ACNS (Full Exam)
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Questions and Answers

What is the maximum frequency of occurrence for a rare EEG pattern as defined in the content?

  • 1 every 5 minutes
  • More than 1/hour
  • Less than 1/hour
  • 1/hour but less than 1/minute (correct)

    • Which condition is necessary for the Cyclic Alternating Pattern of Encephalopathy (CAPE) according to the provided details?

  • The patterns should be random without cycles
  • Each pattern must last less than 5 seconds
  • Each pattern must last at least 10 seconds (correct)
  • Each pattern should be sustained indefinitely

    • Which of the following describes the alternating behavior of patterns in CAPE?

  • Always alternates every 5 seconds
  • Spontaneously alternates between the two patterns in a regular manner (correct)
  • Alternates only after external stimulus
  • Alternates irregularly with no specified cycles

    • What is the minimum number of cycles required for the patterns in CAPE to qualify as valid?

    <p>At least 6 cycles</p> Signup and view all the answers

    Which term best describes an EEG pattern that occurs less frequently than a rare pattern as defined?

    <p>Unclear</p> Signup and view all the answers

    Which rhythmic and periodic pattern is most strongly associated with acute seizures?

    <p>Lateralized rhythmic delta activity (LRDA)</p> Signup and view all the answers

    What type of analysis was used to address the definitions and nomenclature in the studies discussed?

    <p>Live discussions and questionnaires</p> Signup and view all the answers

    Which pattern is associated with intermediate seizure rates based on the findings from the studies?

    <p>Lateralized rhythmic delta activity (LRDA)</p> Signup and view all the answers

    What is associated with a higher chance of acute seizures?

    <p>Higher duration and presence of a 'plus' modifier</p> Signup and view all the answers

    What does not significantly affect the association with seizures?

    <p>Pattern being spontaneous or stimulus-induced</p> Signup and view all the answers

    Which of the following patterns has the highest seizure rate according to the studies presented?

    <p>Lateralized periodic discharges (LPDs)</p> Signup and view all the answers

    What morphological feature was investigated but not changed due to lack of consensus?

    <p>Triphasic morphology</p> Signup and view all the answers

    What was eliminated in previous versions concerning electrographic seizures?

    <p>The 10-second cutoff</p> Signup and view all the answers

    Which frequency was notably mentioned in relation to seizures?

    <p>1.5 Hz</p> Signup and view all the answers

    What was identified as a relevant factor in the prevalence of seizures?

    <p>Frequency and prevalence of the patterns</p> Signup and view all the answers

    What was a primary reason for maintaining the original definition of electrographic seizures?

    <p>Consensus was not reached</p> Signup and view all the answers

    Which of the following factors was considered less significant in seizure association?

    <p>Voting methodology used</p> Signup and view all the answers

    What distinguishes lateralized, bilateral asynchronous bursts from Bilateral Independent (BI) bursts?

    <p>There is a consistent relationship between the activity of the hemispheres.</p> Signup and view all the answers

    Which of the following statements about bursts is true?

    <p>Asynchronous bursts signify a lack of coordination between hemispheres.</p> Signup and view all the answers

    Which feature is NOT associated with bilateral independent bursts?

    <p>Synchronization of waveforms across both sides.</p> Signup and view all the answers

    Why are some bursts categorized as lateralized?

    <p>They present a predictable interhemispheric relationship.</p> Signup and view all the answers

    Which type of burst involves activity occurring in both hemispheres simultaneously but not independently?

    <p>Lateralized bilateral asynchronous bursts.</p> Signup and view all the answers

    In what context might bilateral synchronous bursts be relevant?

    <p>Diagnostic differentiation between hemispheric disorders.</p> Signup and view all the answers

    What is a potential misconception about bilateral independent bursts?

    <p>They indicate the same patterns of neural firing in both hemispheres.</p> Signup and view all the answers

    Which best describes the nature of activity observed in bilateral asynchronous bursts?

