Professional Documents
Culture Documents
(EEG)
A key tool in the diagnosis and
management of
EPILEPSY
Subject Pages
EEG Introduction 1
Epilepsy 2
Certain types of EEG wave patterns, whether they be lower to higher, or slower to faster activity,
along with localization that occur during a patients recording are very useful with the
specification of the epileptic disorder. Doctors refer to some specific patterns as epileptiform
abnormalities or epilepsy waves. These EEG wave patterns consist of Spikes, Sharp Waves, and
Spike-and-Wave discharges, Slow Waves and et al, with relations to assisting in classifying a
seizure disorder type.
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EPILEPSY-Seizure Disorders
Epilepsy is a general term used for a group of seizure disorders that cause disturbances of electrical
signaling in the brain. Although EPILEPSY is a word often heard after a person has incurred a seizure; a
person is not diagnosed without proper evaluation from a physician, has had at least two seizures that
were not caused by some other known medical condition, along with other clinical evaluations which
usually include an EEG. The word "epilepsy" also does not indicate the cause of the person's seizures &
what type or severity they are; as epilepsy can be related to a brain injury, secondary medical disorder,
family tendency, or most of the time the cause is unknown idiopathic.
An EEG does help with determining seizure types and seizure syndromes in patients with epilepsy;
which in-turn provides assistance with the classifying and management of their epileptic disorder(s).
EEG contributes in the diagnosis and classifications of seizure disorders being either Partial (Focal) or
Generalized, idiopathic or symptomatic, or part of another unclassified epilepsy category.
The title EPILEPSY is just a general term to which there are several different types of Seizure Disorders
that fall into this diagnosis. The frequent classification of seizure disorders are split into two categories,
Partial and Generalized. In turn, these two categories are divided further into more descriptive Seizures
Types (see chart below). This report will give in more details a general definition, description of the type
of events a person can experience and the wave patterns that are to be expected to appear on an EEG
during a seizure for each of these few types; Simple Partial, Complex Partial and Generalized Absences,
Myoclonic, Clonic, Tonic, Tonic-Clonic and Atonic.
seizure types = patients appearance during seizure event, patients personal description (if any) during an event, and what, where &
when and event occurs on the EEG recording at the time of a seizure
seizure syndrome = patients age, history and seizure type(s) that appear on the EEG 2
EEG PATTERNS IN EPILEPSY
Along with indicating the location(s) of electrical interference, wave patterns are what also
assists in distinguishing the type of seizure disorders, as seizure waveforms do vary.
An easier way of describing is, think of ocean wave forms, as they can range, high, low, loud,
quiet, rough, slow & smooth, abrupt and harsh etc. Specific waves are usually a distinction
which can indicate the type of events (ex: weather), surroundings or location of the ocean. The
EEG too, indicates well-defined patterns of normal or abnormal brain electrical activity, along
with the locations. Abnormal patterns may be either Nonspecific or Specific.
Nonspecific refers to patterns that may be seen in a number of different conditions. For
example, certain waves may be seen after head trauma, stroke, brain tumor, or even seizures.
Slowing, in which the rhythm of the brain waves is slower than the rhythm that would be
expected for the patients age, is a Nonspecific pattern.
Specific refers to patterns that indicate a tendency toward seizures, as in Epilepsy Waves
(Spikes, Sharp Waves, and Spike-and-Wave discharges, et al). Although these waveforms may
appear similar, yet vary, each type of seizure disorder has a consistent wave form pattern which
helps in the diagnosis to a patient. Spikes and sharp waves occurring in a local area of the brain,
such as the left temporal lobe, are markers of partial seizures. Spike-and-wave discharges
occurring in a widespread area over both cerebral hemispheres, and beginning simultaneously
over both hemispheres, are markers of primary generalized epilepsy. In some cases, actual
seizures may be recorded during the EEG, particularly in children with absence seizures who are
asked to hyperventilate during the test.
That being described, below are titles and measurements of the Specific abnormal wave
patterns which appear during epileptic seizures.
SWCs can be divided further into 2 more specific types: 3-Hz SWCs and
Slow SWCs.
