ACNS 2 (Revisions cont./ Background / New terminology)
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ACNS 2 (Revisions cont./ Background / New terminology)

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Questions and Answers

What is the revised duration category for intermediate duration as defined by the International League Against Epilepsy?

  • 5–10 mins
  • 1–9.9 mins (correct)
  • 10–20 mins
  • 1–4.9 mins

    • What was the previous voltage categorization for high amplitude before the recent changes?

  • $ 100 mV
  • $ 200 mV (correct)
  • $ 250 mV
  • $ 150 mV

    • In the recent changes, what is the new range of voltage defined for medium amplitude?

  • 100–199 mV
  • 200–299 mV
  • 50–149 mV (correct)
  • 50–199 mV

    • Which of the following categories has been changed from a major modifier to a minor modifier?

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

    What is the defined range for long duration according to the changes made?

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

    Which voltage category is newly added for high activity?

    <p>Above 150 mV</p> Signup and view all the answers

    What is the revised categorization for high voltage activity?

    <p>Above 150 mV</p> Signup and view all the answers

    What change was made to the long duration category in the recent revisions?

    <p>Its range was lengthened.</p> Signup and view all the answers

    What aspect of EEG findings was highlighted as an important distinction in some circumstances?

    <p>Asymmetry or slowing</p> Signup and view all the answers

    What major change combined ‘variability’ and ‘Stage II sleep transients’ in the 2021 terminology?

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

    What is the new term introduced for the Cyclic Alternating Pattern of Encephalopathy in the 2021 changes?

    <p>Cyclic Alternating Pattern of Encephalopathy (CAPE)</p> Signup and view all the answers

    Which frequency criterion distinguishes electrographic seizures from PDs or SWs?

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

    What does a typical frequency of .4 Hz and a duration of less than 0.5 seconds indicate?

    <p>Potential polyspike activity</p> Signup and view all the answers

    Under the revised terminology, how is the evolution of an RPP defined?

    <p>Limited to patterns that are ≤ 4 Hz and &lt; 10 seconds</p> Signup and view all the answers

    What would qualify a pattern as a BIRD based on its definition?

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

    What is indicated by a lateralized (bilateral asynchronous) pattern?

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

    If an RPP has a typical frequency of 0.5 Hz and lasts 10 seconds, what does it qualify as?

    <p>An electrographic seizure</p> Signup and view all the answers

    What does 'identical bursts' refer to in the 2021 terminology?

    <p>Consistent repetitive waveforms</p> Signup and view all the answers

    Which major term refers to patterns exhibiting bilateral asynchronous characteristics?

    <p>Lateralized Patterns</p> Signup and view all the answers

    What is the new predominant background frequency that has been added to EEG analysis?

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

    When describing 'Highly Epileptiform Bursts', how has the criteria changed regarding the number of epileptiform discharges?

    <p>Present if 2 or more discharges are seen within 50% of bursts.</p> Signup and view all the answers

    What is the new term that refers to rhythmic discharges that might be linked to seizure activity?

    <p>Brief Potentially Ictal Rhythmic Discharges (BIRDs)</p> Signup and view all the answers

    How has the definition of burst suppression changed regarding attenuation and suppression percentage?

    <p>From 0–100% to 50–99%</p> Signup and view all the answers

    What modifier is associated with the term 'Stimulus-Terminated'?

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

    In the context of electroclinical seizure activity, what term signifies a possible but unconfirmed state of seizure?

    <p>Possible Electroclinical Status Epilepticus</p> Signup and view all the answers

    Which of the following describes the change in the definition of 'nearly continuous' EEG background?

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

    What new term refers to a continuum observed during seizure activity?

    <p>Ictal-Interictal Continuum (IIC)</p> Signup and view all the answers

    What is the new term for prolonged seizure activity characterized by electrographic patterns?

    <p>Electrographic Status Epilepticus (ESE)</p> Signup and view all the answers

    What is the new voltage definition for medium amplitude after the recent revisions?

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

    What is the revised definition for long duration according to the new changes?

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

    Which statement accurately describes the changes made to the categories of voltage?

    <p>High voltage was adjusted from 200 mV to 150 mV.</p> Signup and view all the answers

    What aspect of EEG findings was adjusted from a major modifier to a minor modifier?

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

    In current nomenclature, what has the definition of intermediate duration been adjusted to?

    <p>1–9.9 mins</p> Signup and view all the answers

    What is one of the significant changes regarding RPP frequency in the 2021 terminology?

    <p>No RPP can have a typical frequency greater than 4 Hz.</p> Signup and view all the answers

    In the revised terminology, how is the concept of 'evolution' defined for RPPs?

    <p>Evolution of an RPP must be limited to patterns that are 4 Hz or lower and less than 10 seconds.</p> Signup and view all the answers

    What does the term 'lateralized (bilateral asynchronous)' signify in the context of EEG findings?

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

    Which criteria now differentiates an electrographic seizure from patterns classified as PDs or SWs?

    <p>Electrographic seizures have a duration of 10 seconds or longer.</p> Signup and view all the answers

    What defines an RPP as a BIRD under the revised terminology?

    <p>An RPP with a frequency of 4 Hz and evolution lasting less than 10 seconds.</p> Signup and view all the answers

    What does the new term 'identical bursts' refer to in the updated EEG terminology?

    <p>Burst patterns that are identical both in morphology and frequency.</p> Signup and view all the answers

    What major change has occurred regarding the term 'Cyclic Alternating Pattern of Encephalopathy' in the 2021 terminology?

    <p>It has been introduced as a new term.</p> Signup and view all the answers

    What is the new term for a potential state of seizure that is not definitively diagnosed?

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

    Which of the following changes was made to the definition of burst suppression?

    <p>Defined by a 50-99% attenuation or suppression range</p> Signup and view all the answers

    What is the revised criteria for classifying highly epileptiform bursts?

    <p>Requires two or more discharges within 50% of bursts at 1 Hz or faster</p> Signup and view all the answers

    What has been added to the predominant background frequency category of EEG?

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

    Which of the following is correctly identified as a new term related to ongoing seizure patterns?

    <p>Ictal-Interictal Continuum</p> Signup and view all the answers

    What does the new guideline specify about defining continuity in EEG background?

    <p>Nearly continuous is classified from 1–9% attenuation</p> Signup and view all the answers

    Which term has been introduced to describe brief potentially ictal rhythmic discharges?

    <p>Brief Potentially Ictal Rhythmic Discharges</p> Signup and view all the answers

    What is the new upper limit defined for burst suppression in EEG analysis?

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

    Which of the following describes a significant change regarding EEG background continuity?

    <p>Continuity now allows for a broader attenuation range</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

    Test your knowledge on the ACNS Standardized Critical Care EEG Terminology with this quiz. It covers important changes between the 2012 and 2021 versions, including updates on EEG background and new terminology. Enhance your understanding of critical care EEG for professional practice.

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