Podcast
Questions and Answers
What is the maximum frequency of occurrence for a rare EEG pattern as defined in the content?
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?
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?
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?
What is the minimum number of cycles required for the patterns in CAPE to qualify as valid?
Which term best describes an EEG pattern that occurs less frequently than a rare pattern as defined?
Which term best describes an EEG pattern that occurs less frequently than a rare pattern as defined?
Which rhythmic and periodic pattern is most strongly associated with acute seizures?
Which rhythmic and periodic pattern is most strongly associated with acute seizures?
What type of analysis was used to address the definitions and nomenclature in the studies discussed?
What type of analysis was used to address the definitions and nomenclature in the studies discussed?
Which pattern is associated with intermediate seizure rates based on the findings from the studies?
Which pattern is associated with intermediate seizure rates based on the findings from the studies?
What is associated with a higher chance of acute seizures?
What is associated with a higher chance of acute seizures?
What does not significantly affect the association with seizures?
What does not significantly affect the association with seizures?
Which of the following patterns has the highest seizure rate according to the studies presented?
Which of the following patterns has the highest seizure rate according to the studies presented?
What morphological feature was investigated but not changed due to lack of consensus?
What morphological feature was investigated but not changed due to lack of consensus?
What was eliminated in previous versions concerning electrographic seizures?
What was eliminated in previous versions concerning electrographic seizures?
Which frequency was notably mentioned in relation to seizures?
Which frequency was notably mentioned in relation to seizures?
What was identified as a relevant factor in the prevalence of seizures?
What was identified as a relevant factor in the prevalence of seizures?
What was a primary reason for maintaining the original definition of electrographic seizures?
What was a primary reason for maintaining the original definition of electrographic seizures?
Which of the following factors was considered less significant in seizure association?
Which of the following factors was considered less significant in seizure association?
What distinguishes lateralized, bilateral asynchronous bursts from Bilateral Independent (BI) bursts?
What distinguishes lateralized, bilateral asynchronous bursts from Bilateral Independent (BI) bursts?
Which of the following statements about bursts is true?
Which of the following statements about bursts is true?
Which feature is NOT associated with bilateral independent bursts?
Which feature is NOT associated with bilateral independent bursts?
Why are some bursts categorized as lateralized?
Why are some bursts categorized as lateralized?
Which type of burst involves activity occurring in both hemispheres simultaneously but not independently?
Which type of burst involves activity occurring in both hemispheres simultaneously but not independently?
In what context might bilateral synchronous bursts be relevant?
In what context might bilateral synchronous bursts be relevant?
What is a potential misconception about bilateral independent bursts?
What is a potential misconception about bilateral independent bursts?
Which best describes the nature of activity observed in bilateral asynchronous bursts?
Which best describes the nature of activity observed in bilateral asynchronous bursts?
What implication does the classification of burst patterns have for clinical neurophysiology?
What implication does the classification of burst patterns have for clinical neurophysiology?
How are bilateral asynchronous bursts typically analyzed in a clinical setting?
How are bilateral asynchronous bursts typically analyzed in a clinical setting?
What percentage range indicates that an electrical record is considered suppressed or attenuated?
What percentage range indicates that an electrical record is considered suppressed or attenuated?
What would be described as continuous in EEG activity?
What would be described as continuous in EEG activity?
Which of the following best defines the term 'reactivity' in the context of EEG recordings?
Which of the following best defines the term 'reactivity' in the context of EEG recordings?
What kind of activity qualifies as suppression in an EEG record?
What kind of activity qualifies as suppression in an EEG record?
Which aspect must be noted during the assessment of attenuation or suppression in EEG?
Which aspect must be noted during the assessment of attenuation or suppression in EEG?
What is the significance of the terms 'focal', 'regional', and 'hemispheric' in EEG findings?
What is the significance of the terms 'focal', 'regional', and 'hemispheric' in EEG findings?
Which term is used to describe the EEG patterns that are less common in patients?
Which term is used to describe the EEG patterns that are less common in patients?
In the context of EEGs, what does 'asymmetry' imply?
