-Dr.
Haritha
EEG pattern that is morphologically
epileptiform but is not associated with
epilepsy
To avoid misdiagnosis of the subjects with
epilepsy based on these waveforms
To avoid unnecessary treatments of patients
with antiepileptic drugs or surgery
Mu rhythm
Wickets
Ciganek rhythm
RMTD
Slow alpha and fast alpha variants
Alpha squeak
Frontal arousal rhythm
Benign sporadic sleep spindles (BSSS)
SREDA
14 & 6 Hz positive bursts
6 Hz spike and wave bursts
Wicket waves are single waveforms that occur
in clusters or brief trains
More arciform in appearance and earn their
name by looking like WICKET
Occur more frequent in temporal region
Occur unilaterally or bilaterally
Frequency is 6-11HZ
Amplitude is 60-200microvolts
Mainly seen in older adults in drowsiness and
light sleep
No slow wave component following a wicket
wave
Occurs in trains or in isolation and do not
disturb the background
Age younger than 30 years and abnormal
background are against the diagnosis
Seen in awake state
Arch shaped rhythm of 8-10HZ
Most prominent in c3 and c4
It is often sharp
Its sharpness and amplitude are increased in
the presence of skull defect over central
region
Very often asymmetric or can be unilateral
The key to the identification is blocking by
movement of contralateral arm
Surface positive potentials seen from occipital
region maximal in o1 and o2
Prominent in stage 2 sleep and disappear in
deeper stages
Positive waves that are present when viewing
a scene or complex image
Blocked by eye closure
Seen in awake state in occipital region
Resembles GREEK letter Lambda
Previously known as a psychomotor variant
because of its similarity to focal rhythmic
activity of a seizure discharge
Usually have a flat topped or notched
Unilateral or bilateral
Very short lived 5-15 seconds
Do not spread to other electrodes over time.
Less prominent during increasing levels of
drowsiness and disappears during light NREM
sleep
Normal background before and after the
rhythm
Mono or diphasic with steep ascending or
descending limbs
Mainly occur in drowsiness and light sleep
Seen in adults
Best seen in temporal and ear leads
BSSS have characteristic sharp ascending and
descending limb morphology
BSSS is of brief duration and amplitude and
often bilateral
Lack of background disturbance or focal
abnormality
BSSS tends to disappear in deeper levels of
sleep
MITTEN like morphology
Small or absent spike with more apparent
slow wave
Observed in both adolescents and adults
Seen during drowsiness and light NREM sleep
Either diffuse, anteriorly or posteriorly
Two forms –
WHAM- wakefullness, high amplitude,
anterior, male
FOLD- female, occipital, low amplitude,
drowsy
Rare benign variant
Benign rhythm of drowsiness
4 to 7 Hz arch shaped or sinusoidal rhythm
typically maximal over cz (Fz or Pz)
Also known as CIGANEK rhythm
Posterior dominant rhythm in 4-5HZ
NOTCHED Appearance
Slow background in theta range
NOTCHED appearance
Attenuation of rhythm with eye opening
No polymorphic appearance as opposed to
pathologic slow activity of drowsiness
Normal frontal and cerebral activity with slow
alpha variant as opposed to slowing with
encephalopathy
Normal posterior dominant rhythm but with
increased frequency 16-20HZ in Beta range
Immediately on eye closure, the awake
background is sometimes initially faster, and
of lower voltage
This initial “speeding up” of the background
immediately on eye closure is referred to as
an “alpha squeak”
Slow lambdoids of youth, also known as
cone-shaped waves or O-waves, are high
voltage, slow transients seen over the
occipital
Delta activity in deeper sleep states
cone-shaped.
They can be seen up to 5 yr of age
Posterior slow waves of youth, also called
youth waves, posterior fused transients, are
triangular, 2- to 4-Hz waveforms
Formed by fusion of fast and slow
components
They are best seen over the posterior head
regions in waking.
Occur in 20-60 % of normal population
predominantly in adolesecnts and young
adults
Drowsiness and light NREM sleep
They occur in Bursts of 14 HZ or 6 HZ
“ctenoids” due to their appearance and
complex morphology resembling a comb
Bursts are typically consists of arciform
waveforms over posterior temporal head
regions with alternating positive spiky
component
Best appreciated by using long interelectrode
distance and referential montage
Normal in older and elderly over age 50
Sharply countered Theta frequency (5-6HZ)
Mostly seen in parietal and posterior head
regions
Lasts for few seconds or 1 or 2 minute
duration
More in drowsiness
Seen in children
During arousal from stage-2 sleep
6.5-8.5HZ
Lasts upto 30 sec
monomorphic
MU
SLOW ALPHA VARIANT
FAST ALPHA VARIANT
RHYTHMIC MIDTEMPORAL THETA OF
DROWSINESS(RMTD)
CIGANEK RHYTHM
LAMBDA WAVES
PHANTOM WAVES
SREDA
14 AND 6 HZ POSITIVE WAVES
POSTS
WICKET SPIKES
BSSS
Gibbs FA,Gibbs EL,Atlas of
encephalography.vol3
Hughes JR.A review of positive spike
phenomenon
Neidermeyer-electroencephalography
Yamada T,Tucker RP,Young S-clinical
neurophysiology
THANK YOU
