1. The document discusses EEG patterns and findings in various neurological conditions seen in children. It includes descriptions of normal EEG findings as well as abnormal patterns seen in conditions like absence seizures, West syndrome, benign childhood epilepsy with centrotemporal spikes, Lennox-Gastaut syndrome, non-convulsive status epilepticus, subacute sclerosing panencephalitis, and herpes encephalitis. 2. Case studies are presented with clinical histories and EEG findings to illustrate different pathologies. Treatment options are also mentioned for many of the conditions. 3. International standards for EEG electrode placement and recording parameters are reviewed. Characteristics of different EEG waves, amplitudes, and patterns are described.

1. EEG
DR MANDAR HAVAL

2. • EEG is about pattern recognition
• ECG is about precision

3. EEG – systematic approach
• Minimal technical requirements
• 16 channels
• Atleast 3 montages
• Longitudinal bipolar, horizontal bipolar, referential
• Atleast 20 min recording and in neonates 1 hour

4. International 10-20 system of Electrode
placement

5. Montages
Bipolar: the potential
difference between 2
active electrodes
Referential: potential
difference between 1
active and 1 inactive
electrode

6. EEG- what to look at?
• Background
• Activity – rhythmic, arhythmic, periodic
• Evolution of the rhythm

7. EEG- describing the waves
• Frequency :delta(0-4hz), theta(4-8hz), alpha(8-13hz), beta(>13 hz)
• Amplitude: low(<25 uv), moderate(25-75uv),
high(>75uv)
• Location
• Symmetry
• Synchrony
• Reactivity
• Rhythmic, periodic, arhythmic
• Morphology (spike, sharp, biphasic, triphasic)

8. Normal EEG in a child

9. Normal EEG in adult

11. Spike and wave complex

12. Case 1
• 10 year old girl
• Developmentally normal
• Slight deterioration in school performance last
2 months
• Multiple episodes of brief staring 5 -10 sec
• No loss of tone
• Examination normal

13. EEG

14. Absence seizure
• Onset 4-10 yrs
• Hundreds per day; 4-20 secs
• Eyes open, voluntary activity stops
• EEG – 3per sec spike wave activity. Ppt by
hyperventilation
• Drug of choice – ethosuxamide/ valproate/
lamotrigine

15. Case 2
• 5 month male
• HIE stage 2 at birth
• Clusters of sudden tonic flexion of entire body
several times in a day, especially on awakening
- 2 weeks

16. Diagnosis?

17. West syndrome
• Infantile spasms with hypsarrythmia
• EEG – chaotic
• High amplitude, multifocal spikes and
polyspikes, asynchronous, arrrhythmic
• Drugs of choice- ACTH/ steroids

18. Case 4
• 7 year old boy
• Nocturnal seizure, jerky movements of the
lips, eyes wide open, unable to sleep,
hypersalivation

20. BECTS- benign childhood epilepsy with centro-temporal
spikes (Rolandic epilepsy)
• Onset 1-14 yrs
• Unilateral facial sensorimotor seizures
• Hypersalivation
• Speech arrest
• Oropharyngeal manifestations
• Prognosis- most remit in 2-4 yrs
• Treatment- nil/ CMZ/LVT

21. Case 4
• 8 year old boy
• h/o delayed milestones – walking 2 yrs,
speech 3 years
• Multiple types of seizures several times a day
– 2 months
• Tonic seizures, atonic falls, myoclonic seizures
• Regression of milestones

22. EEG

23. EEG of Lennox Gastaut Syndrome
• Background – slow and disorganised
• Slow generalized spike wave ( < 2.5 cps)
• Multiple independent spike foci
• Very fast ( 10-20 cps) paroxysmal activity s/o
tonic seizures

24. Management of LGS
• Multiple anti epileptic drugs
• Poor response
• Non AED’s- IVIG, steroids, ketogenic diet
• Surgery – corpus callosotomy

25. Case 5
• 4 year old girl
• Fever & recurrent focal seizures – 2 days
• Comes in status epilepticus
• Seizures stop after lorazepam and phenytoin
• Patient remains comatose > 24 hours after all
motor seizures have stopped.