In the context of EEGs, what does 'asymmetry' imply?
What aspect can influence the interpretation of EEG findings during epilepsy surgery?
What aspect can influence the interpretation of EEG findings during epilepsy surgery?
Which of the following best describes 'lateralized' findings in EEG nomenclature?
Which of the following best describes 'lateralized' findings in EEG nomenclature?
What is a crucial factor for classifying EEG discharges as 'sporadic'?
What is a crucial factor for classifying EEG discharges as 'sporadic'?
What clinical consideration is vital when interpreting EEGs for patients undergoing epilepsy surgery?
What clinical consideration is vital when interpreting EEGs for patients undergoing epilepsy surgery?
What term refers to additional information that can aid in localizing EEG patterns?
What term refers to additional information that can aid in localizing EEG patterns?
What does 'hemispheric' EEG findings commonly refer to in a clinical setting?
What does 'hemispheric' EEG findings commonly refer to in a clinical setting?
What duration of evolution qualifies a rhythmic pattern produced at 4 Hz as a definite BIRD?
What duration of evolution qualifies a rhythmic pattern produced at 4 Hz as a definite BIRD?
Which new term is used to describe a type of seizure with simultaneous electrographic and clinical manifestations?
Which new term is used to describe a type of seizure with simultaneous electrographic and clinical manifestations?
What is the newly added predominant background frequency in EEG assessments?
What is the newly added predominant background frequency in EEG assessments?
What change was made regarding the definition of burst suppression in EEG reports?
What change was made regarding the definition of burst suppression in EEG reports?
How should a rhythmic pattern occurring at 1 Hz or faster be classified within bursts?
How should a rhythmic pattern occurring at 1 Hz or faster be classified within bursts?
Which term describes a prolonged seizure state characterized by continuous electrographic activity?
Which term describes a prolonged seizure state characterized by continuous electrographic activity?
What does a continuous streak of nearly continuous EEG background change from?
What does a continuous streak of nearly continuous EEG background change from?
What does the new term 'Ictal-Interictal Continuum' refer to in seizure pattern terminology?
What does the new term 'Ictal-Interictal Continuum' refer to in seizure pattern terminology?
What does the term 'Extreme Delta Brush' refer to in the context of EEG patterns?
What does the term 'Extreme Delta Brush' refer to in the context of EEG patterns?
What is referred to when the suppression of voltage drops is induced by a stimulus?
What is referred to when the suppression of voltage drops is induced by a stimulus?
Which classification best describes bursts that exhibit a pattern with a consistent presence in both hemispheres but do so independently?
Which classification best describes bursts that exhibit a pattern with a consistent presence in both hemispheres but do so independently?
What percentage of the record must consist of attenuation or suppression to qualify as a discontinuous pattern?
What percentage of the record must consist of attenuation or suppression to qualify as a discontinuous pattern?
Which term best describes a pattern where bursts alternate with higher voltage activity?
Which term best describes a pattern where bursts alternate with higher voltage activity?
What is the primary voltage cutoff that delineates periods of lower voltage in bursts?
What is the primary voltage cutoff that delineates periods of lower voltage in bursts?
Which term is used to describe bursts that can shift in their predominant location during observation?
Which term is used to describe bursts that can shift in their predominant location during observation?
In the context of burst patterns, what does the term 'sharpest component' refer to?
In the context of burst patterns, what does the term 'sharpest component' refer to?
Which description most accurately characterizes bursts that have no consistent electrical activity present?
Which description most accurately characterizes bursts that have no consistent electrical activity present?
When defining burst patterns in EEG, what is the significance of identifying 'multifocal' bursts?
When defining burst patterns in EEG, what is the significance of identifying 'multifocal' bursts?
What aspect is NOT typically analyzed when observing burst activity in clinical settings?
What aspect is NOT typically analyzed when observing burst activity in clinical settings?
What state transition is stimulated to achieve during EEG evaluation?
What state transition is stimulated to achieve during EEG evaluation?
What EEG state corresponds to the 'reported background'?
What EEG state corresponds to the 'reported background'?
