EPILEPTIFORM ABN Flashcards
I______________ represent a distinctive group of waveforms that are characteristically seen in personS with epilepsy
Interictal epileptiform discharges (IED)
Abnormal focal interictal epileptiform discharges on EEG represent a heightened predisposition for the expression of__________
partial-onset seizures
WHAT IS THE PROBLEM?
Intracranial versus scalp recording (in the bottom six channels) during a presurgical evaluation of intractable epilepsy. Sensitivities in the top channels are 75 μv versus 7 μv/mm at the scalp. Note the absence of IEDs in the scalp EEG compared to the intracranial EEG where they occur at 1/sec.
WHAT IS THE PROBLEM?
Intracranial versus scalp recording (in the bottom six channels) during a presurgical evaluation of intractable epilepsy. Sensitivities in the top channels are 75 μv versus 7 μv/mm at the scalp. Note the absence of IEDs in the scalp EEG compared to the intracranial EEG where they occur at 1/sec.
WHAT ED ARE SEEN?
Different morphologies include sharp waves (seen during seconds 1 and 2), spikes and sharp waves (in second 3), polyspike-and-slow waves (in second 4), and spike-and-wave discharges (in the last second of the figure) recorded during an ambulatory EEG in a patient with epilepsy.
Both ______and _______waves are referred to as interictal epileptiform discharges (transients)
spikes
sharp
________are more “blunted” than spikes and are IEDs with a duration of 70 to 200 msec.
Sharp waves
WHAT IS THE PROBLEM?
EEG demonstrating a couplet of left anterior temporal spike and- slow waves.
Interictal epileptiform discharges (spikes and sharp waves) are almost always surface negative, generating the typical_________
negative phase reversal
___________often have a clinical association with complex partial seizures of temporal lobe origin more than 90% of the time
Anterior temporal spikes or sharp waves
WHAT IS SHOWN?
Bilateral anterior temporal sharp-and-slow wave in drowsiness
Anterior temporal spikes or sharp waves often have a clinical association with ___________of temporal lobe origin more than 90% of the time
complex partial seizures
WHAT IS THE PROBLEM?
Left mid-temporal sharp wave in a patient with temporal lobe epilepsy. Note the focal theta and delta slowing regionally in the same region.
________also occur in patients with temporal lobe epilepsy (TLE). In general, they are often more regional in distribution with neocortical TLE
Mid-temporal IEDs
____________also called rolandic epilepsy) is a common childhood idiopathic localization-related epilepsy syndrome
Benign childhood epilepsy with centrotemporal spikes (BCECTS;
WHAT IS THE PROBLEM?
Left centroemporal spikes in a patient with BCECTS. Notice the central field of spread of the spikes and low-amplitude right frontal positivity.
The characteristic tangential or horizontal dipole that is formed in BCECTs demonstrates both a _____________during the discharge. This has been used to separate the more “benign” nature of BCECTs from a more pathological rolandic sharp wave
negativity and positivity
WHAT IS THE PROBLEM?
The same spikes depicted in Figure 3.7 demonstrated on linked ears reference montage. Note the frontal positivity denoting the tangential dipole of BCECTs
WHAT KIND OF EPILEPSY?
A right frontal spike and polyspike discharge in frontal lobe
epilepsy
Frontal spikes are often found in patients with ______________, although they may be absent in up to one-third of
patients.
frontal lobe epilepsy (FLE)
__________or diffuse discharges arising from a focal point in the frontal lobe may occur in up to twothirds of individuals with FLE
Secondary bilateral synchrony (SBS)
Some conditions may give rise to central spikes without epilepsy and include ________, _________, _________and normal variants (i.e., fragmented mu rhythm)
cerebral palsy, migraine, and inherited trait without seizures (i.e., siblings of those with BCECTS),
WHAT CONDITION IS SHOWN?
Right central spike-and-slow wave IEDs and focal slowing in a patient with a right frontal tumor and partial seizures.
WHAT IS THE PROBLEM?
Right central spike-and-slow wave IEDs and focal slowing in a patient with a right frontal tumor and partial seizures.
WHAT IS SHOWN?
Midline spikes and polyspikes in a patient with frontal lobe
epilepsy.
No distinct clinical syndrome exists for patients with midline spikes. ________ are the most frequent seizure type
Tonic seizures
________are most frequently reported in the benign childhood epilepsies with occipital paroxysms and the later-onset
Panayiotopoulos syndrome.
Occipital IEDs
Occipital spikes may appear in nonepileptic patients who express the IEDs as a genetic trait, or those
who are ____________
Congenitally blind (“needle spikes” of the blind).
