Epilepsy is a neurological disorder characterized by recurrent seizures, which can have a significant impact on an individual's quality of life. And, electroencephalography (EEG) is the diagnostic test that is commonly used to diagnose and monitor epilepsy. Understanding the clinical features, diagnostic workup, and management of epilepsy and EEG is essential for medical students.
In the NEET PG exam, there are often questions related to epilepsy and EEG, including the clinical features of different types of seizures, the indications and interpretation of EEG, and the management of epilepsy. Therefore, having a good understanding of epilepsy and EEG is crucial for success in the NEET PG exam.
Read this blog for a quick overview of this important medicine topic for NEET PG/NExT exam preparation.
EEG is invented by Hans Berger and it has 10 – 20 lead placement system
- Alpha waves: seen when eyes are closed, drowsy, relaxed → 8 – 13 Hz
- Beta waves: when person is awake Awake, eyes opened → 13 - 30 Hz
- ϒ waves - 30-100 Hz(problem solving)
- NREM 1 → Myoclonic jerk may occur.
- Theta waves: 4- 7 Hz are seen
- NREM 2 → longest phase of NREM
- µ waves/ sleep spindles are present
- 12 - 14 Hz
- NREM 3 → deepest phase of sleep/ most difficult to arouse
- Delta waves: 0.5 – 4 Hz are seen
- Slowest wave pattern
- Maximum amplitude, least frequency
- REM sleep: Decreased tone of muscles is seen
- EEG shows Saw tooth pattern
- Abnormal focus in the brain leading to abnormal electrical discharge.
- Motor manifestation of the same is called convulsion.
- Premonitory symptoms (general unwellness of the patient) are present
- later on loss of consciousness, up rolling of the eye balls and during tonus there is ↑ in Tone of muscles & sudden contraction of muscles of expiration of vocal cord occurs, which lead to “Ictal Cry”.
→ Up rolling of eyes
Tonus → Pooling of secretions
(10-20 → Tongue bite +
Seconds) → Perioral cyanosis
→ ↑ HR, ↑ BP
- GCSE: Convulsions > 5 min
- Violent jerking of all limbs followed by post ictal deficit
- Usual duration of both tonus and clonus: < 60 seconds
- Postictal deficit - confusion, loss of orientation
- Babinski sign is present and corneal reflex is absent in unconscious patients and vice versa at the time of regaining consciousness.
- Epilepsy: If > 2 unprovoked seizures episodes are seen it is k/a Epilepsy
With intact awareness
Without intact awareness
Non – motor
Non – motor
- Aura implies perception of stimulus like bright lights, unpleasant smell of burning rubber
- Hippocampal Sclerosis – causes temporal lobe epilepsy
With intact awareness
- Abnormal electrical activity in left motor cortex is seen
- Right hand/face involuntary movements are seen
Non motor manifestation
- Paresthesia / vertigo is seen
- Sensation of burning rubber
- Micropsia or macropsia
- Subjective events that cannot be observed by someone
- AURA like bright lights, the smell of burning rubber etc.
Focal seizure without intact awareness
- AURA is not a feature of GTCS (generalized tonic clonic seizures). It is a feature of focal seizure
- It is a feature of focal seizure with impaired awareness
- Uncontrollable laughter/ crying
- Progression of focal seizure: AURA → Motionless stare → Automatism
- There is presence of
- Post ictal confusion
- Anterograde amnesia
- Transient neurological deficit in form of Aphasia
- EEG can be normal during interictal period
- The above EEG is showing Focal Seizures; possibly origin is from temporal lobe
GENERALIZED ONSET SEIZURES
- Typical absence seizures
- Transient loss of consciousness for 1-2 seconds
- Seen in 4-10 yr child
- Postural tone is maintained
- Become unresponsive/quiet
- Repeated blinking of eye is seen
- Post ictal deficit is absent
- Aka Day dreamers
- Vacate stare spell is seen
- EEG shows 3 per second spike & slow wave.
