1. Classic EEG Abnormalities Academic Half-Day June 5th 2013

2. HOW DO YOU READ AN EEG?

4. HOW CAN AN EEG BE ABNORMAL?

5. 1.Epileptic 1.Focal or Generalized Interictal 2.Focal or Generalized Seizure 3.Non-convulsive Status 2.Periodic 1.PLEDs/BiPLEDs 2.GPEDs 3.Burst-suppression 4.Triphasic waves 5.Periodic complexes (CJD) 3.Background Abnormality

6. Case One

7. 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

8. Case Two

9. It is generalized It is “inter-ictal” There is normal background

10. Case Three

11. “it is what it sounds like” No normal background It is periodic (which means…) It is bilateral

12. Case Four

14. It looks epileptic Generalized “Neat and orderly” Normal background Don’t get thrown off by high amplitude

16. Case Five

18. “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 Clin Neurophysiol 2005;22:79.

19. Case Six

20. 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.

21. Case Seven

22. 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.

23. Case Eight

24. Focal or generalized Looks epileptic (sharp) Continuous

25. Case Eight

26. Case Nine

27. 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.

28. Case Ten

29. 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. Clin Neurophysiol 2006; 117: 935-51.

30. EEG ELECTIVES…