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Roadmap to EEGs: video-based e-learning modules addressing clinical EEG reading Volume 24, numéro 6, December 2022

Vidéos

  • Roadmap to EEGs: video-based e-learning modules addressing clinical EEG reading
  • Roadmap to EEGs: video-based e-learning modules addressing clinical EEG reading
  • Roadmap to EEGs: video-based e-learning modules addressing clinical EEG reading
  • Roadmap to EEGs: video-based e-learning modules addressing clinical EEG reading
  • Roadmap to EEGs: video-based e-learning modules addressing clinical EEG reading
  • Roadmap to EEGs: video-based e-learning modules addressing clinical EEG reading
  • Roadmap to EEGs: video-based e-learning modules addressing clinical EEG reading
  • Roadmap to EEGs: video-based e-learning modules addressing clinical EEG reading
  • Roadmap to EEGs: video-based e-learning modules addressing clinical EEG reading
  • Roadmap to EEGs: video-based e-learning modules addressing clinical EEG reading

Tableaux

 

In 2019, the International League Against Epilepsy (ILAE) Education Task Force published a competency-based curriculum for epileptology [1]. The Epileptic Disorders Internship Program team has developed a series of online, video-based learning modules (“Roadmap to EEGs”) addressing competencies related to interpreting EEG and describing common adults and pediatric EEG patterns (1.4) and diagnosing and classifying epilepsies and epilepsy syndromes using the most recent ILAE classifications (1.7). This series covers seven major topics in electroencephalography and epileptology (table 1), and all videos are publicly available and readily accessible via the Epileptic Disorders website (see accompanying supplementary material) and the Epileptic Disorders Internship Program YouTube® channel. In alignment with principles of adult learning theory [2] and prior ILAE e-learning experience [3], we ensured that each video is relatively short (duration ranging from 9 to 16 minutes) and focuses on high-yield information. Moreover, all educational content is based on the most recent guidelines and ILAE position statements [4-7]. Additionally, we would encourage all learners to complete a pre-test (https://www.surveymonkey.com/r/RoadmapPreTest) and post-test (https://www.surveymonkey.com/r/RoadmapPost-test)because this data will help us estimate learning outcomes and modify the modules accordingly in future revisions. We believe this e-learning series will allow junior trainees to acquire foundational knowledge in EEG/epilepsy, and senior trainees to review previously learned EEG/epilepsy information. We hope that our Roadmap to EEGs will help innumerable trainees across the globe achieve competency in EEG and epileptology.

Legends for video sequences

 

Module 1. Normal EEG Teaching Module

This module covers topics regarding normal EEG. Learners with be able to recognize and describe background activity and sleep. Learners will be able to recognize key features of an awake EEG background including background frequencies, eye blink artifacts, posterior dominant rhythm (including PDR by age), and anterior to posterior organization. Learners will be able to identify features of drowsiness and stage 2 sleep structures including vertex waves, roving eye movements, sleep spindles and K-complexes, as well as REM sleep features.

Key words for video research on www.epilepticdisorders.com

Phenomenology: multiple

  • K-complex
  • Sleep spindles
  • Vertex waves
  • Saw-tooth waves
  • Normal awake EEG
  • Drowsiness EEG
  • NREM sleep
  • REM sleep

Localization: not applicable

Syndrome: not applicable

Aetiology: not applicable

Module 2A. Normal Variants Part 1

This module covers the most common normal variants seen on EEGs. Learners will be able to recognize normal variants including positive occipital sharp transients of sleep (POSTS), rhythmic mid-temporal theta of drowsiness (RMTD), small sharp spikes (SSS), lambda waves, photic driving, wicket spikes, Mu rhythm and Ciganek rhythm.

Key words for video research on www.epilepticdisorders.com

Phenomenology: multiple

  • POSTS (positive occipital sharp transients of sleep)
  • RMTD (rhythmic mid-temporal theta of drowsiness)
  • SSS (small sharp spikes)
  • Lambda waves
  • Photic driving
  • Wicket spikes
  • Mu rhythm
  • Ciganek rhythm

Localization: not applicable

Syndrome: not applicable

Aetiology: multiple

  • Normal Variants
  • Drowsiness EEG

Module 2B. Normal Variants Part 2

This module covers part 2 of normal variants that are most commonly seen on EEGs. Learners will be able to identify non-epileptiform sharp transients, posterior slow waves of youth, temporal slow of the elderly, slow-fused transients, slow (notched) alpha variant, 14 and 6Hz positive bursts, and 6 Hz SWs (spike-waves).