- Ask the patient to first open the eye – alpha wave present, then close the eye – beta wave present. Ask the patient to hyperventilate or give a photic trigger resulting in 3 per second spike & slow wave.
- T/t: Valproate/ ethosuximide (in younger child)
2. Atypical absence seizures
- EEG < 2.5 Hz spike by slow wave pattern.
- Lapse of consciousness is seen
- Mental retardation is seen
- Lennox gestaut syndrome
- Atonic seizures
- Loss of postural control for 1-2 sec
- Loss of consciousness for 1-2 sec
- Sudden onset of head nodding/dropping
- Myoclonic seizures
- Sudden/brief myoclonic jerky movements
- Neurodegenerative disorder-Variant Creutzfeldt-Jakob disease
- Metabolic encephalopathy
- Anoxic cerebral injury - High altitude cerebral edema
- Epileptic spasm
- Infant with “SALAAM SEIZURES” involving trunk muscle
- On EEG: Hypsarrhythmia/ Grossly chaotic pattern is seen
- Background rhythm is suppressed (REM, NREM waves suppressed): Decremental response
- Premonitory symptoms
- Ictal cry: Tonus ~ 10 seconds
- Cyanosis, tongue bite +, up rolling eyes
- Clonus: involuntary jerking
- Post ictal deficit, Noisy breathing due to pooling of secretions
- Urine passed
- Stool passed
VASOVAGAL SYNCOPE VS. GTCS
|Tonus & clonus||<15 seconds||30 – 60 seconds|
|Tongue bite||Rarely seen||+|
|Loss of consciousness||Gradual||Sudden|
|Minutes to hours|
EEG of Focal seizure and Diffuse GTCS
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- Lennox Gastaut Syndrome
- Atypical absence
- Atonic seizure
- Etiology: multifactorial
- EEG shows <2.5 Hz spike & slow wave
- D.O.C: Na valproate
- JANZ syndrome/ Juvenile myoclonic epilepsy
- Polygenetic inheritance
- MC seen in 10 -19 yrs of age.
- Myoclonic Jerks (early morning) are seen
- EEG: 4-6 Hz Poly-spike patterns are seen.
- May develop GTCS in future and in 30% will also develop absence seizure in future
- Rx – Valproate (lifelong)
- Infantile spasm = hypsarrhythmia
- Juvenile myoclonic epilepsy = 4-6 Hz Polyspike pattern
- Mesial temporal lobe epilepsy
- MRI shows Hippocampal sclerosis
- Febrile convulsion
- Focal seizures with impaired awareness
- “Automatism” is seen
- EEG - temporal (U/L or B/L) spikes
- D.O.C: Sodium valproate
- T.O.C: Surgery- Surgical resection of hippocampal sclerosis lesion
- Focal seizure = Carbamazepine
- Levetiracetam → elderly pt. (less interaction with other drugs)
- Lamotrigine → Steven Johnson syndrome risk
- Carbamazepine → Risk factor- anemia, leucopenia and hepatotoxicity
- Generalized seizures DOC is Sodium valproate
- Safest Antiepileptic drug in pregnancy: Levetiracetam (Least teratogenic) > Lamotrigine
|GTCS||Focal seizure||Typical absence||Atypical absenceAtonic/ myoclonic|
|Lamotrigine Valproate Levetiracetam||Lamotrigine Levetiracetam Carbamazepine Oxcarbazepine|
|Valproate Lamotrigine Ethosuximide||Valproate Lamotrigine Topiramate|
- D.O.C is ACTH
- D.O.C of infantile spasm with Tuberous sclerosis (Neurocutaneous disorder): Vigabatrin
- Prophylaxis: Oral clobazam
- T/t: intranasal midazolam/ Rectal Diazepam (conventional method)
- Most common epilepsy in children: Benign Rolandic epilepsy
- Episodes of Focal seizures is seen
- Peak age of onset: 2-13 yr
- Treatment: Carbamazepine
- MC seizures in child: Febrile seizures
- Mc seizures in neonate: Subtle seizures
‘Jitteriness’ Causes: Hypoxic ischemic encephalopathy and Hypoglycemia
SUBACUTE SCLEROSING PANENCEPHALITIS
- Also called as Slow virus disease
- It is late complication of measles
- On EEG – Periodic sharp wave complex is seen
- 2 yr: Measles Vaccine is not given
- 8 yr: C/F are
- Myoclonic jerk
- Neurodegeneration features – Apathy
- Urinary incontinence
- Stool incontinence
|Clinical||Progressive, subacute metal deterioration with typical signs like myoclonus|
|EEG||Periodic, stereotyped, high voltage discharges|
