Real Time Tele-Epilepsy Consultants - RTTC

22/07/2025

🧠 EEG Tech Tip: Wicket Spikes

Did you know that wicket spikes can easily be mistaken for epileptiform discharges?
🔹 Found in the temporal regions
🔹 Occur in light sleep
🔹 No aftercoming slow wave (key to differentiating from epileptiform activity!)
🔹 Common in older adults

💡 Tech Tip: If you see sharp waves in the temporal region, check for a lack of slow waves and confirm that they appear in runs – this could be a benign variant!

🔍 Have you encountered wicket spikes in your recordings? Share your experience below! 👇

16/07/2025

🧠 Revisiting the Definition of "Rhythmic" in EEG: A Dynamic Approach ⚡️
The term "rhythmic" has been central to EEG interpretation for decades, especially with the discovery of alpha rhythms and spike-and-wave complexes in conditions like childhood absence epilepsy. However, the ambiguity surrounding its definition has led to confusion in clinical practice, especially when distinguishing between rhythmic and periodic EEG patterns.

A recent article delves into these distinctions, proposing a more dynamic approach to defining rhythmic EEG patterns, particularly in the context of seizures and status epilepticus (SE). The key difference is the spatiotemporal evolution of patterns observed in seizures versus the more monomorphic, periodic activity seen in encephalopathies.

Read the full article here: https://doi.org/10.1016/j.clinph.2024.12.024

04/07/2025

Wishing you and your family a safe and fun 4th of July!

25/06/2025

🧠 Sleep Spindles and Memory Consolidation in Children with Rolandic Epilepsy (RE) 💤
A recent study published in Neurology sheds light on the connection between sleep spindle rate and memory consolidation in children with Rolandic Epilepsy (RE), the most common childhood focal epilepsy syndrome.

🔑 Key Findings:
• Impaired Memory Consolidation: Children with active RE had significantly reduced sleep-dependent memory consolidation compared to healthy controls and those in remission.
• Decreased Sleep Spindle Rate: Sleep spindles in the centrotemporal region were notably lower in children with active RE, which correlated with poorer memory consolidation.
• Potential Diagnostic Tool: Sleep spindle rate may serve as a non-invasive biomarker to help diagnose and guide treatment for cognitive dysfunction in RE.
These findings highlight the importance of understanding sleep neurophysiology in epilepsy, particularly how sleep spindles may impact memory processes in children.

Read the full study: https://www.neurology.org/doi/10.1212/WNL.0000000000210232

Background and ObjectivesRolandic epilepsy (RE), the most common childhood focal epilepsy syndrome, is characterized by a transient period of sleep-activated epileptiform activity in the centrotemporal regions and variable cognitive deficits. Sleep ...

17/06/2025

Accurate EEG interpretation hinges on the expertise of EEG technologists performing the study. Proper technique and attention to detail are essential for obtaining high-quality recordings.

✅ Master Artifact Recognition: Learn to distinguish between physiological and non-physiological artifacts (e.g., muscle, eye blinks, EKG) to ensure clean data.
✅ Optimize Electrode Application: Proper skin preparation and secure electrode placement minimize impedance issues and enhance signal quality.
✅ Monitor in Real-Time: Continuously observe the EEG tracing during the recording to catch and correct issues like electrode pops, high impedance, or patient movement before they affect the entire study.

🌟 Highly trained EEG techs play a crucial role in ensuring interpretable, high-quality studies.

11/06/2025

🔍 Mastering EEG Interpretation: A Step-by-Step Guide for Clinicians and Educators 🧠
EEG interpretation can be a complex process, but a systematic approach can make all the difference. This comprehensive guide highlights key steps to help trainees navigate EEG analysis:
✅ Technical Foundations: Understand EEG settings and filters for accurate readings.
✅ Video-EEG Integration: Use video recordings to assess patient consciousness.
✅ Background Activity: Learn to define and describe normal EEG rhythms.
✅ Identifying Artifacts: Recognize common artifacts to ensure clarity.
✅ Epileptiform Findings: Differentiate between normal, interictal, and ictal patterns.
As clinicians, we must always interpret EEG findings in clinical context, ensuring a holistic understanding of each case.
For educators, this guide offers valuable strategies to enhance teaching EEG skills, from basic principles to advanced clinical applications. 📚
Read the full guide here: https://www.neurology.org/doi/10.1212/NE9.0000000000200208

03/06/2025

A recent study published in JAMA Neurology demonstrates that an AI model, SCORE-AI, achieved diagnostic accuracy comparable to human experts in interpreting routine EEGs. This advancement could enhance diagnostic efficiency and consistency in both underserved areas and specialized epilepsy centers. Read more: https://jamanetwork.com/journals/jamaneurology/fullarticle/2806244

What are your thoughts on integrating AI into EEG interpretation?

