How EEG can Show an Epileptogenic Process

This is the first of a few posts with a variety of ways the EEG can show an epileptogenic process. The morphology of the underlying process are quite dramatically varied.

The two images below show the referential and sequential montage display of an active right temporal-parietal spike and slow wave focus, seen in a child clinically diagnosed with an attachment disorder. There was no history of convulsion, nor any suspicion of the actual underlying pathophysiological basis for the behavioral presentation.

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Epilepsy and EEG

Epilepsy and EEG have been inextricably linked since the 1930s, when Frederick and Erna Gibbs discovered that epileptic events were visible in the EEG.  The evolution of other medical imaging in the 1970s and 1980s provided a better way to localize tumors, and the clinical use tapered off in areas other than epilepsy and encephalopathies.  Even with the multiplicity of other methods, the EEG remains the gold standard for identification of epilepsy.

In modern neuroscience centers, the EEG is still the tool of choice in evaluation of convulsive epilepsy, as well as some other non-convulsive forms, such as staring episodes seen in “absence epilepsy” typically as a 3/second spike and wave dominant anteriorly, or temporal lobe epilepsy, which is seen as a “notched” slow wave discharge fronto-temporally.

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