|Cerebrospinal fluid||Raised gamma globulin or oligoclonal pattern|
|Measles antibodies||RAISED Titre in serum (≥ 1:256) and /or cerebrospinal fluid (≥ 1:4)|
|Brain biopsy||Suggestive of pan encephalitis|
|Definitive: criteria 5 with three more criteria; probable: three of the five criteria.|
PHAKOMATOSIS/ NEUROCUTANEOUS DISORDER
Tuberous sclerosis: AD
- Family history is present
- TSC1 (Chromosome 9) & TSC2 gene (Chromosome 16) involvement is seen
- Adenoma sebaceum- Acne like lesion in butterfly distribution is seen
- Shagreen patch: Irregular appearance of skin is seen
- Subungual fibroma: fleshy growth from below the nail is seen
Earliest cutaneous manifestation
- Ash- leaf macules: Hypopigmented macules on Trunk
- < 1yr: Infantile spasm = Vigabatrin
- > 1 yr : Focal/ seizures = Carbamazepine
- On CT, Subependymal astrocytoma is seen
- Lesion in Kidney: Angiomyolipoma (having fat, muscle and blood vessel together)
- Bleeding in angiomyolipoma of Tuberous sclerosis is k/a Wunderlich syndrome
STURGE WEBER SYNDROME
- Port wine stain
- Cavernous angioma
- Seizures (focal)
- S – Seizure
- T – Trigeminal Nerve distribution
- U – U/L weakness
- R – Mental Retardation
- G – Glaucoma
- E - Eye = Buphthalmos
CT scan head shows Tram Track Appearance
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An EEG records the electrical activity of your brain via electrodes affixed to your scalp. EEG results show changes in brain activity that may be useful in diagnosing brain conditions, especially epilepsy and other seizure disorders.Can an epileptic person have a normal life? ›
Most people with epilepsy live a full life. However, the risk of early death is higher for some. We know that the best possible seizure control and living safely can reduce the risk of epilepsy-related death.Can you lead a normal life after a seizure? ›
A. Yes. People with epilepsy can live normal, long healthy lives by managing seizures.Is the most useful tool for diagnosing epilepsy is the EEG? ›
Electroencephalography. If a doctor suspects epilepsy is causing your symptoms, he or she may order an electroencephalography, or EEG. This tool is the most specific test for diagnosing epilepsy because it records the electrical activity of the brain.Is there a definitive test for epilepsy? ›
Blood tests, an Electroencephalogram (EEG) and scans are used to gather information for a diagnosis. Tests on their own cannot confirm or rule out epilepsy.Is it hard to diagnose epilepsy? ›
Diagnosing epilepsy is not simple. Doctors gather lots of different information to assess the causes of seizures. If you have had two or more seizures that started in the brain you may be diagnosed with epilepsy. Getting a diagnosis is not always easy as there is no single test that can diagnose epilepsy.Does epilepsy get worse with age? ›
The incidence of any type of seizure increases substantially over the age of 60, commonly due to other neurological conditions such as dementia or stroke.Does epilepsy go away with age? ›
Some people require lifelong treatment. For others, seizures eventually go away. Some children with epilepsy may outgrow the condition with age.How long do epilepsy patients live? ›
Summary: On average, people with epilepsy live 10-12 years fewer than those who do not have the condition. Excess mortality is particularly pronounced among people with epilepsy and mental disorders. On average, people with epilepsy live 10-12 years fewer than those who do not have the condition.Does exercise help with epilepsy? ›
Exercise is good for everyone, but it also has important benefits for people with epilepsy. Occasionally seizures can be triggered by physical exercise, but this is rare. In general, physical activity doesn't worsen epilepsy and in many cases, it may even improve seizure control through improved overall health.
