Clinical Neurophysiology for definingEEG

Teaching criteria 6

1. TWEETABLE TEACHING IMAGE OPEN ACCESS
Teachingthe6CriteriaoftheInternationalFederation
ofClinicalNeurophysiologyforDefiningInterictal
EpileptiformDischargesonEEGUsingaVisualGraphic
F´abio A. Nascimento, MD, and S´andor Beniczky, MD, PhD
Neurology®Education2023;2:e200073. doi:10.1212/NE9.0000000000200073
Correspondence
Dr. Nascimento
[email protected]
The 6 operational criteria for defining interictal epileptiform discharges (IEDs) proposed by the
International Federation of Clinical Neurophysiology simplify IED identification into a series of
systematic feature extraction tasks. The presence of at least 4 criteria defines a sharp transient as
epileptiform.
1
The criteria displayed in the teaching graphic (Figure) can be used to train novice
EEG readers how to critically appraise the components of a sharp transient.
2,3
The visual-based,
systematic teaching method ensures that trainees can accurately and reliably identify IEDs on
EEG.
4
We use this graphic to teach the criteria to trainees and as a visual aid when applying the
criteria during supervised EEG reading sessions.
Author Contributions
F.A. Nascimento: drafting/revision of the manuscript for content, including medical writing
for content; major role in the acquisition of data; study concept or design; analysis or
interpretation of data. S. Beniczky: drafting/revision of the manuscript for content,
FigureTeaching Image Displaying the 6 Criteria of the IFCN for Identifying Interictal
Epileptiform Discharges on EEG
(1) Sharp or spiky morphology (20–200 milliseconds); (2) different waveduration than background activity;
(3) waveform asymmetry; (4) after-going slow wave; (5) disruption of background activity: flattening or low-voltage
alpha or beta frequency activity after (most frequently) orbefore sharp transient; (6) distribution suggestive of
cerebral source/physiologic field. Criteria 4 and 5 are independent. IFCN = International Federation of Clinical
Neurophysiology.
From the Department of Neurology (F.A.N.), Washington University School of Medicine, St. Louis, MO; and Department of Clinical Neurophysiology (S.B.), Danish Epilepsy Center,
Dianalund and Aarhus University Hospital; Department of Clinical Medicine (S.B.), Aarhus University, Denmark.
Go to Neurology.org/NE for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
This is an open access article distributed under the terms of the Creative Commons Attribution License 4.0 (CC BY), which permits unrestricted use, distribution, and reproduction in any
medium, provided the original work is properly cited.
Copyright © 2023 American Academy of Neurology 1

2. including medical writing for content; major role in the
acquisition of data; study concept or design; analysis or
interpretation of data.
Study Funding
No targeted funding reported.
Disclosure
F.A. Nascimento is a former member of theNeurology
®
Resident & Fellow Section editorial team and is deputy editor
of the Neurology Minute
®Daily Briefing. S. Beniczky reports
no disclosures relevant to the manuscript. Go to Neurology.
org/NE for full disclosures.
Publication History
Received byNeurology: EducationDecember 29, 2022. Accepted infinal
form April 4, 2023. Submitted and externally peer reviewed. The
handling editor was Editor Roy Strowd III, MD, MEd, MS.
References
1. Kane N, Acharya J, Beniczky S, et al. A revised glossary of terms most commonly used
by clinical electroencephalographers and updated proposal for the report format of
the EEGfindings. Revision 2017.Clin Neurophysiol Pract. 2017;2:170-185. doi:10.
1016/j.cnp.2017.07.002
2. EEG Talk Curriculum: Spike Operational Criteria (Part 1). Accessed February 19,
2023. youtube.com/watch?v=zlv4S62QbTQ.
3. EEG Talk Curriculum: Spike Operational Criteria (Part 2). Accessed February 19,
2023. youtube.com/watch?v=KGO9iFKBn5M.
4. Kural MA, Aydemir ST, Levent HC, et al. The operational definition of epileptiform
discharges significantly improves diagnostic accuracy and inter-rater agreement of trainees in
EEG reading.Epileptic Disord. 2022;24(2):353-358. doi:10.1684/epd.2021.1395
2Neurology: Education | Volume 2, Number 2 | June 2023 Neurology.org/NE