ACNS 1 (Major & Minor Revisions)
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Questions and Answers

What is the new voltage category added to EEG classifications?

  • Very high voltage
  • Low voltage
  • Medium voltage
  • High voltage (correct)

    • How has the definition of intermediate duration changed in EEG classifications?

  • From 1–4.9 mins to 1–9.9 mins (correct)
  • From 5–10 mins to 10–15 mins
  • From 1–4.9 mins to 5–59 mins
  • From 1–9.9 mins to 5–10 mins

    • What change was made to the definition of high voltage?

  • Changed from 100 mV to 200 mV
  • Changed from 200 mV to 150 mV (correct)
  • Changed from 150 mV to 200 mV
  • Changed from 50 mV to 150 mV

    • Which classification was changed from a major modifier to a minor modifier in EEG readings?

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

    Which of the following accurately reflects the changed duration for long duration EEG?

    <p>Changed from 5–59 mins to 10–59 mins</p> Signup and view all the answers

    What has been stated about findings on EEG in terms of their classification?

    <p>Any finding can be focal, regional, or hemispheric.</p> Signup and view all the answers

    What is the new frequency added to the EEG background predominant frequency?

    <p>0.13 Hz</p> Signup and view all the answers

    Which of the following best describes Highly Epileptiform Bursts after the updates?

    <p>Two or more epileptiform discharges seen within the majority of bursts at an average frequency of 1 Hz or faster.</p> Signup and view all the answers

    What change has been made regarding the description of burst suppression?

    <p>Burst suppression is now described as 50-99% attenuation.</p> Signup and view all the answers

    Which term refers to possible electroclinical status epilepticus?

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

    What has been updated concerning the description of nearly continuous EEG backgrounds?

    <p>Changed from #10% to 1-9% attenuation/suppression.</p> Signup and view all the answers

    What is the new modifier that has been introduced?

    <p>Stimulus-Terminated</p> Signup and view all the answers

    What defines an electrographic status epilepticus (ESE)?

    <p>Electrographic seizures that last longer than 30 minutes.</p> Signup and view all the answers

    What major change combines 'variability' and 'stage II sleep transients'?

    <p>State changes</p> Signup and view all the answers

    Which of the following statements about the Ictal-Interictal Continuum is correct?

    <p>It encompasses both ictal and interictal activities on the EEG.</p> Signup and view all the answers

    What constitutes Brief Potentially Ictal Rhythmic Discharges (BIRDs)?

    <p>Rhythmic patterns that may indicate seizure activity.</p> Signup and view all the answers

    Which term is newly introduced to describe bursts that are identical?

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

    What is the frequency threshold below which no RPP can exist?

    <p>4 Hz</p> Signup and view all the answers

    Which statement about the suppression/attenuation in EEG is accurate after the updates?

    <p>It is now applicable if there is suppression of 99% of the record.</p> Signup and view all the answers

    How should patterns with a frequency of 2.5 Hz and a duration of 10 seconds be classified?

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

    What does any RPP with a frequency greater than or equal to 4 Hz and an evolution lasting less than 10 seconds qualify as?

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

    Which of the following definitions aligns with a pattern that is lateralized?

    <p>Patterns consistently beginning in one hemisphere and propagating to the other</p> Signup and view all the answers

    What duration disqualifies a pattern from being categorized as any RPP?

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

    What is classified as a criterion A when it comes to PDs and SW patterns?

    <p>2.5 Hz frequency and 10 seconds duration</p> Signup and view all the answers

    What is the limit for RPP evolution according to the updated terminology?

    <p>Less than 10 seconds and up to 4 Hz</p> Signup and view all the answers

    What is the updated range for medium voltage in EEG classifications?

    <p>50–149 mV</p> Signup and view all the answers

    How was the classification of high voltage changed in recent updates?

    <p>Changed from $ 200 mV to $ 150 mV</p> Signup and view all the answers

    What is the new duration range for long duration EEG readings?

    <p>10–59 mins</p> Signup and view all the answers

    Which statement accurately describes the change in the classification of polarity in EEG readings?

    <p>Changed from major modifier to minor modifier</p> Signup and view all the answers

    What significant definition change occurred with intermediate duration in EEG data?