Danny Glover: The Academy Award-winning actor struggled with epilepsy and seizures as a child. Like many people with epilepsy, he outgrew the disorder. Glover attributes part of his success to being able to recognize the warning signs of seizures after his first one at the age of 15.Can epilepsy go away? ›
About 6 out of 10 people diagnosed with epilepsy can become seizure free within a few years with proper treatment. Many of these people will never have any more seizures. For the rest of the people, some will have occasional breakthrough seizures or side effects of medicines and others will have uncontrolled seizures.What are the 4 types of epilepsy? ›
- Generalized epilepsy.
- Focal epilepsy.
- Generalized and focal epilepsy.
- Unknown if generalized or focal epilepsy.
Stress and anxiety can cause the physical symptoms of a seizure that are not caused by abnormal changes in the electrical activity of the brain. These seizures are known as Non-Epileptic Seizures (NES). Stress is also a trigger for people who have been diagnosed with epilepsy.Can an epileptic have a normal EEG? ›
Many patients with epilepsy have a normal EEG between attacks. An abnormal EEG means I have epilepsy. Many people without seizures have mild abnormalities on EEG. Epilepsy is a clinical diagnosis, that is, made on the basis of history and examination.What is the gold standard test for epilepsy? ›
Upon clinical suspicion, the gold standard diagnostic method of epilepsy is EEG, which can detect abnormal electrical discharges in the brain.How often is epilepsy misdiagnosed? ›
A study showed that as many as 90,000 people were misdiagnosed with epilepsy, which is as many as 1 in 4 cases. It's not surprising that misdiagnosis is common with epilepsy as, in some cases, it can be notoriously difficult to diagnose and there are a number of other medical conditions that can appear very similar.How far back can an EEG detect a seizure? ›
EEG: If performed within 24-48 hours of a first seizure, EEG shows substantial abnormalities in about 70% of cases. The yield may be lower with longer delays after the seizure. If the standard EEG is negative, sleep-deprived EEG will detect epileptiform discharges in an additional 13-31% of cases.Can you have mild epilepsy and not know it? ›
Some seizures cause obvious physical movements or loss of consciousness, but in other cases a seizure might not be visible to a bystander — not even a health professional. Some people with undiagnosed epilepsy may not even realize that the strange sensations or emotions they're experiencing are due to a seizure.Can epilepsy be detected by blood test? ›
A neurologist will also use blood tests, imaging scans, and EEGs to determine if you have epilepsy. If you receive a diagnosis, they'll use different techniques to identify the types of seizures that you're having.
Epilepsy can begin at any time of life, but it's most commonly diagnosed in children, and people over the age of 65. Some children with epilepsy will outgrow their seizures as they mature, while others may have seizures that continue into adulthood.Is epilepsy a big deal? ›
If seizures can't be stopped or repeated seizures occur one right after another, permanent injury or death can occur. People with epilepsy can also die from problems that occur during or after a seizure, such as inhaling vomit. This problem can be prevented if the person is turned onto one side as soon as possible.Is epilepsy hereditary from mother? ›
It can be inherited from one or both parents. Some studies³ have found that epilepsy is more likely to be passed down from the mother than the father. Even if someone does have one parent with an inheritable form of epilepsy, it doesn't necessarily mean that person will inherit the gene.Can epilepsy stop later in life? ›
Epilepsy can start at any age, but usually starts either in childhood or in people over 60. It's often lifelong, but can sometimes get slowly better over time.What triggers epilepsy? ›
Triggers can differ from person to person, but common triggers include tiredness and lack of sleep, stress, alcohol, and not taking medication. For some people, if they know what triggers their seizures, they may be able to avoid these triggers and so lessen the chances of having a seizure.Can stress cause epilepsy? ›
Stress can sometimes contribute to people developing epilepsy in the first place. This is more likely if your stress is severe, lasts a long time, or has affected you very early in life.What age do seizures stop? ›
About two-thirds of all children with epilepsy outgrow their seizures by the time they are teenagers. For some, though, epilepsy may be a lifelong condition. It is important for parents to partner with their health care providers to help understand their child's condition and treatment.What is the last stage of epilepsy? ›
Ending (post-ictal) phase
This is the recovery stage and during this phase any physical after effects of the seizure are felt. The type of seizure and the part of the brain involved will determine how long it takes for a person to return to their usual self. Some common signs of this phase include: Confusion.
