Journal
JOURNAL OF CLINICAL NEUROPHYSIOLOGY
Volume 36, Issue 4, Pages 257-263Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/WNP.0000000000000613
Keywords
Benign or normal variant EEG patterns; Wickets rhythms/spikes; Small sharp spikes; Rhythmic mid-temporal theta of drowsiness; Interictal epileptiform discharges; Epilepsy misdiagnosis
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Electroencephalographers may misclassify benign variant EEG patterns as epileptiform discharges, resulting in delays in the diagnosis and appropriate treatment of other paroxysmal disorders, such as psychogenic nonepileptic seizures, anxiety/panic disorders, and near syncope. These benign variant patterns include wicket spikes, small sharp spikes, and rhythmic mid-temporal theta of drowsiness. Cautious interpretations of semi-rhythmic sharp transients, usually gradually rising from the EEG background in drowsiness, can help avoid misdiagnosing patients as having seizures. Viewing the EEG as confirmatory for a clear clinical diagnosis is also helpful-elderly patients with syncope, for example, often have microvascular disease and EEG wicket rhythms in drowsiness-a careful review of the clinical history and the paroxysmal EEG pattern usually help distinguish normal variant patterns from interictal sharp waves and spikes and avoid misdiagnosing epilepsy.
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