✅ Game-changer! AI will improve accuracy and efficiency.
🤝 Useful tool, but human expertise is still essential.
⚠️ Cautiously optimistic – needs more validation.
❌ Not convinced – EEG interpretation requires human judgment.

This diagnostic study investigates whether an artificial intelligence model can be trained to interpret clinical encephalograms similar to human experts.

26/05/2025

In memory of those who gave all, we honor your bravery and selflessness.

13/05/2025

Identifying nonconvulsive seizures in ICU patients can be challenging. Our Medical Director, Dr. Nabil Azar, shares 3 tips for detecting subtle patterns in critically ill patients:

✅Continuous EEG Monitoring: Implement prolonged EEG monitoring to capture transient, subtle seizure activities that might be missed in shorter recordings.
✅ Pattern Recognition: Be vigilant for atypical patterns such as rhythmic delta activity or evolving rhythmic patterns, which may indicate nonconvulsive seizures.
✅ Clinical Correlation: Always correlate EEG findings with the patient's clinical status, as some EEG abnormalities may be nonspecific without clinical context.

07/05/2025

Sharp Wave Transients in Neonates - Abnormal Negative Sharp Wave Transients

These appear as sharp waves or true spikes. They most commonly arise in the context of an abnormal EEG background for PMA. Although they may also appear in the familiar midtemporal, central, or centrotemporal locations, they may be heavily concentrated in one region or hemisphere, rather than being randomly or evenly distributed spatially. They may also be seen in atypical locations such as the frontal, midline vertex, or occipital regions. They may be much more abundant compared with physiologic negative sharp wave transients. Data for neonates who were assessed developmentally at 1 year or older indicate that negative sharp waves more frequent than 11 per hour for preterm and 13 per hour for term infants are abnormal (Biagioni et al., 1996b; Clancy and Spitzer, 1985; Karbowski and Nencka, 1980; Rowe et al., 1985; Scher et al., 1994a; Statz et al., 1982). Abnormal negative sharp EEG transients are more likely than physiologic negative sharp waves to recur in brief runs or trains (Clancy, 1989).

Source: Tsuchida TN, Wusthoff CJ, Shellhaas RA, Abend NS, Hahn CD, Sullivan JE, Nguyen S, Weinstein S, Scher MS, Riviello JJ, Clancy RR; American Clinical Neurophysiology Society Critical Care Monitoring Committee. American clinical neurophysiology society standardized EEG terminology and categorization for the description of continuous EEG monitoring in neonates: report of the American Clinical Neurophysiology Society critical care monitoring committee. J Clin Neurophysiol. 2013 Apr;30(2):161-73. doi: 10.1097/WNP.0b013e3182872b24. PMID: 23545767.

30/04/2025

Dravet syndrome (DS) is a severe form of infantile onset epilepsy characterized by multiple seizure types, prolonged convulsive seizures and frequent episodes of status epilepticus. Seizures precipitated by fever are a main characteristic. Affected children exhibit normal early development. Cognitive impairment, behavioral disturbances with hyperactivity and sometimes autistic traits occur after seizure onset. Seizures persist into adulthood but become less frequent.

DS is indicated by the presence of focal spikes or polyspikes on an .

Source: Guerrini R. Dravet syndrome: the main issues. Eur J Paediatr Neurol. 2012 Sep;16 Suppl 1:S1-4. doi: 10.1016/j.ejpn.2012.04.006. Epub 2012 Jun 15. PMID: 22705271.

23/04/2025

Sharp Wave Transients in Neonates - Physiologic Negative Sharp Waves

Physiologic negative sharp waves lasting 100 to 200 milliseconds are commonly seen in the EEGs of healthy near-term and term infants. They are typically observed against the backdrop of a normal EEG background for PMA. They appear in greatest abundance in the midtemporal, central, and centrotemporal regions. They are rare in the frontal, midline vertex, and occipital regions. They are symmetrically distributed between homologous regions of the hemispheres. They are mostly single, solitary transients, but a few may appear in brief trains or runs (Biagioni et al., 1996a).

Source: Tsuchida TN, Wusthoff CJ, Shellhaas RA, Abend NS, Hahn CD, Sullivan JE, Nguyen S, Weinstein S, Scher MS, Riviello JJ, Clancy RR; American Clinical Neurophysiology Society Critical Care Monitoring Committee. American clinical neurophysiology society standardized EEG terminology and categorization for the description of continuous EEG monitoring in neonates: report of the American Clinical Neurophysiology Society critical care monitoring committee. J Clin Neurophysiol. 2013 Apr;30(2):161-73. doi: 10.1097/WNP.0b013e3182872b24. PMID: 23545767.