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EEG Chapter 10 - Epileptiform Normal Variant (NIF)

This document discusses several types of epileptiform normal variants seen on EEGs: 1. Small sharp spikes that occur in light sleep and resemble temporal spikes but are shorter in duration and amplitude. 2. Wicket spikes that appear as trains of arched waveforms at 6-11 Hz over the temporal regions during drowsiness. 3. 14-Hz and 6-Hz positive spikes that occur as bursts of arched waveforms during drowsiness and light sleep, maximal over the posterior temporal region. 4. Phantom spike-and-waves that are brief discharges at 6 Hz seen during relaxed wakefulness and light sleep, with a small spike and larger slow wave.

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85 views27 pages

EEG Chapter 10 - Epileptiform Normal Variant (NIF)

This document discusses several types of epileptiform normal variants seen on EEGs: 1. Small sharp spikes that occur in light sleep and resemble temporal spikes but are shorter in duration and amplitude. 2. Wicket spikes that appear as trains of arched waveforms at 6-11 Hz over the temporal regions during drowsiness. 3. 14-Hz and 6-Hz positive spikes that occur as bursts of arched waveforms during drowsiness and light sleep, maximal over the posterior temporal region. 4. Phantom spike-and-waves that are brief discharges at 6 Hz seen during relaxed wakefulness and light sleep, with a small spike and larger slow wave.

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Yossy Catarina
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EEG Chapter 10

EPILEPTIFORM NORMAL VARIANTS

NIF
270221

Departemen Neurologi, FK-KMK Universitas Gadjah Mada/RSUP Dr Sardjito, Yogyakarta


INTRODUCTION

• Epileptiform normal variants are EEG patterns


that resemble epileptogenic abnormalities.
• No clinical significance.
• To avoid overinterpretation or misinterpretation
with regard to their significance

Epileptiform normal variants include:

1. Small sharp spikes (SSS),


2. wicket spikes,
3. 14- and 6-Hz positive spikes,
4. phantom spike and waves,
5. psychomotor variants,
6. subclinical rhythmic EEG
7. discharges of adults (SREDA), and
8. midline theta.
Small Sharp Spikes(SSSs)

• Also known as benign epileptiform transients of sleep


• (BETS), SSSs occur in light sleep (stages I and II of nonrapid eye movement [NREM] sleep)
• Location is temporal or frontotemporal, either unilateral or bilaterally independent
• Morphology is typically monophasic, occasionally diphasic or polyphasic, and the decline after the first negative peak
is very steep.
• however, they do not have the prominent aftercoming slow wave that temporal spikes have, and they do not occur
in repetitive trains.
• The main features of SSSs are in their name: duration is short, amplitude is small, and an easy guideline states that
SSSs generally should be less than 50 µV and less than 50 milliseconds.
• most often in adults and the elderly.
• can occur in epileptic patients but often are seen in healthy individuals.
Small Sharp Spikes(SSSs)
Wicket spikes

• Wicket spikes are trains of arch


shaped or a single spike-like waveform
that resembles a Mu rhythm.
• frequency of 6 to 11 Hz and range
from 60 to 200 microvolts in amplitude.
• over the temporal regions and there is
usually no slow wave seen after the
spikelike waveform
• Wickets are best seen in drowsiness
and light sleep when the alpha rhythm
drops out
• perdominantly in adults older than 30
years
Wicket spikes
14- and 6-Hz positive spikes
• bursts occur predominantly during drowsiness and light sleep
• consist of short trains of arch shaped waveforms with alternating
positive spiky components and a negative, smooth, rounded
waveform that resembles a sleep spindle with a sharp positive phase.
• rate of 14 Hz or 6-7 Hz and last from 0.5 to 1 second.
• It usually has maximal amplitude over the posterior temporal region.
• begin to appear in children between 3 and 4 years old, are maximally
expressed in the adolescent age group (with a peak at age 13-14
years)

Sleep spindles -
12 to 14 hertz bursts of rhythmic waves which often increase and
decrease in voltage and are maximal in the central midline head region.

14 and 6 hertz positive spikes -


surface-positive spikes most prominent in the posteriortemporal regions
occurring at 14 Hz, 6 Hz, or a mixture of 14 Hz and 6 Hz
14- and 6-Hz positive spikes
Phantom spike and waves (6Hz spike and wave)

• The 6-Hz spike-and-wave discharges have a repetition rate of 6 Hz, with a range of 5-7 Hz.
• brief, lasting 1 or 2 seconds,
• "phantom spike and wave" because of the evanescentnature of the spike, which is usually very brief and small in
amplitude, in contrast to the more prominent slow-wave component, which has a higher amplitude and a more
widespread distribution.
• seen in both adolescents and adults. It generally occurs during relaxed wakefulness and stage I sleep and disappears
during deeper levels of sleep.
• diffuse, bisynchronous, and relatively symmetric.
• Morphology is a typically small (<30 µV and <30 ms), evanescent diphasic spike followed by a higher (50-100 µV)
slow wave component.
• with a very small or absent spike component, and a more apparent slow wave.
• A helpful way to distinguish them is by the tendency of benign phantom spike and waves to disappear during sleep
while epileptic discharges(spike and wave complexes)tend to persist or become more prominent with deeper levels
of sleep.
Phantom spike and waves (6Hz spike and wave)
Psychomotor variants (Rhythmic Midtemporal Theta of Drowsiness)

• Frequency is theta (4-7 Hz). Location is maximum


midtemporal,
• unilateral or bilaterally.
• Morphology typically is notched, flat topped, or
sharply contoured.
• lasting for a few seconds or as long as 30-45 and
thus resemble temporal lobe seizures.
• Psychomotor variant differs from a seizure
discharge because it is usually a monomorphic or
monorhythmic pattern that does not evolve into
other frequencies or waveforms as usually occurs
during seizures.
• disappears during light NREM sleep, which is the
opposite for epileptiform activity.
Psychomotor variants (Rhythmic Midtemporal Theta of Drowsiness)
Psychomotor variants (Rhythmic Midtemporal Theta of Drowsiness)
Subclinical rhythmic EEG discharges of adults (SREDA)

• people older than 50 years.


• SREDA may occur at rest or during drowsiness, and occasionally occurs mainly during hyperventilation.
• This 40 to 100 microvolt discharge is a repetitive sharply contoured theta waveform of 5 - 6 hertz.
• from a brief 4 seconds to a prolonged 80 seconds in either the parietal and/or temporal head regions bilaterally
• must distinguish it from epileptiform activity by having the patient perform various mental or physical activities
during the discharge period
• Use such techniques as eye opening and closing, mental arithmetic, reading, answering questions, and
hyperventilation. All patients with SREDA are fully responsive during the discharges and bear no clinical motor
manifestations or complaint of sensory symptoms, as might be found during a partial seizure.
Subclinical rhythmic EEG discharges of adults (SREDA)
Subclinical rhythmic EEG discharges of adults (SREDA)
Subclinical rhythmic EEG discharges of adults (SREDA)

SREDA pattern, longitudinal bipolar


montage. Black brackets show onset
of periodic posterior-predominant
sharply contoured waveforms,
becoming rhythmic, then resolving
at latter portion of figure. This
normal elderly adult was
asymptomatic during the discharge
and showed no sign of behavioral or
response alteration
Midline Theta

• focal rhythm maximal at the midline, most prominently


at Cz,
• frequency of 5-7 Hz and typically has an arciform, spiky,
mu-like appearance
• can appear during wakefulness or drowsiness
• reactive to eye opening or limb movement.
Midline Theta
MANY THANKS..

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