Textbook of electroencephalography

Textbook of electroencephalography
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1. INDEX| Preface | Web ste

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20. 7

24. erictal epileptic activity

The interictal marker of a seizure focus is the spike or sharp wave. The distinction between
these two patterns has no etiologic : ce being one of EEG
pattern morphology. A s ed as being less than 70 milliseconds in duration, and a
sharp wave has a di seconds. The terms spike or sharp wave, while
having particular meaning to the electroencephalographer, are often used interchangeably.
Spikes and sharp waves are almost always of negative polarity at the sealp

epileptiform discharges may arise from any region of the cerebral hem

commonly are manifested in the anterior temporal, frontal, or centrotemporal regions.

nly associated with the occurrence of
‘seen on the EEG, the likelihood of the
er 90% onverse is not

of most patients w

poral discharges. Approximately 70-80% of individuals whose EEG.
demonstrates frontal spikes . Frontal spikes or sharp waves are more

ely to be associated wi a traumatic lesions, or congenital
cerebral malformations.

are often a marker for a particular epilepsy
syndrome of childhood known as benign rolandic epilepsy or benign focal epilepsy of
childhood wi . This isa disorder in which a child, typically aged 4.
12 years, develops focal seizures with sensory or motor seizures in the mouth or face
These children also may have generalized seizures; typically, these seizures are
The EEG pattern is unusual in that there is often a simultaneous negative
waveform in the centrotemporal region and a positive one in the frontal region. This
pattern of EEG polarity is virtually diagnostic of benign rolandic e

Epileptiform EEG patterns are seen less commonly in the occipital, central, or parietal
regions. Occipital spikes typically are seen in young children and may or may not be
associated with clinical seizures. Discharges in any of these regions may indicate the
presence of partial epilepsy.

29. 4 sony

30. Polymorphic delta activity (PDA)

consists of arrhythmic slow waves that vary in frequency, amplitude
PDA can oceur in either ized distribution. Continuous Pi
of abnorm cortical white matter. One of the shortcor

ted. spatial resolution. Th
relationship of PDA to an underlying structural abnormality. Not only is th
localizing ability of the scalp El (ed, but also the PDA of a structural lesion is
referable not to the lesion itself but to the surrounding brain tissue. Because of this
limitation, the area of a lesion is indicated not by the maximal amplitude of PDA b
rather by a region of relatively low-an rather than
intermittent, PDA is associated with In

Persistent polymorphic delta activity ma

lesion, particularly since it presumably arises fro

lying on the margin of the destructive lesion. Pel
onspecifie and is seen in a vari

cluding neoplasms, infarctions, abscesses, trauma, and haemorrhage.
be seen in reversible processes such as focal ischemia in transient ischemic attacks or fo:
depression from a recent seizure.

31. [Rhythmic delta activity

consists of sinusoidal waveforms of approxi
EEG recording. It is most often symmetri

activity has a frontal pred (frontal

In children, it is maximal posteriorly. (occ

{OIRDAD. Intermittent rhythmic delta activity is associated wit siuctural ss, must
‘commonly diencephalic, orial or intraventric or with. diffuse
ne FIRB Al Goering pens Le euere
that the pattern is due to a structural lesion; when associated with EEG background
abnormalities, it is likely to be due to encephalopathy. In cases of encephalopathy with
FIRDA, the pathophysiologie processes are believed to involve cortical and subcortical
matter. OIRDA is associated with absence epilepsy ren aged 6-10 years

32. Is less likely to rı ral lesion than is focal delta. Theta is
commonly, 1 disturbance, such as epileptogenic
cortex, especially postictally mplitude suppression and focal delta have resolved. In
addition, localized theta isu perimposed on focal delta to some degre ive
proportion of del x severity of the underlying structural
or functor

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46. Y

47. Grade amen om aa hm ve mia eta ET

Grade (ky abnermal Dominant theta background with some aba and della acia

5 eratelyabneemsl) Continuous dela activi predominates li acthiy ol faster fr

ade Y (extremely abrormat la” tracing or lecrocerebral inactivty

51. A
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56. Brain death should not be determined until at east 7 days of age
Seven days to 2 months: two examinations and two EEGs separated by at least 48
hours are required,
Two months to 1 year: two examina Gs separated by at least 24
hours are required.

Older than 1 year: a and at least 12 hours of

observation)

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91. ossi abnormal ba

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1 Lowvoltage EEG
“ave paraystique eupsression burs)

8. Gross interremispharic aoynchrondasymmeiny
id oi und atv
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sleep states
cesse dscontinuty
cal abrormaliio
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‘exomsive frontal or muliccal sharp lor CA, eos

mie acsvties, ete

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109. ker ofa seizure focus is the spike or sharp wave. The distinction between

these two patterns has no etiologic significance, the only difference being one of EEG
pattern

o, while

used interchangeably.

Ip surface, These

spheres but most

spikes, an EEG is finding does not exclude a diagnosis of
epilepsy. Often, repeated EEG recordings or prolonged EEG

110. demonstrate the epileptiform pattern,

€ clinical seizures. Frontal spikes or sharp waves are more
likely to be associated with mass lesions such as neoplasms, traumatic lesions, or congenital
cerebral malforma

Centrotemporal or rolandic sharp waves are offen a marker for a particular epilepsy
syndrome of ch as benign rolandic epilepsy or benign focal epilepsy of

n which a child, typically aged 4
tor seizures in the mouth or face
ized seizures; typically, these seizures are
The EEG pa re is often a
in the centrotemporal r
attern of EEG polarity is virt

Epileptiform EEG patterns are seen less commonly in the occipital, central, or parietal
regions. Occipital spikes typically are seen in young children and may or may not be
assoc cal seizures. Discharges in e dicate the
presence of parti

111. In childhood, the occurrence of central-midtemporal (also parietal) spikes is associated
with over seizures in only 50-70% of the cases; this pertains mainly to the age from 3-12
x. In occipital spikes (mainly age 3-5 yr), the epileptogenicity is even lower
a (such as seen in benign Rolandic epilepsy) is seen, in
{synchronous bursts of spikes or
pike waves. In most children, the abnormalities disappear on follow up EGG studies and
the minority de rt clinical s
Both generalized synchronous (spike wave, polyspike wave) and Rolandic (centroparicto-
midtemporal) spikes in nonepileptic children suggest a genetic predisposition if no
elicit and no history of insult to the CNS are present.
In children, focal epileptiform discharges arising from the temporal region have the
greatest incidence of clinical seizures, ranging from 85 to 95 percent. T
incidence (70 to 75 percent is associated with frontal discharges. The central, parietal
and occipital regions have the lowest incidence of seizures related to epileptiform

When applied in the appropriate clinical setting, the EEG is useful in classifying the
scizure type, predicting the long-term outcome, and choosing the appropriate antiepileptic

medication
EEG has not proven to be a reliable 1001 in predicting whether a patients antiepileptic
medication can be di «1. The decision to discontinue an antiepileptic medication
in a patient with a seizure disorder should be based on the type, etiology and response 10
medications ofthe seizures and not on inerictal EEG findings.

121. NUMBER OF stoke [NEOPLASM

PATIENTS.

psy

[ASSOCIATED]
Iseızures

134. TI

135. ee

157. in

158. RE Dr Deer AA
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Di

180. WA