Pseudo-epileptiform patterns

Question 1

Six hertz spike-and-slow-wave (‘wave and spike phantom’) – wave shape, duration, distribution, age, vigilance

Answer 1

• miniature (<5Hz more likely epileptic)
• adult
• drowsy - usually goes away during deeper levels of sleep

Question 2

Fourteen and six hertz positive bursts (‘ctenoids’)– wave shape, duration, distribution, age, vigilance, other associated conditions

Answer 2

• repetetive positive spikes arch-shaped - best seen in referential montage
• less than 1-2 sec
• post -TEMPORAL, parietal, bilaterally independent or synchronous
• adolecents, children
• sleep/drowsy
• also seen in comatose, Reye’s, toxic liver disease, metabolic, or anoxic events

Question 3

Rythmic temporal theta burst of drowsiness

(Rythmical mid-temporal discharge ‘RMTD’ , ‘Psychomotor variant’) – wave shape, duration, distribution, age, vigilance

Answer 3

• rythmic THETA 4-7Hz negative sharp waves with notched or flat phases, usually monomorphic or monorhythmic with no evolution(different than seizure)
• few seconds
• midTEMPORAL, unilateral, bilateral, idependent, or synchronous
• middle aged females
• sleep/drowsy

Question 4

Small sharp spikes (‘sss’), ‘benign epileptiform transients of sleep (‘BETS’) – wave shape, duration, distribution, age, vigilance

Answer 4

• short spikes, small, mono or biphasic - horizontal dipole –> true phase reversal
• less than 65msec for single phrase - rarely repeat with same configuration/morphology
• mid-and anterior temporal shifting distribution
• adults/adolescents
• drowsy/sleep

Question 5

Wiket spikes – wave shape, duration, distribution, age, vigilance

Answer 5

• repetetive spikes forming arches
• repeats every few seconds
• anterior and mid temporal
• adults
• awake/asleep

Question 6

Occipital spikes and sharp waves of blind persons – wave shape, duration, distribution, age, vigilance

Answer 6

• focal spike and sharp waves
• 200ms
• occipital, uni or bilateral
• children
• awake/asleep

Question 7

Subclinical Rythmical Electrographic (Theta) Discharge in Adults (‘SREDA’) – wave shape, duration, distribution, age, vigilance
UNCOMMON

Answer 7

• mono or bi-phasic sharp followed by rythmic THETA 4-7Hz waves
• 20 sec to more than 5 min- repeats many times
• assymmetric/symmetrical posterior temporal and parietal
• ADULTS >50 years old
• awake/asleep - hyperventilation

Question 8

Paroxysmal hyponogogic hypersynchrony – wave shape, duration, distribution, age, vigilance

Answer 8

• 3-5hz moderate to high amplitude intermixed spikes
• 1-6 seconds
• generarlized, maximum anterior to posterior
• children
• drowsy

Question 9

Midline theta rythyms (of Ciganek) – wave shape, duration, distribution, age, vigilance

Answer 9

• THETA 4-7Hz rythmic trains with sinusoidal, spiky, archiform sharp
• 4-20 seconds (variable)
• MIDLINE, central
• chilren > adults
• awake/drowy - variable reactivity