EEG INTERPRETATION

MRCPCH 2009 SITE

For Part 2 Exam

ELBABA M.A. 2010

EEG for Part 2 Exam

This material is composed of two parts; a teaching tips
followed by self assessment EEG test
It is strongly recommended to do it under Exam situation with
STRICT time factor. Less than one minute each. It is mainly
for part II Exam candidates.
Answer is available on request.
Interested candidates can ask for the answers from
MRCPCH2009 Site.
Email: mrcpch2009@gmail.com
Visit MRCPCH2009 website:
http://sites.google.com/site/mrcpch2009/

7 Steps to answer EEG question

1.
2.
3.
4.
5.
6.
7.

Look for a clue in the scenario

Special attention to Age
Montage & scale orientation
Normal activity shape & amplitude trace
If abnormal, it is a Generalized or focal lesion
Look for a particular Pattern
Look for any associated Event

The five questions for

normal trace recording
1. In what state of alertness is the child?
age?
2. Is the background activity appropriate for age?
3. Are any waveforms asymmetries present,
which cannot be ascribed to artifact?
4. Are any definite spikes present?
5. Is there any focal or diffuse excessive delta
activity?

Manikin orientation

Waveforms
The EEG waves are classified according to their frequency as:
Beta
(1320/sec)
Alpha
(812/sec)
Theta
(47/sec)
Delta
(13/sec)
Delta

These waves are altered by many factors, including age,

state of alertness, eye closure, drugs, and disease states.

Normal recording

Waveforms
Abnormalities of waveform include spikes and slow
waves.
waves
Spikes are characteristically paroxysmal, sharp, and of
high voltage followed by a slow wave. Spikes and slow
waves are associated with epilepsy, but some normal
patients may have this EEG finding.

Spikes

Polyspikes

Slow wave

Bursts of theta and delta in drowsiness, a

normal phenomenon of childhood.

Waveforms
Spikes & slow waves may be generalized or Focal.
Focal spikes are often associated with irritative lesions,
like cysts, slow-growing tumors, and glial scar tissue.
Focal Slow waves usually with less irritative
circumscribed lesion such as a hematoma, tumor,
infarction, or abscess;
Generalized spikes suggest generalized convulsions
Generalized slow waves suggest encephalitis or
encephalopathy like, metabolic, inflammatory, or
degenerative widespread process.
Epileptiform activity may be enhanced by activation
procedures, including hyperventilation
hyperventilation, photic
stimulation, and sleep deprivation.
deprivation

Periodic complex
Bursts of waves at regular intervals
Bursts of polyspikes: Myoclonic epilepsy
Bursts of slow waves:
Generalized: e.g. SSPE, Jacob disease.
Localized: e.g. Herpes encephalitis at temporal lobe

Patterns
3 spikespike-wave complex per second: Simple Absence
Chaotic trace: Hypsarrhythmia
Periodic Complex : Generalized or localized
Low voltage: severely suppressed brain
Localized slow waves: Focal lesion
Flat EEG: Brain death ECG waves may be transmitted

Synopsis
Simple absence: Staring, Generalized, 3 per second, Hyperventilation
Grand mal : Generalized, symmetrical, spikes and polyspikes
Hypsarrhythmia : Generalized chaotic in infant <1 year
Lennox
Lennox--Gastaut : Generalized spikes & slow waves in age 11-4 years
Myoclonic : Periodic complex of spikes and polyspikes, sleep
deprivation; neonatal or juvenile.

Partial : localized spikes and polyspikes e.g. centrotemporal Rolandic 5510 years & anterior temporal region Temporal lobe epilepsy

Coma : Generalized symmetrical depressed activity Brain death NO

activity

Encephalitis / encephalopathy : Generalized, symmetrical slow

waves same in post ictal state

Test Time !
The coming slides are to apply the previous tips to
test your self.
Total of 20 EEG image. One minute and one mark
each.
You may face repeated image for same diagnosis.

1) 7 years
old
admitted
with
intractable
seizure on
multiple
drugs

2) 3 months old boy with birth marks

3) 7 years old at night

4) 9 years old girl with possible poisoning

5) 12 years old girl in early morning

6) 6 years old with difficult to treat illness

7) 7 years old girl deteriorate at school

8) 12 years old boy deteriorate at school

9) 10 years old girl watching TV after midnight

10) 4 years old boy in PICU

11) 9 months old boy with developmental delay

12) Newborn in NICU

13) 5 years old girl crashed to A& E

14) 8 years old boy with staring look

15) Mother was scared at night after grunting sound of her child

16) Unexplained abnormal movement

17) 3 years old child with altered level of consciousness & fever

18) 6 years old boy with abnormal behavior

19) 8 years old boy with unilateral weakness

20) 8 years old girl with mental retardation

GO O D
L UC K
EL-BABA M.A. 2010