    <p>Simultaneous but unrelated patterns across hemispheres.</p> Signup and view all the answers

    What implication does the classification of burst patterns have for clinical neurophysiology?

    <p>It aids in the interpretation of EEG readings.</p> Signup and view all the answers

    How are bilateral asynchronous bursts typically analyzed in a clinical setting?

    <p>Examining relationships in EEG data across hemispheres.</p> Signup and view all the answers

    What percentage range indicates that an electrical record is considered suppressed or attenuated?

    <p>1% to 99%</p> Signup and view all the answers

    What would be described as continuous in EEG activity?

    <p>Suppression below 1%</p> Signup and view all the answers

    Which of the following best defines the term 'reactivity' in the context of EEG recordings?

    <p>Change in cerebral EEG activity to stimulation</p> Signup and view all the answers

    What kind of activity qualifies as suppression in an EEG record?

    <p>All activity less than 10 mV</p> Signup and view all the answers

    Which aspect must be noted during the assessment of attenuation or suppression in EEG?

    <p>The strength and/or nature of the stimulus</p> Signup and view all the answers

    What is the significance of the terms 'focal', 'regional', and 'hemispheric' in EEG findings?

    <p>They specify the location of abnormalities within the brain.</p> Signup and view all the answers

    Which term is used to describe the EEG patterns that are less common in patients?

    <p>Rare patterns</p> Signup and view all the answers

    In the context of EEGs, what does 'asymmetry' imply?

    <p>A difference in activity levels between brain lobes.</p> Signup and view all the answers

    What aspect can influence the interpretation of EEG findings during epilepsy surgery?

    <p>Knowing the precise lobe involved in abnormalities.</p> Signup and view all the answers

    Which of the following best describes 'lateralized' findings in EEG nomenclature?

    <p>Patterns that are significantly more pronounced on one side of the brain.</p> Signup and view all the answers

    What is a crucial factor for classifying EEG discharges as 'sporadic'?

    <p>Their isolated appearance in the data.</p> Signup and view all the answers

    What clinical consideration is vital when interpreting EEGs for patients undergoing epilepsy surgery?

    <p>Understanding the specific patterns indicative of epilepsy.</p> Signup and view all the answers

    What term refers to additional information that can aid in localizing EEG patterns?

    <p>Localizing modifiers</p> Signup and view all the answers

    What does 'hemispheric' EEG findings commonly refer to in a clinical setting?

    <p>Findings that are observable on one entire hemisphere.</p> Signup and view all the answers

    What duration of evolution qualifies a rhythmic pattern produced at 4 Hz as a definite BIRD?

    <p>10 seconds or longer</p> Signup and view all the answers

    Which new term is used to describe a type of seizure with simultaneous electrographic and clinical manifestations?

    <p>Electroclinical seizure</p> Signup and view all the answers

    What is the newly added predominant background frequency in EEG assessments?

    <p>Beta (13 Hz)</p> Signup and view all the answers

    What change was made regarding the definition of burst suppression in EEG reports?

    <p>Changed from 50% to 99% suppression</p> Signup and view all the answers

    How should a rhythmic pattern occurring at 1 Hz or faster be classified within bursts?

    <p>As highly epileptiform if it appears in the majority of bursts</p> Signup and view all the answers

    Which term describes a prolonged seizure state characterized by continuous electrographic activity?

    <p>Electrographic status epilepticus</p> Signup and view all the answers

    What does a continuous streak of nearly continuous EEG background change from?

    <p>From 10% to 1–9% attenuation/suppression</p> Signup and view all the answers

    What does the new term 'Ictal-Interictal Continuum' refer to in seizure pattern terminology?

    <p>The relationship between interictal and ictal activities</p> Signup and view all the answers

    What does the term 'Extreme Delta Brush' refer to in the context of EEG patterns?

    <p>A specific rhythmic discharge pattern in seizures</p> Signup and view all the answers

    What is referred to when the suppression of voltage drops is induced by a stimulus?

    <p>SI-suppression</p> Signup and view all the answers

    Which classification best describes bursts that exhibit a pattern with a consistent presence in both hemispheres but do so independently?