26. EEG

27. EEG of NCSE (non convulsive status epilepticus)
• Spikes, waves, rhythmic activity
• Focal or partial features, discrete or
continuous
• Cyclic or recurrent patterns
• May correlate with changes in behaviour and
responsiveness
• Significant improvement in discharges and
sensorium on giving IV anti epileptics

28. Case 7
• 11 year old boy
• Cognitive decline last 6 months
• Repetitive extensor myoclonus last 1 month
• Stopped walking, speaking, swallowing last 15
days
• Past h/o measles at 3 years

29. EEG

30. SSPE
• EEG: stereotyped, generalized and
synchronous high amplitude periodic
complexes
• Diagnosis: Elevated CSF anti measles
antibodies
• Prognosis: grim

55. • 8 mts old female child with delayed development milestones
flexor spasm EEG done.
• Describe characteristic EEG findings
• What is diagnosis?
• What is T/t?
• Which type having the good prognosis?
10/15/2014 CME,Pune 55

56. • Hppsarrythmia
• Infartile spasms
• ACTH and glucocorticoids
• Cryptogenic infantile spasms
10/15/2014 CME,Pune 56

57. 12.Child with fever , convulsions, altered
sensorium
CSF picture : protein 62,
cells 95 P10 L90,
sugars 45/80,
RBCs 80/ hpf
• Additional 2 investigations of choice
• Treatment with dose

58. • EEG - PLEDS-periodic lateralizing epileptiform
discharges
• HSV PCR,( ? HSV IgG, IgM ), CT scan / MRI
with contrast – bi/ uni temporal
hyperintensities
• Acyclovir 10mg/kg/dose 8 hrly for 14 -21 days

60. 6) What does this EEG show?
• What is the drug of choice?
• Prognosis?
• One OPD procedure to confirm diagnosis

61. • 3 Hz spike and wave activity in Absence
seizure – childhood /Juvenile
• Valproate, Lamotrigine, clobazam
• Good in childhood, slightly less for juvenile
• Hyperventilation

62. Jerk jerk

63. 7) Diagnosis
• Confirmatory test
• 3 therapeutic options

64. • SSPE –burst suppression pattern
• CSF measles IgG
• Ribavarine, interferons, inosiplex,
amantidine

66. 8) Diagnosis
• Commonest etiology
• Drug of choice

67. • PLEDS
• Herpes encephalitis
• Acyclovir

68. 9) 6 yr old male admitted with prolonged
generalised seizures.
• Immediate AEDs –name 2 with dose
• 2nd line AEDs –2 with dose
• 3rd line – name 2

69. • Lorazepam [0.05mg/kg],
• Diazepam [0.3mg/kg],
• midazolam[ 0.2mg/kg]
• Phenytoin[ 20mg/kg],
• phenobarb[20/kg]
• Midazolam drip,
• propofol,
• thiopentol

70. 10) 6 months old child with h/o perinatal
insult comes with regression of social
milestones and clusters of startles on
awakening .
• Diagnosis
• Name 2 investigations you will ask for?

71. • Infantile spasms, West syndrome
• EEG, MRI
• Hypsarrhythmia
• ACTH / steroids, Vigabatrin, Valproate
/Topiramate / Nitrazepam

72. • Station No : A term newborn who required resuscitation at
birth with a 5 minute APGAR of 5 is admitted in NICU. The
neonate had seizures in first 12 hrs of life
• Identify the findings-[1]
• What is the significance of this finding- [1/2]
• Name of the staging system other than Sarnat and Sarnat and
give its component- [1]

73. • EEG of neonate showing Burst Suppression
pattern
• It indicates serious outcome in HIE patients
• Levene’s staging system (Mild, Moderate and
Severe)
– Consciousness
– Tone
– Seizures
– Sucking/Respiration