    <p>Changed from 1–4.9 mins to 1–9.9 mins</p> Signup and view all the answers

    What was the original range for intermediate duration before the updates?

    <p>1–4.9 mins</p> Signup and view all the answers

    What new classification term allows for patterns that begin in one hemisphere and propagate to the other to be classified in a particular way?

    <p>Lateralized (bilateral asynchronous)</p> Signup and view all the answers

    Which statement accurately describes the requirements for classifying patterns with a typical frequency of 2.5 Hz?

    <p>They must be classified as electrographic seizures if &gt;= 10 seconds.</p> Signup and view all the answers

    What is the maximum frequency that an RPP can have if it is to meet any criteria for classification?

    <p>4 Hz</p> Signup and view all the answers

    Which of the following represents the updated criteria for defining BIRDs?

    <p>Any RPP with evolution lasting less than 10 seconds.</p> Signup and view all the answers

    What did the revised terminology indicate about RPP evolution?

    <p>Any evolution lasting more than 10 seconds is disqualified.</p> Signup and view all the answers

    Which characteristic is now defined for Identical bursts under the new terminology?

    <p>Repetitive patterns that are exactly the same in amplitude and shape.</p> Signup and view all the answers

    What must patterns that express an evolution lasting 10 seconds or more do to be properly classified?

    <p>They must meet criterion B for classification as an electrographic seizure.</p> Signup and view all the answers

    What constitutes the new term 'Cyclic Alternating Pattern of Encephalopathy' in EEG terminology?

    <p>It signifies an unsteady EEG background indicative of encephalopathy.</p> Signup and view all the answers

    In the revised terminology, what happens to patterns that have a frequency above 4 Hz and a duration below 0.5 seconds?

    <p>They may qualify as a polyspike.</p> Signup and view all the answers

    What is the updated condition for identifying Highly Epileptiform Bursts?

    <p>Identified if multiple spikes are seen at an average of 1 Hz or faster within 50% of bursts.</p> Signup and view all the answers

    According to the updates, what characterizes Electrographic Status Epilepticus (ESE)?

    <p>It is defined as persistent electrographic seizure activity without interruption.</p> Signup and view all the answers

    Which change was made regarding the continuity of nearly continuous EEG backgrounds?

    <p>The percentage required for nearly continuous has changed to 1-9% attenuation.</p> Signup and view all the answers

    What is the significance of the term Stimulus-Terminated in the context of EEG readings?

    <p>It describes seizure activity that ends when a stimulus is applied.</p> Signup and view all the answers

    What frequency has been newly added to the predominant background frequency classification?

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

    How has the definition of Burst Suppression been updated in EEG classifications?

    <p>It indicates 50-99% attenuation/suppression.</p> Signup and view all the answers

    What defines Possible Electroclinical Status Epilepticus?

    <p>Shows potential seizure activity without definitive clinical signs.</p> Signup and view all the answers

    What is stated about Brief Potentially Ictal Rhythmic Discharges (BIRDs)?

    <p>They indicate rhythmic patterns that could link to ictal activity briefly.</p> Signup and view all the answers

    What critical update was made to the criteria for describing EEG background frequency?

    <p>The inclusion of beta rhythms has been officially established.</p> Signup and view all the answers

    What describes the revised criteria for the classification of suppression/attenuation in EEG readings?

    <p>Suppression is understood to mean up to .99% of the recorded activities.</p> Signup and view all the answers

    Study Notes

    Major Changes in EEG Terminology

    • EEG background terms have been updated to combine "variability" and "Stage II sleep transients" under "state changes."
    • Introduction of the term "Cyclic Alternating Pattern of Encephalopathy (CAPE)" as a new entry in Section A7.
    • New terminology includes "identical bursts" in Section A4d.

    Rhythmic and Periodic Patterns (RPPs)

    • "Unilateral Independent (UI)" is a new option in Main Term 1 (Section C1d).
    • "Lateralized (bilateral asynchronous)" patterns are now defined to include those starting in one hemisphere and propagating to another.
    • PDs (Periodic Discharges) and SW (Spike-Wave) patterns have stipulated criteria: a frequency of 2.5 Hz is defined as very brief (<10 s) for RPPs; longer durations classify them as electrographic seizures.
    • RPPs cannot have typical frequencies ≤4 Hz; such patterns lasting under 0.5 s do not qualify as RPPs but may be polyspikes.