    <p>Bilateral independent bursts</p> Signup and view all the answers

    What percentage of the record must consist of attenuation or suppression to qualify as a discontinuous pattern?

    <p>10% to 49%</p> Signup and view all the answers

    Which term best describes a pattern where bursts alternate with higher voltage activity?

    <p>Burst suppression</p> Signup and view all the answers

    What is the primary voltage cutoff that delineates periods of lower voltage in bursts?

    <p>10 mV</p> Signup and view all the answers

    Which term is used to describe bursts that can shift in their predominant location during observation?

    <p>Generalized bursts</p> Signup and view all the answers

    In the context of burst patterns, what does the term 'sharpest component' refer to?

    <p>Distinctive peak</p> Signup and view all the answers

    Which description most accurately characterizes bursts that have no consistent electrical activity present?

    <p>Discontinuous patterns</p> Signup and view all the answers

    When defining burst patterns in EEG, what is the significance of identifying 'multifocal' bursts?

    <p>They occur in diverse locations simultaneously.</p> Signup and view all the answers

    What aspect is NOT typically analyzed when observing burst activity in clinical settings?

    <p>Patient's subjective experience</p> Signup and view all the answers

    What state transition is stimulated to achieve during EEG evaluation?

    <p>From less alert to more alert</p> Signup and view all the answers

    What EEG state corresponds to the 'reported background'?

    <p>Higher voltage background activity</p> Signup and view all the answers

    How is the background voltage categorized in EEG analysis?

    <p>By its continuity and voltage level</p> Signup and view all the answers

    What type of EEG activity does 'sporadic epileptiform discharges' refer to?

    <p>Nonrhythmic and nonperiodic spikes, polyspikes, and sharp waves</p> Signup and view all the answers

    What is the significance of 'state changes' in EEG recordings?

    <p>They can occur both spontaneously and through stimulation</p> Signup and view all the answers

    Which of the following factors does NOT influence the chance of acute seizures?

    <p>Triphasic morphology of the pattern</p> Signup and view all the answers

    What relationship was observed regarding stimulus-induced patterns and seizures?

    <p>Their pattern type does not affect seizure occurrence.</p> Signup and view all the answers

    In studies of higher frequency patterns, which statement is accurate regarding the context of seizures?

    <p>Not all high frequency patterns are clinically relevant.</p> Signup and view all the answers

    Which of the following statements regarding seizure patterns is true?

    <p>Duration and frequency both contribute to seizure risk but interact with other factors.</p> Signup and view all the answers

    What percentage range defines a record as attenuated or suppressed?

    <p>1% to 99%</p> Signup and view all the answers

    If a record contains less than 1% attenuation or suppression, how is it classified?

    <p>Continuous</p> Signup and view all the answers

    What term is used to describe continuous low voltage activity in an EEG record?

    <p>Attenuation</p> Signup and view all the answers

    What must be noted when assessing EEG records for suppression or attenuation?

    <p>Strength and nature of stimulus</p> Signup and view all the answers

    What percentage indicates that EEG activity is classified as either suppressed or attenuated?

    <p>Between 1% and 99%</p> Signup and view all the answers

    Which of the following classifications would not apply to an EEG record showing 99% suppression?

    <p>Highly continuous</p> Signup and view all the answers

    In EEG terminology, what does reactivity refer to?

    <p>Change in EEG activity due to stimulation</p> Signup and view all the answers

    If an EEG shows all activity below 20 mV but also lacks suppression, how is it classified?

    <p>Low voltage activity</p> Signup and view all the answers

    Which of the following correctly describes an EEG finding of 0.5% suppression?

    <p>Considered continuous</p> Signup and view all the answers

    What is indicated by a 99% attenuation in an EEG record?

    <p>Maximal suppression</p> Signup and view all the answers

    What distinguishes SI-attenuation from other forms of attenuation in EEG recordings?

    <p>It is stimulus-induced.</p> Signup and view all the answers

    Which of the following best describes burst suppression in EEG activity?