WHAT IS SHOWN?
single right occipital spike-and-slow wave discharge shown
in both a bipolar and reference montage (last two channels).
____________may be seen in individuals with discrete structural lesions, although usually they are associated with diffuse structural injury involving the gray matter of the hemispheres
Multifocal spikes
_________ AND _________are common underlying substrates for patients with multifocal independent spike discharges
There may be a primary site of focal dysfunction or be associated with concomitant generalized epileptiform discharges such as with the________
Mental retardation and cerebral palsy
Lennox-GastauT syndrome.
WHAT IS SHOWN?
Multifocal independent spike discharges seen in a patient
with encephalopathic generalized epilepsy
_____________is a term used for a generalized discharge with a focal onset
Secondary bilateral synchrony (SBS)
Patients with medial frontal seizures such as those with supplementary motor area, medial frontal convexity, or cingulate gyrus area involvement are most likely to manifest SBS given their proximity to the____________
corpus callosum
WHAT IS SHOWN?
A burst of secondary bilateral synchronous burst of sharpand- slow waves. Note the left frontotemporal spikes prior to the burst.
______________consists of a burst of generalized spikes and/or polyspike-and-slow wave complexes provoked by photic stimulation
A photoparoxysmal (PPR) or photoconvulsive response
PPR has a clinical correlation with _____________although it may also appear as an inherited trait without seizures
idiopathic generalized epilepsy (IGE),
THIS PATIENT WAS EVALUATED FOR HEADACHES
Self-limited photoparoxysmal response in a patient without
seizures evaluated for headaches.
The prototypic abnormality on EEG seen with generalized seizures is the____________
3-Hz spike-and-slow-wave complex.
Alerting responses inhibit generalized spike-and-wave (GSW), while ______________often increase it in IGE.
sleep, hyperventilation, and intermittent photic stimulation
WHAT IS SHOWN
A generalized burst of 3-Hz spike-and-slow waves in a
patient with IGE and absence seizures
Spike-and-slow-wave complexes that have a repetition rate of >3 Hz are referred to as fast GSW. ___________is the most common idiopathic generalized epilepsy (IGE) syndrome associated with iy
JME
WHAT SYNDROME IS ASSOCIATED?
A burst of generalized 3.5-Hz spike-and-slow waves in JME
The most characteristic feature on EEG in patients with __________predominant “fast” polyspike-and-slow wave (PSW) complexes, although this may also be seen in other IGEs as well
JME
________is a potent activator of the generalized IEDs seen with JME. ________may occur in up to 40% of patients with JME and is more prominent in females.
Sleep deprivation
Photosensitivity
WHAT SYNDROME IS ASSOCIATED?
Generalized polyspike-and-slow wave in a patient with JME
_______is a distinctive pattern that is seen in children and often associated with infantile spasms as a manifestation of West syndrome
Hypsarrhythmia
Many patients with hypsarrhythmia evolve into the
pattern of diffuse slowing, multifocal IEDs, and slow-spike-and-waves
characteristic of the_______
Lennox-Gastaut syndrome
WHAT SYNDROME IS ASSOCIATED? The pattern findings?
Hypsarrhythmia in a child with infantile spasms.
Note the high amplitude waves, in multifocal areas, and they are not synchronous
Slow-spike(or sharp)-and-wave discharges (SSW) are <3 Hz and are present in patients with the________
Lennox-Gastaut syndrome (LGS).
CHARACTERISTICS OF WAVE PATTERNS OF LGS
They often appear as repetitive bursts or runs of frequencies ranging from 1.5 to 2.5 Hz and often asymmetrical or shifting and prolonged in sleep
WHAT SYNDROME IS ASSOCIATED?
Slow-spike-and-wave in a patient with Lennox-Gastaut
syndrome.
WHAT IS SHOWN?
An asymptomatic burst of GPFA in a patient with the
Lennox-Gastaut syndrome and tonic seizures
____________is another feature on
EEG that occurs with the slow spike-and-waves of LGS. It is primarily
seen during sleep and consists of diffuse, bilateral bursts of 15
to 20 Hz frontally predominant bursts of fast frequencies
Generalized paroxysmal fast activity (GPFA)
Características morfologicas das atividades epileptiformes, quais os padrões de onda de 1 à 6?
1- Ponta ou espícula
2- Poliespiculas
3- Onda aguda
4-Espicula-onda lenta
5- poliespiculas e onda lentas
6- onda aguda-onda lenta