Key words for video research on www.epilepticdisorders.com

Phenomenology: multiple

  • Non-epileptiform sharp transients
  • Posterior slow waves of youth
  • Temporal slow of the elderly
  • Slow-fused transients
  • Slow (notched) alpha variant
  • 6Hz SWs (spike-waves)
  • 14 and 6 Hz Positive bursts

Localization: not applicable

Syndrome: not applicable

Aetiology: multiple

  • Normal variants
  • Drowsiness EEG

Module 3. EEG Artifacts

In this teaching module learners will be able to recognize artifacts frequently seen on EEG and take actions necessary for eliminating artifacts. Learners will be able to identify the following artifacts: sweat, EKG, eye blink, horizontal (lateral) eye movements, eye flutter, glossokinetic, secretion, myogenic, and patting.

Key words for video research on www.epilepticdisorders.com

Phenomenology: multiple

  • Sweat artifact
  • EKG artifact
  • Eye blink artifact
  • Horizontal (lateral) eye movement artifact
  • Eye flutter artifact
  • Glossokinetic artifact
  • Secretion artifact
  • Myogenic artifact
  • Patting artifact.

Localization: not applicable

Syndrome: not applicable

Aetiology: EEG artifacts

Module 4. Interictal Epileptiform Discharges

In this teaching module learners will be able to identify an interictal epileptiform discharge (IED) based on the 6 International Federation of Clinical Neurophysiology (IFCN) criteria with examples of both IED and non-epileptiform sharp transients.

Key words for video research on www.epilepticdisorders.com

Phenomenology: multiple

  • Interictal epileptiform discharges
  • Non-epileptiform sharp transients

Localization: multiple

  • Right temporal interictal epileptiform discharge
  • Right frontal interictal epileptiform discharge
  • Left parietotemporal interictal epileptiform discharge

Syndrome: not applicable

Aetiology: interictal discharges

Module 5A. Focal Seizures Part 1

In this module we will cover the basic principles of focal seizures including the definition of an electroclinical and electrographic seizure. By the end of this teaching module learners will be able to recognize and describe ictal patterns and to correctly diagnose and classify focal epilepsies. The seizure types discussed in this module include brief pattern qualifying as ictal, low voltage fast activity, an evolving rhythm and focal electrodecrement seizure. Multiple seizure localizations will be covered including left frontal seizure, right frontal seizure and right temporal seizure.

Key words for video research on www.epilepticdisorders.com

Phenomenology: multiple

  • Brief pattern qualifying as ictal
  • Low voltage fast activity
  • Evolving rhythm
  • Focal electrodecrement seizure

Localization: multiple

  • Left frontal seizure
  • Right frontal seizure
  • Right temporal seizure

Syndrome: not applicable

Aetiology: multiple

  • Focal seizures
  • Myoclonic seizure
  • Clinical seizure
  • Electrographic seizure

Module 5B. Focal Seizures Part 2

This module covers part 2 of focal seizures. By the end of the end of the module learners will be able to recognize and describe ictal patterns and correctly diagnose and classify focal epilepsies. Learners will be able to identify a right occipital seizure, a right temporal seizure and an ictal pattern with greater >2.5Hz spike-wave activity. Multiple seizure localizations will be covered including right occipital seizure and right temporal seizure.

Key words for video research on www.epilepticdisorders.com

Phenomenology: ictal pattern with >2.5Hz spike-wave

Localization: multiple

  • Right occipital seizure
  • Right temporal seizure

Syndrome: mesial temporal lobe sclerosis

Aetiology: multiple

  • Focal seizures
  • Electrographic seizures
  • Temporal lobe epilepsy

Module 6. Idiopathic Generalized Epilepsy

In this teaching module learners will be able to recognize and identify idiopathic generalized epilepsy (IGE) syndromes in accordance with the 2022 ILAE position statement. EEG hallmarks of IGE and basic principles including both EEG findings and diagnostic criteria will be covered. The following syndromes that will be discussed include childhood absence epilepsy, juvenile absence epilepsy, juvenile myoclonic epilepsy, and epilepsy with generalized tonic-clonic activity.