    <p>A pattern alternating between suppression and lower voltage.</p> Signup and view all the answers

    What is the typical voltage cutoff for suppression periods as defined in the content?

    <p>Below 10 mV.</p> Signup and view all the answers

    In the context of bursts, which term is NOT used to describe localization types?

    <p>Unilateral co-dependent.</p> Signup and view all the answers

    Which duration percentage range indicates a record is considered discontinuous?

    <p>10% to 49% of the record.</p> Signup and view all the answers

    What is the sharpness component of a typical burst important for in EEG analysis?

    <p>Classifying discharge patterns.</p> Signup and view all the answers

    During the assessment of burst patterns, what should be noted about the voltage activity?

    <p>It is acceptable for there to be periods of low voltage.</p> Signup and view all the answers

    When analyzing periodic discharges, which classification would NOT be appropriate?

    <p>Randomized sporadic.</p> Signup and view all the answers

    What is a defining factor of generalized bursts in EEG records?

    <p>They exhibit shifting predominance.</p> Signup and view all the answers

    What is the maximum duration for a pattern to be classified as an RPP if it has a frequency of 4 Hz?

    <p>10 seconds</p> Signup and view all the answers

    Which of the following correctly describes when a pattern meets the criteria for BIRDs?

    <p>Pattern frequency exceeding 4 Hz and duration of less than 10 seconds</p> Signup and view all the answers

    What characterizes an electrographic seizure in terms of frequency and duration?

    <p>Frequency of 2.5 Hz and duration 10 seconds or more</p> Signup and view all the answers

    Which of the following statements is true regarding the classification of a pattern as lateralized?

    <p>It must begin in one hemisphere and propagate to the other.</p> Signup and view all the answers

    What minimum frequency disqualifies a pattern from being classified as any RPP?

    <p>0.4 Hz</p> Signup and view all the answers

    Which factor is not a criterion for distinguishing electrographic seizures from other patterns?

    <p>A clear bilateral synchronous activity</p> Signup and view all the answers

    What defines a pattern as a polyspike in terms of frequency and duration?

    <p>Frequency of above 0.4 Hz and duration less than 0.5 seconds</p> Signup and view all the answers

    What is the criteria for a pattern to be considered as exhibiting periodic discharges?

    <p>They must have a consistent structure without interruption.</p> Signup and view all the answers

    Which of the following is an important characteristic of the term 'synchrony' in the context of EEG patterns?

    <p>It indicates simultaneous activity in both hemispheres without delay.</p> Signup and view all the answers

    What is the required duration for a pattern to qualify as a sustained state change in background EEG?

    <p>60 seconds</p> Signup and view all the answers

    Which state change is categorized as the primary reported background EEG pattern?

    <p>More alert/stimulated pattern</p> Signup and view all the answers

    What condition would indicate the presence of CAPE despite the absence of state changes?

    <p>CAPE being present continuously without interruption</p> Signup and view all the answers

    Which of the following describes the characteristics of abnormal stage N2 sleep transients?

    <p>Includes both K-complexes and spindles but is not typical</p> Signup and view all the answers

    Which factor is NOT necessary for stimulation to transition a patient from a less alert to a more alert state?

    <p>Ability to alter heart rate</p> Signup and view all the answers

    What is the defining characteristic of a bilateral asynchronous pattern in EEG?

    <p>Patterns that consistently begin in one hemisphere and propagate to the other</p> Signup and view all the answers

    What is the frequency limit for a rhythmic pattern to be classified as a BIRD?

    <p>Greater than 0.5 Hz but less than 4 Hz</p> Signup and view all the answers

    How long must a rhythmic pattern last to qualify for classification under new guidelines?

    <p>Less than or equal to 10 seconds</p> Signup and view all the answers

    In terms of frequency, what threshold is specifically mentioned for patterns related to PDs and SW?

    <p>Should not exceed 4 Hz</p> Signup and view all the answers

    What duration excludes a pattern from qualifying as any RPP?