How is the background voltage categorized in EEG analysis?
How is the background voltage categorized in EEG analysis?
What type of EEG activity does 'sporadic epileptiform discharges' refer to?
What type of EEG activity does 'sporadic epileptiform discharges' refer to?
What is the significance of 'state changes' in EEG recordings?
What is the significance of 'state changes' in EEG recordings?
Which of the following factors does NOT influence the chance of acute seizures?
Which of the following factors does NOT influence the chance of acute seizures?
What relationship was observed regarding stimulus-induced patterns and seizures?
What relationship was observed regarding stimulus-induced patterns and seizures?
In studies of higher frequency patterns, which statement is accurate regarding the context of seizures?
In studies of higher frequency patterns, which statement is accurate regarding the context of seizures?
Which of the following statements regarding seizure patterns is true?
Which of the following statements regarding seizure patterns is true?
What percentage range defines a record as attenuated or suppressed?
What percentage range defines a record as attenuated or suppressed?
If a record contains less than 1% attenuation or suppression, how is it classified?
If a record contains less than 1% attenuation or suppression, how is it classified?
What term is used to describe continuous low voltage activity in an EEG record?
What term is used to describe continuous low voltage activity in an EEG record?
What must be noted when assessing EEG records for suppression or attenuation?
What must be noted when assessing EEG records for suppression or attenuation?
What percentage indicates that EEG activity is classified as either suppressed or attenuated?
What percentage indicates that EEG activity is classified as either suppressed or attenuated?
Which of the following classifications would not apply to an EEG record showing 99% suppression?
Which of the following classifications would not apply to an EEG record showing 99% suppression?
In EEG terminology, what does reactivity refer to?
In EEG terminology, what does reactivity refer to?
If an EEG shows all activity below 20 mV but also lacks suppression, how is it classified?
If an EEG shows all activity below 20 mV but also lacks suppression, how is it classified?
Which of the following correctly describes an EEG finding of 0.5% suppression?
Which of the following correctly describes an EEG finding of 0.5% suppression?
What is indicated by a 99% attenuation in an EEG record?
What is indicated by a 99% attenuation in an EEG record?
What distinguishes SI-attenuation from other forms of attenuation in EEG recordings?
What distinguishes SI-attenuation from other forms of attenuation in EEG recordings?
Which of the following best describes burst suppression in EEG activity?
Which of the following best describes burst suppression in EEG activity?
What is the typical voltage cutoff for suppression periods as defined in the content?
What is the typical voltage cutoff for suppression periods as defined in the content?
In the context of bursts, which term is NOT used to describe localization types?
In the context of bursts, which term is NOT used to describe localization types?
Which duration percentage range indicates a record is considered discontinuous?
Which duration percentage range indicates a record is considered discontinuous?
What is the sharpness component of a typical burst important for in EEG analysis?
What is the sharpness component of a typical burst important for in EEG analysis?
During the assessment of burst patterns, what should be noted about the voltage activity?
During the assessment of burst patterns, what should be noted about the voltage activity?
When analyzing periodic discharges, which classification would NOT be appropriate?
When analyzing periodic discharges, which classification would NOT be appropriate?
What is a defining factor of generalized bursts in EEG records?
What is a defining factor of generalized bursts in EEG records?
What is the maximum duration for a pattern to be classified as an RPP if it has a frequency of 4 Hz?
What is the maximum duration for a pattern to be classified as an RPP if it has a frequency of 4 Hz?
Which of the following correctly describes when a pattern meets the criteria for BIRDs?
Which of the following correctly describes when a pattern meets the criteria for BIRDs?
What characterizes an electrographic seizure in terms of frequency and duration?
What characterizes an electrographic seizure in terms of frequency and duration?
Which of the following statements is true regarding the classification of a pattern as lateralized?
Which of the following statements is true regarding the classification of a pattern as lateralized?
What minimum frequency disqualifies a pattern from being classified as any RPP?
What minimum frequency disqualifies a pattern from being classified as any RPP?
Which factor is not a criterion for distinguishing electrographic seizures from other patterns?