Key words for video research on www.epilepticdisorders.com

Phenomenology: multiple

  • 3 Hz generalized spike-and-wave discharges
  • 4-6 Hz generalized spike-and-wave discharges

Localization: generalized

Syndrome: multiple

  • Childhood absence epilepsy (CAE)
  • Juvenile absence epilepsy (JAE)
  • Juvenile myoclonic epilepsy (JME)
  • Epilepsy with generalized tonic-clonic activity

Aetiology: Idiopathic Generalized Epilepsy (IGE)

Module 7A. Developmental and Epileptic Encephalopathy Part 1

This teaching module covers part 1 of developmental and epileptic encephalopathies (DEEs) with discussion that is in accordance with the most recent ILAE guidelines. Learners will be able to identify interictal abnormalities, ictal patterns and correctly diagnose and classify DEEs. The syndromes discussed in part 1 of this module include early infantile developmental and epileptic encephalopathy (EIDEE), Ohtahara syndrome, early myoclonic epilepsy, infantile epileptic spasms syndrome (IESS), West syndrome and Dravet syndrome.

Key words for video research on www.epilepticdisorders.com

Phenomenology: multiple

  • Developmental and epileptic encephalopathy

Localization: not applicable

Syndrome: multiple

  • Early infantile developmental and epileptic encephalopathy (EIDEE)
  • Ohtahara syndrome
  • Early myoclonic encephalopathy
  • Infantile epileptic spasms syndrome (IESS)
  • West syndrome
  • Dravet syndrome

Aetiology: developmental and epileptic encephalopathy

Module 7B. Developmental and Epileptic Encephalopathies Part 2

This teaching module covers part 2 of developmental and epileptic encephalopathies (DEEs) with discussion that is in accordance with the most recent ILAE guidelines. Learners will be able to identify interictal abnormalities, ictal patterns and correctly diagnose and classify DEEs. The syndromes discussed in part 2 of this module include Lennox Gastaut syndrome (LGS), Landau-Kleffner syndrome and epileptic encephalopathy with spike wave activation in sleep (EE-SWAS).

Key words for video research on www.epilepticdisorders.com

Phenomenology: multiple

  • Developmental and epileptic encephalopathy
  • Epileptic encephalopathy with spike wave activation in sleep (EE-SWAS)

Localization: not applicable

Syndrome: multiple

  • Lennox Gastaut syndrome (LGS)
  • Landau-Kleffner syndrome

Aetiology: developmental and epileptic encephalopathy

Test yourself

 

  • Which of the following is considered to be an EEG normal variant?
    • EKG artifact
    • K-complex
    • Sleep spindle
    • Slow-fused transient
    • Low-voltage fast activity with evolving rhythm
  • Which of the following is seen during stage 2 sleep (NREM sleep)?
    • Rhythmic mid-temporal theta of drowsiness (RMTD)
    • Posterior dominant rhythm
    • Sleep spindles
    • Ciganek rhythm
    • Mu rhythm
  • List all of the idiopathic generalized epilepsies in accordance with the updated ILAE 2022 position statement.

Note: Reading the manuscript provides an answer to all questions. Correct answers may be accessed on the website, www.epilepticdisorders.com.

Supplementary material

Supplementary data and summary slides accompanying the manuscript are available at www.epilepticdisorders.com.

Disclosures

The authors would like to disclose the following: I. Sheikh, R. Katyal, and A. Hadjinicolaou are Interns of the Epileptic Disorders Internship Program. S. Beniczky is Editor-in-Chief of Epileptic Disorders, and F. Nascimento is Associate Editor of Epileptic Disorders.

Licence Cette œuvre est mise à disposition selon les termes de la Licence Creative Commons Attribution - Pas d'Utilisation Commerciale - Pas de Modification 4.0 International