3-Hz SWC pattern is characterized by a frequency of 2.5-4 Hz and a very
monomorphic (perfectly regular rhythm) morphology
Slow SWCs are not only slower than 3-Hz SWCs (< 2.5 Hz) but also more
irregularthat is, less monomorphic
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EEG RECORDINGS OF PARTIAL SEIZURES
PARTIAL SEIZURES, also called Focal seizures, are titled exactly as to what they pertain to; a
partial, focalized section of the brain, usually within one hemisphere consisting of electrical
disturbances. They consists of abnormal neuron activity restricted to a relatively small
region of the brain. These seizures are divided into two types based on the symptoms the
patient experiences during an event and the brain waves that appear on an EEG. The two
basic partial seizure disorders are titled - Simple Partial and Complex Partial. Partial seizures
are the most common type of events experienced by people with epilepsy.
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EEG RECORDINGS OF PARTIAL SEIZURES
Epileptic discharges begin and remain Unilateral (sometimes can spread to the other hemisphere,
if the seizure is to become Generalized)
Usually consisting of repetitive, Rhythmic Spike, Sharp and/or Slow Wave discharges
Most partial seizures can be recorded by scalp electrodes; however, the mesial surfaces may
cause difficulty for some recordings
Periodic Spike and Slow Wave discharges occurring in the posterior, right temporal location
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EEG RECORDINGS OF PARTIAL SEIZURES
Simple Partial Events: consists in which consciousness or awareness is retained (no loss of
consciousness). Sudden jerking, twitching, numbness or tingling can occur, particularly on one side of
the body; psychic symptoms (hallucinations, dj vu). This seizure disorder, especially most common in
children can be more difficult to diagnose without full evaluation and testing. An Aura* may also occur
and progress to a generalized seizure, in which case the classification category is Partial-(simple or
complex)- into secondarily-Generalized seizure.
*Aura : A sensation that is known as the onset, warning before a seizure, is also called a simple partial
seizure when it occurs within seconds before another generalized seizure. At times an Aura may appear
alone and not progress, at which time it then represents a seizure in its own.
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EEG RECORDINGS OF PARTIAL SEIZURES
Complex Partial Events: Consciousness is impaired or responsiveness may diminish during this seizure
which can lasts 30 seconds to a few minutes. They are common in both children and adults. It can
consist of warning (most typical is sensation in stomach, numbness), automatisms (such as lip smacking,
picking at clothes, fumbling), unaware of environment (may wander, amnesia of the events, mild to
moderate confusion during), and possibly appear drowsy after seizure with no recollection of the event.
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EEG RECORDINGS OF PARTIAL SEIZURES
TEMPORAL LOBE seizures are typically defined as simple partial seizures, which do
not cause loss of awareness, and complex partial seizures, which do. Although
they can lead into generalized seizures. These seizures may occur after brain injury
or infection, such as meningitis or encephalitis. Sometimes, they are caused by
stroke or the presence of a brain tumor or are diagnosed as idiopathic, cryptogenic.
Image above shows the EEG finding during interictal state of MTLE; a typical epileptiform
abnormality with spike or sharp wave with negative polarity and followed by a slow wave.
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EEG RECORDINGS OF GENERALIZED SEIZURES
Generalized is a classification in which the seizures are widely spread over both
hemispheres of the brain, especially when they begin in both at the same time.
Although each of these seizure classifications are categorized as generalized and occur
throughout both hemispheres, they each have different signs, symptoms, EEG patterns
and also differ based upon the age of the patient. Therefore, each generalized type is
titled and further distinguished separately.
This category of seizure disorders consists of several types, some particular being titled;
Myoclonic, Clonic, Tonic, Tonic-Clonic, Atonic and both Typical & Atypical Absence
seizures disorders.
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EEG RECORDINGS OF GENERALIZED SEIZURES
ABSENCE seizures, also called in the past Petit-mal seizures,falls into two different
categories, Typical and Atypical, which are indications of primary and secondary
description of events that occur within Absence seizures. These seizures are more
common in children.
Absence Events:
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EEG RECORDINGS OF GENERALIZED SEIZURES
TONIC seizures consist of sudden stiffness of limbs, which often causes the person to
lose balance and fall. Along with stiffening of limbs, will occur flexion of certain arm
and leg joints, and possible grunting sounds. These seizures are usually short and
last a few seconds, although they are the usual onset of Tonic-Clonic seizures (as
discussed further).