    <p>Less than 0.5 seconds</p> Signup and view all the answers

    What classification is given to a pattern with a frequency of 0.4 Hz and lasting 0.6 seconds?

    <p>It is considered a polyspike</p> Signup and view all the answers

    Which term is used for patterns that exhibit a frequency of 2.5 Hz and a duration of 10 seconds or more?

    <p>Electrographic Seizures</p> Signup and view all the answers

    What is the maximum duration of evolution for a rhythmic pattern at 4 Hz to qualify as a definite BIRD?

    <p>10 seconds</p> Signup and view all the answers

    Which term is newly defined for an electrographic seizure that combines both clinical and electrographic features?

    <p>Electroclinical seizure</p> Signup and view all the answers

    How has the definition of nearly continuous EEG background changed?

    <p>From 10% to 1-9% attenuation</p> Signup and view all the answers

    What percentage of attenuation defined burst suppression in EEG reports was changed?

    <p>50-99%</p> Signup and view all the answers

    What term is used to describe rhythmic and potentially ictal-appearing patterns that occur at an average rate of 1/s or faster?

    <p>Highly Epileptiform Bursts</p> Signup and view all the answers

    Which EEG pattern is now included as a predominant background frequency?

    <p>Beta (13 Hz)</p> Signup and view all the answers

    What significant change was made regarding the classification of electrographic seizure activity?

    <p>Inclusion of stimulus-terminated activity</p> Signup and view all the answers

    What criteria aligns with defining highly epileptiform bursts in EEG assessments?

    <p>Rhythmic patterns at 1/s or faster in the majority of bursts</p> Signup and view all the answers

    What does the term 'Ictal-Interictal Continuum' refer to in seizure terminology?

    <p>The spectrum of electrographic patterns during seizures</p> Signup and view all the answers

    What characterizes the presence of 'Identical Bursts' in EEG recordings?

    <p>They are defined by their presence in the first 0.5 seconds or longer of each burst.</p> Signup and view all the answers

    Which term refers to rhythmic, periodic, or ictal-appearing discharges in EEG patterns?

    <p>SIRPIDs</p> Signup and view all the answers

    What does the presence of generalized bursts denote in EEG recordings?

    <p>Bursts that shift predominance based on asynchrony.</p> Signup and view all the answers

    What is indicated by the term 'SIRPIDs-only'?

    <p>Only stimulus-induced reactivity is present with no other activities.</p> Signup and view all the answers

    Which characteristic defines bilateral asynchronous bursts in EEG analysis?

    <p>They exhibit activity that is independent on both hemispheres simultaneously.</p> Signup and view all the answers

    In the assessment of burst activity, what is significant regarding symmetric bursts?

    <p>They can start on either side but are never consistent.</p> Signup and view all the answers

    What is true about the localization of bursts in EEG?

    <p>There is considerable variability in their localization based on the presence of certain stimuli.</p> Signup and view all the answers

    What criterion must rhythmic patterns produced at 4 Hz meet to qualify as definite BIRD?

    <p>They need to evolve progressively over time.</p> Signup and view all the answers

    Which component is vital for understanding the patterns of activity in EEG discharges?

    <p>The symmetry of burst activity needs to be evaluated carefully.</p> Signup and view all the answers

    What does the term 'ictal' specifically refer to in the context of EEG patterns?

    <p>An EEG pattern that occurs during an epileptic seizure, clinical or electrographic-only</p> Signup and view all the answers

    Which measurements are emphasized in the provided content for voltage in EEG recordings?

    <p>Peak to trough measurements</p> Signup and view all the answers

    Which frequency unit is used in the discussion of rhythmic patterns within EEGs?

    <p>Hz (hertz)</p> Signup and view all the answers

    What does the term 'reactivity' refer to in EEG recordings?

    <p>The brain's response to external stimuli in EEG patterns</p> Signup and view all the answers

    Which aspect related to burst measurement remains poorly defined in EEG literature?

    <p>The duration determining burst classification</p> Signup and view all the answers

    What is the significance of 'peak to trough' measurements in EEG analysis?