Which factor is not a criterion for distinguishing electrographic seizures from other patterns?
What defines a pattern as a polyspike in terms of frequency and duration?
What defines a pattern as a polyspike in terms of frequency and duration?
What is the criteria for a pattern to be considered as exhibiting periodic discharges?
What is the criteria for a pattern to be considered as exhibiting periodic discharges?
Which of the following is an important characteristic of the term 'synchrony' in the context of EEG patterns?
Which of the following is an important characteristic of the term 'synchrony' in the context of EEG patterns?
What is the required duration for a pattern to qualify as a sustained state change in background EEG?
What is the required duration for a pattern to qualify as a sustained state change in background EEG?
Which state change is categorized as the primary reported background EEG pattern?
Which state change is categorized as the primary reported background EEG pattern?
What condition would indicate the presence of CAPE despite the absence of state changes?
What condition would indicate the presence of CAPE despite the absence of state changes?
Which of the following describes the characteristics of abnormal stage N2 sleep transients?
Which of the following describes the characteristics of abnormal stage N2 sleep transients?
Which factor is NOT necessary for stimulation to transition a patient from a less alert to a more alert state?
Which factor is NOT necessary for stimulation to transition a patient from a less alert to a more alert state?
What is the defining characteristic of a bilateral asynchronous pattern in EEG?
What is the defining characteristic of a bilateral asynchronous pattern in EEG?
What is the frequency limit for a rhythmic pattern to be classified as a BIRD?
What is the frequency limit for a rhythmic pattern to be classified as a BIRD?
How long must a rhythmic pattern last to qualify for classification under new guidelines?
How long must a rhythmic pattern last to qualify for classification under new guidelines?
In terms of frequency, what threshold is specifically mentioned for patterns related to PDs and SW?
In terms of frequency, what threshold is specifically mentioned for patterns related to PDs and SW?
What duration excludes a pattern from qualifying as any RPP?
What duration excludes a pattern from qualifying as any RPP?
What classification is given to a pattern with a frequency of 0.4 Hz and lasting 0.6 seconds?
What classification is given to a pattern with a frequency of 0.4 Hz and lasting 0.6 seconds?
Which term is used for patterns that exhibit a frequency of 2.5 Hz and a duration of 10 seconds or more?
Which term is used for patterns that exhibit a frequency of 2.5 Hz and a duration of 10 seconds or more?
What is the maximum duration of evolution for a rhythmic pattern at 4 Hz to qualify as a definite BIRD?
What is the maximum duration of evolution for a rhythmic pattern at 4 Hz to qualify as a definite BIRD?
Which term is newly defined for an electrographic seizure that combines both clinical and electrographic features?
Which term is newly defined for an electrographic seizure that combines both clinical and electrographic features?
How has the definition of nearly continuous EEG background changed?
How has the definition of nearly continuous EEG background changed?
What percentage of attenuation defined burst suppression in EEG reports was changed?
What percentage of attenuation defined burst suppression in EEG reports was changed?
What term is used to describe rhythmic and potentially ictal-appearing patterns that occur at an average rate of 1/s or faster?
What term is used to describe rhythmic and potentially ictal-appearing patterns that occur at an average rate of 1/s or faster?
Which EEG pattern is now included as a predominant background frequency?
Which EEG pattern is now included as a predominant background frequency?
What significant change was made regarding the classification of electrographic seizure activity?
What significant change was made regarding the classification of electrographic seizure activity?
What criteria aligns with defining highly epileptiform bursts in EEG assessments?
What criteria aligns with defining highly epileptiform bursts in EEG assessments?
What does the term 'Ictal-Interictal Continuum' refer to in seizure terminology?
What does the term 'Ictal-Interictal Continuum' refer to in seizure terminology?
What characterizes the presence of 'Identical Bursts' in EEG recordings?
What characterizes the presence of 'Identical Bursts' in EEG recordings?
Which term refers to rhythmic, periodic, or ictal-appearing discharges in EEG patterns?
Which term refers to rhythmic, periodic, or ictal-appearing discharges in EEG patterns?