Teens and young adults with epilepsy MUST achieve a minimum of 8 hours a night of good-quality sleep! 15 Tips to Follow: Go to sleep at the same time every day.What is the best epilepsy medication? ›
Common types include:
- sodium valproate.
Generally speaking, most people with epilepsy should be OK to drink coffee, tea, soda and other caffeinated drinks in small quantities without any serious risk of increasing the number of seizures they have.What not to do with epilepsy? ›
- Do not hold the person down or try to stop his or her movements.
- Do not put anything in the person's mouth. This can injure teeth or the jaw. ...
- Do not try to give mouth-to-mouth breaths (like CPR). ...
- Do not offer the person water or food until he or she is fully alert.
In the February 15, 2011 issue of the Journal Neurology Dr. Steven Lomazow presents intriguing information based on historical research that he had done addressing the neurologic condition that surrounded Franklin Delano Roosevelt.What success people have epilepsy? ›
- Aga tha Christie. Born in 1890 was an English crime writer of novels, short stories and plays. ...
- Leonardo Da Vinci. ...
- Alfred Nobel. ...
- Peter Tchaikovsky. ...
- Harriet Tubman. ...
- Michelangelo. ...
- Charles Dickens. ...
- Danny Glover.
Scholars have long been fascinated by evidence that prominent religious leaders, political leaders, philosophers, and many who achieved greatness in the arts and sciences suffered from epilepsy. Aristotle was apparently the first to connect epilepsy and genius.Is epilepsy 100% Curable? ›
There's no cure for epilepsy. But there are many options to treat epilepsy.What foods prevent seizures? ›
A low glycemic index diet focuses on foods with a low glycemic index, meaning they affect blood glucose levels slowly, if at all. Although it's not understood why, low blood glucose levels control seizures in some people. Foods on this diet include meat, cheese, and most high-fiber vegetables.Who is most likely to get epilepsy? ›
Children and older adults are more likely to have epilepsy because risk factors are more common in these groups.What is the rarest epilepsy? ›
Dravet syndrome is a rare, genetic epileptic encephalopathy that gives rise to seizures that don't respond well to seizure medications. It begins in the first year of life in an otherwise healthy infant.Can epilepsy lead to dementia? ›
People with epilepsy develop Alzheimer's disease at a rate 6 times higher than the non-epileptic population, and seizures can damage the memory centers of the brain and contribute to dementia.
