First consider the patient's age.
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1.
Eisermann M, Kaminska A, Moutard ML, Soufflet C, Plouin P. Normal EEG in childhood: From neonates to adolescents. Neurophysiologie Clinique/Clinical Neurophysiology [Internet]. 2013 [cited 2020 Apr 13];43(1):35–65. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0987705312003735
Consider the functional state (awake or asleep, and the sleep stage).
Assess the background tracing next.
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1.
Zafar S, Doria J, Karceski S. Should we standardize the EEG classification of mild, moderate, and severe cerebral dysfunction? Epilepsy Behav [Internet]. 2020 Nov 1 [cited 2022 Sept 6];112. Available from: https://www.epilepsybehavior.com/article/S1525-5050%2820%2930511-4/fulltext
Review paroxysms next.
Rule out normal variants.
Mu rhythm and lambda waves.
Hypnagogic hypersynchrony.
Wicket spikes.
Others:
Multiple resources exist to learn the patterns of normal variants:
Keep in mind the presence of pathological findings not related to epilepsy.
Breach rhythm.
Excess beta activity (benzodiazepine effect).
Underlying neurodevelopmental disorder.
The incidence of epileptiform activity in adults without epilepsy is 2-3%, in children without epilepsy it is 5%, and in children with neurodevelopmental disorders without epilepsy it is 40-50%.
Others:
Multiple resources exist to learn pathological patterns:
Make sure the epileptic discharge meets the 2 defining features.
- It has a congruent field: by analyzing the phase reversal pattern of the spike (depolarization), you can locate its origin.
- It disrupts the background rhythm, which is easier to identify if a subsequent slow wave appears (repolarization).
Finally, classify the epilepsy syndrome by placing the tracing in one of the following 5 groups, depending on the background rhythm and paroxysms:
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Kim SH, Korff CM, Kim AJ, Nordli DR. A practical, simple, and useful method of categorizing interictal EEG features in children. Neurology. 2015 Aug 4;85(5):471–8.