# CANADIAN SOCIETY OF CLINICAL N EU ROPHYSIO LOGISTS (CSCN ) EEG EXAMINATION

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1 INTRODUCTION CANADIAN SOCIETY OF CLINICAL * * * Note: This document was revised October * ** OUTLINE OF CONTENT: TERMS and CONCEPTS The following outline is intended to assist candidates in preparation for the CSCN EEG examination. The list is not intended to be "all inclusive" but rather a "guide" to tapies that may be covered in the examination. I. TECHNOLOGY 1. Basic electricity and electronics Ohm's law Measurement and definitions of current, voltage, resistance Capacitors Resistance in series; parallel circuits 2. Electrodes Types Material Characteristics Measurement of resistance/impedance; what is the difference? Nomenclature and rationa le of the "10-20" system: how to measure; naming of electrodes including expanded nomenclature and "nonstandard" positions. 3. Amplifiers Sensitivity/gain Differential amplifier Common mode rejection ratio Calibration in analog and digital systems Filters High frequency (low pass) Low frequency (high pass) Notch filter Cutoff freq uency Roll-off and "order" with digita l filters Types of digita l filters Finite impulse response(fir) Infinite impulse response (IIR) Frequency domain filtering; fast Fourier transform (FFT) Frequency response curves related to filters

2 CANADIAN SOCIETY OF CLINICAL 4. Principles of acquisition of digital EEG Analog to digital conversion Nyquist theorem Aliasing Amplitude resolution and number of "bits" Screen resolution Sample skew System reference and principles of montage reformatting 5. Artifacts Types and "troubleshooting" Physiologie Non-physiologie "Noise" 6. Electrical Safety Leakage current 7. Polarity convention and application to localization 8. Montage design (bipolar, referential, Common average, Laplaclan) and comprehenslon of strengths/weaknesses of each montage) 9. Published society guidelines (Canadian Society of Clinical Neurophysiology; American Clinical Neurophysiology Society); see "Reading List" 10. Infection control (with particular reference to electrodes) II. PHYSIOLOGY 1. Physiology of normal neurons Resting membrane potential; Ionie types; Nernst equation Synaptic potentials (EPSPs, PSPs) Action potentials Membrane depolarlzation and hyperpolarization Voltage gated channels and ligand gated channels Neurotransmitters (type; function, synthesis) Gap junctions

3 CANADIAN SOCIETY OF CLINICAL 2. Physiology of normal EEG Volume conduction "Sources and sinks" Neuroanatomy-physiology of normal EEG rhythms Thalamocortical circuits Neurophysiology of normal sleep; anatomie structures; effects on epileptic spikes 3. Pathophysiology of abnormal EEG Delta; theta (focal; generalized) Paroxys mal depolarization shift (PDS) Epileptiform abnormalities (spikes and sharp waves; focal and generalized); excitation and inhibition determining which components of of spikes and slow waves; what part(s) of cortex, thalamus involved. 4. Neurophysiology and anatomy of temporal lobe-hippocampus Trisynaptic pathway:or igins and connections Perforant pathway Schaffer collaterals Long term potentiation Kindling III. CLINICAL EEG 1. Normal EEG (from prematurity to the elderly) Alpha rhythm and its var iants Mu rhythm and breach rhythms Beta Theta Posterior rhythms (posterior slow of youth; lambda waves) Normal drowsy rhythms Sleep patterns (posterior occipital sha rp transients of sleep; vertex waves, K complexes, sleep spindles, REM sleep) Activation procedures Hyperventilation responses Photic stimulation "Benign" transients and rhythms Benign epileptiform transients of sleep Rhythmic temporal theta burst of drowsiness Six per second spike and wave 14 and 6 positive spikes Wicket spikes SREDA (sub clinica l rhythmic electrographic discharge of adults)

4 CANADIAN SOCIETY OF CLI N ICAL N EUROPHYSIOLOGISTS {CSCN ) 2.. Abnormal EEG in adults and children "Nonspecific" Patterns (a) Theta (focal, genera lized) (b) Delta Polymorphie Delta (focal; generalized) Intermittent rhythmic delta (fronta l intermittent rhythmic delta; occipita l intermittent rhythmic delta; tempora l intermittent rhythmic delta) (c) Asymmetries and suppression (d) Photo convulsive (photoparoxysma l) patterns Inter-Ictal Epileptiform Patterns (a) Genera lized "Slow" sharp and slow wave complexes ("slow" spike and wave) 3 per second spike and wave Poly spike and wave "Fragments" of generalized spike and wave Genera lized paroxysma l fast activity (b) Focal spikes Va rious lobes Rolandic Multifocal 3. Ictal Patterns (a) Hypsarrhythmia (b) Focal (c) Genera lized; including recruiting rhythms, generalized paroxysma l fast 4. Other Characterist ic EEG patterns (a) Triphasic waves (b) Periodic lateralized epileptiform discharges (PLEDs) (c) Periodic genera lized sharp waves (as in creutzfeldt Jakob disease) (d) Coma patterns (including burst suppression, alpha- theta coma, spindle coma, coma with diffuse beta; S RPIDS (stimulus induced rhythmic, periodic, or ictal discharges); isoelectric EEG) 5.. Neonatal (a) Normal patterns Trace alternans; trace discontinu "Brushes" Encoches frontales Quiet (non-rem) verses active ("REM") sleep (b) Abnormal Neonatal

5 CANADIAN SOCIETY OF CLI N ICAL N EUROPHYSIOLOGISTS {CSCN ) 6. Abnormal EEG in adults and children "Nonspecific" Patterns (a) Theta (focal, genera lized) (b) Delta Polymorphie Delta (Focal; generaliz ed) Intermittent rhythmic delta (frontal intermittent rhythmic delta; occipital intermittent rhythmic delta; temporal intermittent rhythmic delta) (c) Asymmetries and suppression (d) Photo convulsive (photoparoxys mal) patterns Inter-Ictal Epileptiform Patterns (c) Generalized "Slow" sharp and slow wave complexes ("slow" spike and wave) 3 per second spike and wave Poly spike and wave "Fragments" of generalized spike and wave Generalized paroxysmal fa st activity (d) Focal spikes Various lobes Rolandic Multifocal

### EEG of Newborn and Infants. Ki Joong Kim MD PhD Pediatric Neurology Seoul National University Children s Hospital Seoul, Korea

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