What does the presence of generalized bursts denote in EEG recordings?
What does the presence of generalized bursts denote in EEG recordings?
What is indicated by the term 'SIRPIDs-only'?
What is indicated by the term 'SIRPIDs-only'?
Which characteristic defines bilateral asynchronous bursts in EEG analysis?
Which characteristic defines bilateral asynchronous bursts in EEG analysis?
In the assessment of burst activity, what is significant regarding symmetric bursts?
In the assessment of burst activity, what is significant regarding symmetric bursts?
What is true about the localization of bursts in EEG?
What is true about the localization of bursts in EEG?
What criterion must rhythmic patterns produced at 4 Hz meet to qualify as definite BIRD?
What criterion must rhythmic patterns produced at 4 Hz meet to qualify as definite BIRD?
Which component is vital for understanding the patterns of activity in EEG discharges?
Which component is vital for understanding the patterns of activity in EEG discharges?
What does the term 'ictal' specifically refer to in the context of EEG patterns?
What does the term 'ictal' specifically refer to in the context of EEG patterns?
Which measurements are emphasized in the provided content for voltage in EEG recordings?
Which measurements are emphasized in the provided content for voltage in EEG recordings?
Which frequency unit is used in the discussion of rhythmic patterns within EEGs?
Which frequency unit is used in the discussion of rhythmic patterns within EEGs?
What does the term 'reactivity' refer to in EEG recordings?
What does the term 'reactivity' refer to in EEG recordings?
Which aspect related to burst measurement remains poorly defined in EEG literature?
Which aspect related to burst measurement remains poorly defined in EEG literature?
What is the significance of 'peak to trough' measurements in EEG analysis?
What is the significance of 'peak to trough' measurements in EEG analysis?
How does the ACNS contribute to critical care EEG monitoring based on the content?
How does the ACNS contribute to critical care EEG monitoring based on the content?
What defines the new classification of 'Extreme Delta Brush' in EEG contexts?
What defines the new classification of 'Extreme Delta Brush' in EEG contexts?
Flashcards
ACNS
ACNS
The American Clinical Neurophysiology Society (ACNS) is a professional organization that focuses on clinical neurophysiology, including EEG.
Standardized Critical Care EEG Terminology
Standardized Critical Care EEG Terminology
Standardized Critical Care EEG Terminology is a set of terms used to describe EEG findings in critically ill patients, ensuring consistent language.
ACNS Standardized Critical Care EEG Terminology: 2021 Version
ACNS Standardized Critical Care EEG Terminology: 2021 Version
This set of terms, developed by the ACNS, is a well-recognized standard for describing and interpreting EEG recordings in critical care settings.
Authors of the ACNS Guidelines
Authors of the ACNS Guidelines
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Journal of Publication
Journal of Publication
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Date Downloaded
Date Downloaded
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Unique Identifier
Unique Identifier
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Electrographic Seizure
Electrographic Seizure
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Electrographic Seizure (without clinically relevant meaning)
Electrographic Seizure (without clinically relevant meaning)
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Frequency (Hz)
Frequency (Hz)
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Prevalence
Prevalence
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Duration
Duration
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Modifier (e.g., 'triphasic')
Modifier (e.g., 'triphasic')
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Stimulus-induced
Stimulus-induced
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Spontaneous
Spontaneous
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Blinded Voting
Blinded Voting
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Consensus
Consensus
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What are RPPs?
What are RPPs?
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What is Lateralized Rhythmic Delta Activity (LRDA)?
What is Lateralized Rhythmic Delta Activity (LRDA)?
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What is Generalized Rhythmic Delta Activity (GRDA)?
What is Generalized Rhythmic Delta Activity (GRDA)?
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What are Lateralized Periodic Discharges (LPDs)?
What are Lateralized Periodic Discharges (LPDs)?
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What was the main finding of the multicenter cohort study?
What was the main finding of the multicenter cohort study?
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What is the significance of LRDA?
What is the significance of LRDA?
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How were the definitions for RPPs established?
How were the definitions for RPPs established?