CLONIC seizures are very similar to Myoclonic, although they are characterized with
repetitive jerks of muscle groups throughout any part of the body , along with
lasting longer, ranging anywhere from several seconds to two minutes.
Spike or Spike-Wave discharges usually match the frequency of the body jerks
Frequency of the seizure discharge is usually rhythmic
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EEG RECORDINGS OF GENERALIZED SEIZURES
Generalized tonic-clonic seizures are characterized by five distinct phases that occur in
a child. The body, arms, and legs will flex (contract), extend (straighten out), tremor
(shake), a clonic period (contraction and relaxation of the muscles), followed by the
postictal period. During the postictal period, the child may be sleepy, have problems
with vision or speech, and may have a bad headache, fatigue, or body aches. The final
phase in which consciousness is regained may last anywhere between 2 and 30
minutes. Sometimes these seizures are preceded by an aura (a partial seizure itself), in
which case the seizure is secondarily generalised.
Usually begin with Rapid Spikes that slow in frequency after a few seconds, which
indicates the Tonic phase
As spikes slow down, they become Spike-Waves and represent the Clonic phase
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EEG RECORDINGS OF GENERALIZED SEIZURES
EEG samples of both Tonic and Clonic seizure patterns, along with muscles
artifacts which usually occur in between each phase.
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EEG RECORDINGS OF GENERALIZED SEIZURES
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EEG RECORDINGS OF GENERALIZED SEIZURES
High-voltage of Poly-spike waves that usually lasts less than a second, followed by
slow-waves
Bursts of the waves may occur single or in a quick series
Can be rhythmic or non-rhythmic
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EEG RECORDINGS OF GENERALIZED SEIZURES
Juvenile Myoclonic Epilepsy (JME) seizures occurs at the age of 12 years until 13, of
which then is usually classified further as Tonic-Clonic seizure disorder. The seizure
event can consist of quick, sudden, small jerks of the legs, arms or shoulders -
particularly the upper limbs.
High-voltage of Poly-spike waves (4-5 Hz) that usually lasts less than a second,
followed by slow-waves
Often occur in Stage I sleep
Epileptiform findings can be triggered by hyperventilation and/or intermittent
photic stimulation
A 12 year old patient having high amplitude, poly-spike waves within a 1 second
period, followed by slow-wave activity throughout, along with indications of
myoclonic jerks
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EEG RECORDINGS OF GENERALIZED SEIZURES
Atonic seizures are consistent with a sudden loss of muscle tone. The seizure can range
from mild - consisting of eyelids drooping, head nodding, shoulders slumping and the
person dropping things; to dramatic - brief loss of postural tone, often resulting in falls, the
most severe form of which is known as drop attacks. The seizures are brief - usually less
than fifteen seconds. Atonic seizures are known to occur at any age, and are always
associated with diffuse cerebral damage, learning disabilities and are common in severe
symptomatic epilepsies. *Atonic seizures usually begin in childhood and are often seen in
syndromes like Lennox Gastaut syndrome.*
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EEG RECORDINGS OF GENERALIZED SEIZURES
Figure 1: showing slow spike-and-waves (1.5-2.5 Hz) associated with atypical absences.
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EEG RECORDINGS OF GENERALIZED SEIZURES
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EEG RECORDINGS OF GENERALIZED SEIZURES
Figure 3:
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EEG RECORDINGS OF
GENERALIZED-NEONATAL SEIZURES
Symptoms
In nine out of 10 children with the condition, infantile spasms occur in the first
year of life, typically between three and eight months old. To begin with, the
attacks are usually brief and infrequent and do not occur in clusters. Therefore it is
quite common for the diagnosis to be made late. The first diagnosis is often colic,
because of the pattern of the attacks and the cry that a child gives during or after
an attack can mimic gastrointestinal discomforts.
EEG Patterns in West Syndrome seizure:
This EEG shows Hypsarrhythmia, a chaotic pattern of continuous, high-
amplitude polymorphic, rapid spikes, high-voltage generalized slowing and
other abnormalities. Often sleep is the period of seizure occurrence.
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