Hence, the rule governing the required waiting time before declaring seizure freedom, which we may call the “Rule of Three-To-Six”, can be stated as follows: When the a priori probability that an intervention will confer seizure freedom is >50%, then an observation period 3 times the typical pre-intervention ...Can emotional trauma cause epilepsy? ›
Seizures caused by a delayed response to a very stressful event or situation, for example, being in a war or a disaster, are a response to post-traumatic stress disorder (PTSD) - a condition that sometimes happens after a traumatic event.Can lack of sleep cause a seizure? ›
Can sleep deprivation trigger a seizure? Yes, it can. Seizures are very sensitive to sleep patterns. Some people have their first and only seizures after an "all-nighter" at college or after not sleeping well for long periods.Does an EEG always pick up epilepsy? ›
An EEG can usually show if you are having a seizure at the time of the test, but it can't show what happens to your brain at any other time. So even though your test results might not show any unusual activity it does not rule out having epilepsy. Some types of epilepsy are very difficult to identify with an EEG.Does epilepsy show up on MRI? ›
Does epilepsy show up on MRI scans? No, not necessarily. An MRI scan can help your doctor understand some of the possible underlying structural causes of your seizures. However, for many people there is no structural cause behind their epilepsy and so the brain scan comes back 'normal'.What not to do before a EEG test? ›
Do not eat or drink anything with caffeine in it for 12 hours before the test. This includes cola, energy drinks, and chocolate. Shampoo your hair and rinse with clear water the evening before or the morning of the test. Do not put any hair conditioner or oil on after you wash your hair.What kind of seizure doesn't show on EEG? ›
If a seizure is caused by a psychological condition, there will be no evidence of atypical activity on an electroencephalogram (EEG). These types of seizures are sometimes called: psychogenic nonepileptic seizures (PNES) “pseudoseizures,” which is an outdated term.Is an MRI or EEG better for seizures? ›
MRI (Magnetic Resonance Imaging)
Epilepsy treatment is most effective when the onset of the seizure can be specifically localized to one or more origins within the brain. MRI collects structural information and creates images of the brain by using a large magnet.
People sometimes think that imaging tests such as an EEG, CT scan or an MRI will determine that they have had a seizure. However, information from tests alone can't always confirm that a seizure has occurred, or that the person has epilepsy.What does epilepsy look like on EEG? ›
EEG recording of a seizure can begin with the appearance of abnormal discharges in bursts, known as ictal epileptiform discharges. The discharges increase in frequency to rapid continuous spikes and waves, progressing to numerous spikes with buried waves, at peak seizure activity.
PNES are attacks that may look like epileptic seizures but are not epileptic and instead are caused by psychological factors. Sometimes a specific traumatic event can be identified. PNES are sometimes referred to as psychogenic events, psychological events, or nonepileptic seizures (NES).What scan is best for epilepsy? ›
The most common neuroimaging tests for epilepsy are computed tomography (CT scan) and magnetic resonance imaging (MRI). Both produce a picture of how the brain looks. MRI is preferred because it provides more information than CT. In fact, MRI is recommended as the imaging test of choice.What is a major disadvantage of EEG? ›
A drawback for EEG is the spatial resolution – as the electrodes measure electrical activity at the surface of the brain, it is difficult to know whether the signal was produced near the surface (in the cortex) or from a deeper region.Can you have epilepsy but no seizures? ›
About 6 out of 10 people diagnosed with epilepsy can become seizure free within a few years with proper treatment. Many of these people will never have any more seizures. For the rest of the people, some will have occasional breakthrough seizures or side effects of medicines and others will have uncontrolled seizures.What should you not do before an EEG test? ›
Do not eat or drink anything with caffeine in it for 12 hours before the test. This includes cola, energy drinks, and chocolate. Shampoo your hair and rinse with clear water the evening before or the morning of the test. Do not put any hair conditioner or oil on after you wash your hair.Does epilepsy show in blood tests? ›
A neurologist will also use blood tests, imaging scans, and EEGs to determine if you have epilepsy. If you receive a diagnosis, they'll use different techniques to identify the types of seizures that you're having.Can you have seizure activity on EEG but no seizures? ›
Furthermore, about 2% of normal school-age children who do not have seizures have epileptic activity on EEG. Conversely, a normal EEG does not exclude epilepsy. Many types of epilepsy may be associated with a normal EEG between seizures. A normal EEG during a "seizure" usually excludes epilepsy as the cause.Why do you develop epilepsy later in life? ›
Epilepsy is more likely to develop in older adults because some risk factors for epilepsy are more common in older adults,3 such as: Strokes. Head injuries from falls.