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

Classic EEG Abnormalities

Academic Half-Day

June 5th 2013


How do you read an eeg

How do you read an eeg?


How can an eeg be abnormal

How can an eeg be abnormal?


Classic eeg abnormalities

  • 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


    Case one1

    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


    Case two1

    Case Two

    • It is generalized

    • It is “inter-ictal”

    • There is normal background


    Case three

    Case Three


    Case three1

    Case Three

    • “it is what it sounds like”

    • No normal background

    • It is periodic (which means…)

    • It is bilateral


    Case four

    Case Four


    Case four1

    Case Four

    • It looks epileptic

    • Generalized

    • “Neat and orderly”

    • Normal background

    • Don’t get thrown off by high amplitude


    Case five

    Case Five


    Case five1

    Case Five


    Case five2

    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


    Case six1

    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


    Case seven1

    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


    Case eight1

    Case Eight

    • Focal or generalized

    • Looks epileptic (sharp)

    • Continuous


    Case eight2

    Case Eight


    Case nine

    Case Nine


    Case nine1

    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


    Case ten1

    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

    Eeg electives…


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