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How are RPPs classified?
How are RPPs classified?
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What is the clinical significance of RPPs?
What is the clinical significance of RPPs?
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Cyclic Alternating Pattern of Encephalopathy (CAPE)
Cyclic Alternating Pattern of Encephalopathy (CAPE)
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Modifier
Modifier
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Lateralized Bilateral Asynchronous Bursts
Lateralized Bilateral Asynchronous Bursts
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Bilateral Independent (BI) Bursts
Bilateral Independent (BI) Bursts
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Lateralized, Bilateral Asynchronous Bursts
Lateralized, Bilateral Asynchronous Bursts
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What is ACNS?
What is ACNS?
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What’s Standardized Critical Care EEG Terminology?
What’s Standardized Critical Care EEG Terminology?
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What's 'Journal of Clinical Neurophysiology?'
What's 'Journal of Clinical Neurophysiology?'
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When was the document downloaded?
When was the document downloaded?
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What signifies a document was accessed and used?
What signifies a document was accessed and used?
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What is Figure 7.A?
What is Figure 7.A?
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What is a BIRD on an EEG?
What is a BIRD on an EEG?
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What is the definition of an electrographic seizure based on BIRD duration?
What is the definition of an electrographic seizure based on BIRD duration?
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What is an Electrographic Seizure (ESz)?
What is an Electrographic Seizure (ESz)?
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What is Electrographic Status Epilepticus (ESE)?
What is Electrographic Status Epilepticus (ESE)?
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What is an Electroclinical Seizure (ECSz)?
What is an Electroclinical Seizure (ECSz)?
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What is Electroclinical Status Epilepticus (ECSE)?
What is Electroclinical Status Epilepticus (ECSE)?
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What is Possible Electroclinical Status Epilepticus?
What is Possible Electroclinical Status Epilepticus?
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What is the Ictal-Interictal Continuum (IIC)?
What is the Ictal-Interictal Continuum (IIC)?
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What is Extreme Delta Brush (EDB)?
What is Extreme Delta Brush (EDB)?
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What is a conflict of interest?
What is a conflict of interest?
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Why is disclosure of conflicts of interest important?
Why is disclosure of conflicts of interest important?
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What is blinded voting?
What is blinded voting?
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What is consensus?
What is consensus?
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What are Rhythmic and Periodic Patterns (RPPs)?
What are Rhythmic and Periodic Patterns (RPPs)?
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Rhythmic and Periodic Patterns (RPPs)
Rhythmic and Periodic Patterns (RPPs)
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Attenuation
Attenuation
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Suppression
Suppression
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Lateralized Rhythmic Delta Activity (LRDA)
Lateralized Rhythmic Delta Activity (LRDA)
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Lateralized Periodic Discharges (LPDs)
Lateralized Periodic Discharges (LPDs)
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Attenuation Percent or Suppression Percent
Attenuation Percent or Suppression Percent
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Reactivity
Reactivity
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Generalized Rhythmic Delta Activity (GRDA)
Generalized Rhythmic Delta Activity (GRDA)
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Spontaneous Activity
Spontaneous Activity
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American Clinical Neurophysiology Society (ACNS)
American Clinical Neurophysiology Society (ACNS)
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Burst Suppression
Burst Suppression
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Localization of Bursts
Localization of Bursts
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Bilateral Independent Bursts
Bilateral Independent Bursts
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Stimulus-Induced Attenuation/Suppression
Stimulus-Induced Attenuation/Suppression
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Bursts
Bursts
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Duration of Bursts
Duration of Bursts
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Interburst Intervals
Interburst Intervals
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Sharpest Component of a Burst
Sharpest Component of a Burst
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Brief, Potentially Ictal Rhythmic Discharge (BIRD)
Brief, Potentially Ictal Rhythmic Discharge (BIRD)
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State Changes in EEG
State Changes in EEG
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State (within CAPE)
State (within CAPE)
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Stimulus-Induced vs. Spontaneous
Stimulus-Induced vs. Spontaneous
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Modifier (in EEG)
Modifier (in EEG)
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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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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.