    Evolution Criteria

    • Evolution in RPPs is confined to those patterns ≤4 Hz with durations <10 s.
    • RPPs with evolution lasting ≥10 s are classified as electrographic seizures (criterion B).

    New Terminology for Seizure Activity

    • New terms include:
      • Electrographic seizure (ESz)
      • Electrographic status epilepticus (ESE)
      • Electroclinical seizure (ECSz)
      • Electroclinical status epilepticus (ECSE)
      • Possible electroclinical status epilepticus (Section D4b)
      • Brief Potentially Ictal Rhythmic Discharges (BIRDs)
      • Ictal-Interictal Continuum (IIC)

    Minor Changes in EEG Terminology

    • Beta frequency (≥13 Hz) added to predominant background frequency.
    • Nearly continuous EEG updated from #10% to 1–9% attenuation/suppression.
    • Burst suppression criteria modified from ≥50% to 50–99% attenuation/suppression.
    • Voltage categories now include high voltage (>150 mV).

    Updates in Rhythmic and Periodic Pattern Definitions

    • Intermediate duration for rhythms adjusted from 1–4.9 minutes to 1–9.9 minutes.
    • Long duration changed from 5–59 minutes to 10–59 minutes.
    • Revised voltage categorization: medium voltage now defined as 50–149 mV; high voltage ≥150 mV.
    • Polarity is redefined from a major modifier to a minor modifier.

    Compatibility with Existing Glossaries

    • Changes align with the 2017 multinational revised glossary of terms used in clinical electroencephalography.

    Major Changes in EEG Terminology

    • EEG background terms have been updated to combine "variability" and "Stage II sleep transients" under "state changes."
    • Introduction of the term "Cyclic Alternating Pattern of Encephalopathy (CAPE)" as a new entry in Section A7.
    • New terminology includes "identical bursts" in Section A4d.

    Rhythmic and Periodic Patterns (RPPs)

    • "Unilateral Independent (UI)" is a new option in Main Term 1 (Section C1d).
    • "Lateralized (bilateral asynchronous)" patterns are now defined to include those starting in one hemisphere and propagating to another.
    • PDs (Periodic Discharges) and SW (Spike-Wave) patterns have stipulated criteria: a frequency of 2.5 Hz is defined as very brief (<10 s) for RPPs; longer durations classify them as electrographic seizures.
    • RPPs cannot have typical frequencies ≤4 Hz; such patterns lasting under 0.5 s do not qualify as RPPs but may be polyspikes.

    Evolution Criteria

    • Evolution in RPPs is confined to those patterns ≤4 Hz with durations <10 s.
    • RPPs with evolution lasting ≥10 s are classified as electrographic seizures (criterion B).

    New Terminology for Seizure Activity

    • New terms include:
      • Electrographic seizure (ESz)
      • Electrographic status epilepticus (ESE)
      • Electroclinical seizure (ECSz)
      • Electroclinical status epilepticus (ECSE)
      • Possible electroclinical status epilepticus (Section D4b)
      • Brief Potentially Ictal Rhythmic Discharges (BIRDs)
      • Ictal-Interictal Continuum (IIC)

    Minor Changes in EEG Terminology

    • Beta frequency (≥13 Hz) added to predominant background frequency.
    • Nearly continuous EEG updated from #10% to 1–9% attenuation/suppression.
    • Burst suppression criteria modified from ≥50% to 50–99% attenuation/suppression.
    • Voltage categories now include high voltage (>150 mV).

    Updates in Rhythmic and Periodic Pattern Definitions

    • Intermediate duration for rhythms adjusted from 1–4.9 minutes to 1–9.9 minutes.
    • Long duration changed from 5–59 minutes to 10–59 minutes.
    • Revised voltage categorization: medium voltage now defined as 50–149 mV; high voltage ≥150 mV.
    • Polarity is redefined from a major modifier to a minor modifier.

    Compatibility with Existing Glossaries

    • Changes align with the 2017 multinational revised glossary of terms used in clinical electroencephalography.

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    Description

    Explore the standardized EEG terminology changes in critical care between the 2012 and 2021 versions. This quiz covers major and minor revisions, including new terms and concepts relevant to EEG backgrounds and state changes.

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