    <p>They provide a standard for measuring voltage fluctuations</p> Signup and view all the answers

    How does the ACNS contribute to critical care EEG monitoring based on the content?

    <p>It offers guidelines for improving EEG interpretation</p> Signup and view all the answers

    What defines the new classification of 'Extreme Delta Brush' in EEG contexts?

    <p>A complex pattern involving both delta waves and a faster rhythm</p> Signup and view all the answers

    Study Notes

    American Clinical Neurophysiology Society's Standardized Critical Care EEG Terminology: 2021 Version

    • This guideline standardizes terminology for periodic and rhythmic EEG patterns in critically ill patients.
    • The initial terminology was proposed in 2005 and published as a guideline in 2013. 
    • Interrater agreement for most terms was high in the 2012 version.
    • A database incorporating the terminology was developed for clinical and research purposes. 
    • Several terms are added based on current research, including electrographic seizures, electrographic status epilepticus, electroclinical seizures, electroclinical status epilepticus, brief potentially ictal rhythmic discharges, and the ictal-interictal continuum.
    • The 2021 version incorporates updated terminology, definitions, and clarifications of terms. 
    • Key changes include a new main term (Unilateral Independent), updated lateralized terms, corrections to the calculation of phases, and additions of terms like Identical Bursts, and Cyclic Alternating Pattern of Encephalopathy (CAPE). 
    • This guideline also incorporates new terms and concepts based on recent research and clarifies old terms. 

    EEG Background

    • Symmetry: Assessment of EEG symmetry, including symmetric versus mild/marked asymmetry in voltage and frequency is key. Report asymmetry separately for each hemisphere.
    • Predominant Background Frequency: Frequency bands like Beta (>13 Hz), Alpha, Theta, and Delta are evaluated. If two or more are equally prominent, all should be reported.
    • Posterior Dominant ('Alpha') Rhythm: presence or absence of posterior dominant rhythm, requires demonstration of attenuation with eye opening and 1-second wait after eye closing. 
    • Voltage: 'High' (most or all activity ≥150 µV), 'normal,' 'low' (<20 µV), or 'suppressed' (<10 µV)

    Continuity

    • Continuous: Less than 1% of the record showing attenuation or suppression periods of 1+ seconds. 
    • Nearly Continuous: 1-9% of record showing attenuation or suppression of ≥1 second duration.
    • Discontinuous: 10%–49% of record showing alternating periods of attenuation/suppression.
    • Burst-attenuation/Burst-suppression: 50-99% showing periods of alternating attenuation or suppression. Include localization (e.g., generalized, lateralized, bilateral independent, unilateral independent, or multifocal). Specify the typical duration of bursts and interburst intervals, and the sharpness of the bursts (e.g., spiky, sharp, sharply contoured, or blunt). Provide the presence or absence of highly epileptiform bursts.

    Rhythmic and Periodic Patterns (RPPs)

    • Includes Periodic Discharges (PDs), Rhythmic Delta Activity (RDA), and Spike-and-wave or Sharp-and-wave (SW).
    • Key components for PDs: Repetition of a waveform with uniform morphology; duration, discernible interdischarge interval, and recurrence at nearly regular intervals with minimal variation (<50%) in cycle length. 
    • Key components of RDA: Similar to PD, but waveforms occur without interdischarge interval, minimal variation (<50%) in cycle length to define "rhythmic."
    • "Cycle Length" is used to describe the time between successive similar waveforms, providing a more standardized approach to defining rhythmic/periodic patterns.

    Electrographic and Electroclinical Seizures (ESz and ECSz)

    • Electrographic Seizures (ESz): characterized by epileptiform discharges with frequency >2.5 Hz lasting ≥10 seconds or with >25 discharges in 10 seconds.
    • Electrographic Status Epilepticus (ESE): characterized by an ESz lasting ≥10 continuous minutes, or for a ≥20% total duration in a 60-minute recording period, or for ≥ 5 minutes of bilateral tonic-clonic activity.
    • Electroclinical Seizures (ECSz): definite clinical correlate within pattern, EEG and clinical improvement with antiseizure medication. 
    • Electroclinical Status Epilepticus (ECSE): Electroclinical seizure lasting ≥10 continuous minutes, 20% in 60 minutes, or 5 minutes of bilateral tonic-clonic seizure/ clinical improvement with anti-seizure medication.

