch and Spehlman’s EEG Primer


    Case Two


    Case Two

    • It is generalized

    • It is “inter-ictal”

    • There is normal background


    Case Three


    Case Three

    • “it is what it sounds like”

    • No normal background

    • It is periodic (which means…)

    • It is bilateral


    Case Four


    Case Four

    • It looks epileptic

    • Generalized

    • “Neat and orderly”

    • Normal background

    • Don’t get thrown off by high amplitude


    Case Five


    Case Five


    Case Five

    • “it is what it sounds like”

    • Epileptic, Periodic, Lateralized

    • Don’t worry about volume conduction

    Chong DJ and Hirsch LJ. Which EEG patterns warrant treatment in the critically ill?Reviewing the evidence for treatment of periodic epileptiform discharges and related patterns. J ClinNeurophysiol 2005;22:79.


    Case Six


    Case Six

    • Repetitive spikes or sharp waves (alone or in complexes with slow waves) at > 2.5 / sec

    • Above, < 2.5 / sec, with either clinical ictal phenomena or response to AED

    • Rhythmic slow waves with evolution in frequency or location

    Kaplan P. EEG criteria for non-convulsive status epilepticus. Epilepsia 2007; 48 (suppl 8):39-41.


    Case Seven


    Case Seven

    • Generalized

    • Synchronous

    • Periodic

    Foreman et al. Generalized periodic discharges in the critically ill. A case control study of 200 patients. Neurology 2012;79:1951-60.


    Case Eight


    Case Eight

    • Focal or generalized

    • Looks epileptic (sharp)

    • Continuous


    Case Eight


    Case Nine


    Case Nine

    • Fairly strict criteria; it does have to be periodic and triphasic

    • But…mimics

    • So…clinical context

    Kaplan P. EEG criteria for non-convulsive status epilepticus. Epilepsia 2007; 48 (suppl 8):39-41.


    Case Ten


    Case Ten

    • Periodic

    • Clinical context

    • “The least unique”

      • Usually bilateral but can be unilateral

      • Sharp waves but variable morphology

    Weiser et al. EEG in Creutzfeld-Jakob disease. ClinNeurophysiol 2006; 117: 935-51.


    Eeg electives…


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