Epileptiform EEG abnormalities in adults and children

Focal and generalized epileptiform discharges including epileptic encephalopathies. Adult and pediatric EEG atlas.

1. EEG Lecture 4 Epileptiform EEG Abnormalities Dr. Md. Saiduzzaman Munna Medical Officer Department of Neurology Mymensingh Medical College Hospital, Bangladesh.

2. “The Fog Warning”: Painting by Winslow Homer; 1885

3. Background & Foreground Background is described by six key features: S ymmetry Continuity Voltage O rganization R eactivity or variability Sleep architecture Foreground is categorized into Cerebral activity Normal Epileptiform Variants discharge b) Artifacts/ Contaminats

4. Fig: Spikes

5. Interictal epileptiform paroxysmal patterns Spike: A transient discharge, clearly distinguished from background activity, having a pointed peak at conventional paper speed and duration 20-70 ms. Main component is generally negative; amplitude variable. Easier to recognize than to describe. May be monophasic, biphasic or polyphasic.

6. Fig: Morphological Patterns of Spike

7. Fig: BECTS/ SeLECTS

8. Fig: Fronto -central spike and wave.

9. Fig: Right hemispheric epileptiform discharge.

10. Fig: Polyspikes and wave discharge.

11. Fig: Right occipital focal spikes.

12. Fig: Focal epileptiform discharge at T6 & O2; Volume conduction to left.

13. Fig: Left frontal focal spikes with ‘End of Chain phenomenon’.

14. Fig: Focal epileptiform discharges.

15. Fig: Bilateral, independent and bisynchronous centrotemporal spikes.

16. Fig: Focal epileptiform discharges at right hemisphere.

17. Fig: Right fronto -temporal spikes and wave with volume conduction to left.

18. Fig: Right sided spikes with phase reversal at P4

19. Fig: Phase reversing spikes at left ant. Temporal region; with volume distribution.

20. Generalized Epileptiform Discharges

21. Fig: Generalized epileptiform discharge characteristic of IGE.

22. Fig: Generalized epileptiform discharge (typical absence epilepsy)

23. Fig: Generalized polyspikes and wave (JME)

24. Fig: Generalized polyspikes and wave in JME ( Photoparoxysmal )

25. Fig: IGE/GGE

26. Fig: Eyelid myoclonia with absence

27. Epileptic Encephalopathies

28. Fig: Hypsarrhythmia (West Syndrome)

29. Fig: Landau- Kleffner Syndrome (posterior predominant)

30. Fig: Lennox- Gastaut Syndrome (frontally predominant)

31. Fig: Rasmussen Encephalitis (background asymmetry with slowing and spikes)

32. Fig: Delta Brush.