    Brief Potentially Ictal Rhythmic Discharges (BIRDs)

    • Brief, focal or generalized rhythmic activity >4 Hz lasting 0.5–<10 seconds.
    • Should not be consistent with a known normal pattern or benign EEG variant.
    • Should be categorized as “evolving” if it exhibits changes in frequency, morphology or location.  Specify localization as "Generalized, lateralized, bilateral independent, unilateral independent, or multifocal." Provide the presence or absence of highly epileptiform bursts and the typical duration of activity prior to and following stimulus (if any).
    • Include the possibility of additional characteristics like "sharp," "spiky," "blunt," or "sharply contoured" morphology.

    Ictal-Interictal Continuum (IIC)

    • Electrographic pattern that does not meet the criteria of an ESz or ESE; however, there is a possible ictal component that potentially contributes to other clinical issues.
    • Ictal-interictal continuum is a purely electrographic term; for a complete evaluation consider full clinical context. It requires careful interpretation. Qualifying patterns must not meet ESz/ESE criteria, but have frequency (either >1.0 or ≥0.5 Hz), and may have a plus modifier or demonstrate fluctuation. Specify localization, and provide the presence or absence of highly epileptiform bursts, and the duration of activity prior to and following any potential stimulus (if any).
    • Include a note that this is a less-defined concept currently without widespread agreement.

    Other Terminology

    • State Changes: At least two sustained types of background EEG related to level of alertness or stimulation and persisting at least 60 seconds, used to categorize different states.
    • Cyclic Alternating Pattern of Encephalopathy (CAPE): repetitive, spontaneous shifts between EEG patterns, each ≥10 seconds, spanning minutes to hours.
    • Anterior-Posterior (AP) Gradient: patterns of decreased voltage and increased frequency detected in anterior derivations, and increased voltage and decreased frequencies seen in posterior derivations. Document the duration for at least 1 minute.
    • Breach Effect: higher amplitude and faster frequencies detected above or near skull defects. Specify location.
    • Sporadic Epileptiform Discharges: non-rhythmic, non-periodic spikes, polyspikes, or sharp waves. Specify their frequency as either "abundant," "frequent," "occasional," or "rare."  Note the duration and whether or not it is associated with other patterns.
    • Rhythmic, Periodic, or Ictal-appearing Discharges (SIRPIDs): stimulus-induced patterns. Note potential stimuli (e.g., "noxious" or "non-noxious"). Specify whether patterns are "stimulus-induced,", "stimulus-exacerbated,", "stimulus-terminated," or "spontaneous."
    • Identical Bursts: bursts in which the first 0.5 seconds are visually similar in most (>90%) channels.
    • Extreme Delta Brush (EDB): A subtype of +F (fast activity). Includes abundant or continuous RDA+F, or PDs+F(if PDs is blunt delta waves). The stereotypical relationship of fast activity to each delta wave should be characterized in sufficient detail to allow recognition of the phenomenon. The possible subcategory describes the patterns without stereotypical relationships to delta waves or are only occasional or frequent.
    • Evolution, Fluctuation, and Static: changes in frequency, morphology, or location, used to describe fluctuations in EEG patterns over time. Specify the direction of changes.

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    Related Documents

    ACNS Critical Care EEG Terminology 2021 PDF
    ACNS Guideline on Standardized Critical Care EEG Terminology (2021 Version) PDF

    Description

    Test your knowledge of the American Clinical Neurophysiology Society's guidelines with this quiz. Covering key aspects and details, you will explore authorship, publication types, and specific EEG patterns outlined in the guidelines. Perfect for students and professionals in neurophysiology.

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