Clinical electroencephalography

Preface
Acknowledgements
Contents
Contributors
Part I: Technical Aspects and Normal EEG Patterns
	1: Past, Present and Future of the EEG
		References
	2: Neurophysiological Basis of EEG
		2.1	 Central Nervous System: Anatomo-physiological Considerations
		2.2	 Origin of the Electrical Activity of the Brain
		2.3	 Focus on Alpha Rhythm
		2.4	 Origin of Slow Brain Rhythms
		References
	3: Scalp and Special Electrodes
		3.1	 General Characteristics of Electrodes
		3.2	 Electrode Chloridation
		3.3	 Standard Recording Electrodes
		3.4	 Recent Developments: Dry and Active Electrodes
		3.5	 Special Electrodes
			3.5.1	 Sphenoidal Electrodes
			3.5.2	 Naso-Ethmoidal Electrodes
			3.5.3	 Nasopharyngeal Electrodes
			3.5.4	 Zygomatic Electrodes
			3.5.5	 Supraorbital Electrodes
			3.5.6	 Tympanic Electrodes
		3.6	 Infection Control
		Appendix: Electro-Physical Characteristics of Electrodes
		References
	4: Electrode Placement Systems and Montages
		4.1	 Traditional International 10-20 System
		4.2	 Modification of 10-20 System (10-10 System)
		4.3	 Proposed 10-5 System for High-Resolution EEG
		4.4	 Final Recommendations
		4.5	 Electrode Derivations and Montages
			4.5.1	 Reference Derivations
				4.5.1.1	 Common Reference
				4.5.1.2	 Common Average Reference
				4.5.1.3	 Source Derivation
				4.5.1.4	 Bipolar Derivations
				4.5.1.5	 Choice of Derivation in Clinical Practice
			4.5.2	 Montages
		References
	5: EEG Signal Acquisition
		5.1	 Introduction
			5.1.1	 Digital EEG System Structure
		5.2	 Analogue Components
			5.2.1	 EEG Signal Detection: The Electrodes
			5.2.2	 EEG Acquisition System: The Differential Amplifier
			5.2.3	 EEG Acquisition Technique: Common Reference and Bipolar Electrodes
			5.2.4	 EEG Acquisition System: Noise
		5.3	 Analogue-To-Digital Conversion
			5.3.1	 Sampling
			5.3.2	 Quantization
			5.3.3	 Decimation
			5.3.4	 Summary of the Parameters of EEG Signal Acquisition
			5.3.5	 Examples of Other Analogue-To-Digital Conversion Processes
		5.4	 The Digital Component
			5.4.1	 EEG Signal Storage
			5.4.2	 EEG Signal Digital Processing
			5.4.3	 EEG Signal Display
			5.4.4	 EEG Signal Printout
		5.5	 Synchronized Digital Video
			5.5.1	 Digital Video EEG Acquisition
			5.5.2	 Video Signal Digitalization
			5.5.3	 Digital Video Compression
			5.5.4	 Digital Video File Display
		Appendix 1: The Aliasing
		Appendix 2: Source Reference
		Reference
	6: EEG Signal Analysis
		6.1	 Introduction
		6.2	 EEG Signal Analysis in the Frequency Domain
			6.2.1	 EEG Parameters in the Frequency Domain
			6.2.2	 Data Calculation
		6.3	 EEG Signal Analysis in the Time Domain
			6.3.1	 EEG Parameters in the Time Domain
		6.4	 Data Display Technique
			6.4.1	 Display of Data Evolution over Time
			6.4.2	 Display of Spatial Distribution of Data
				6.4.2.1	 Spatial Sampling
				6.4.2.2	 Scalp Models
				6.4.2.3	 Interpolation Techniques
				6.4.2.4	 Choice of the Reference in Cerebral Mapping
		6.5	 Examples
		References
	7: EEG Laboratory: Patient Care and the Role of the EEG Technician
		7.1	 Environment, Patient Care, and Recording Preparation
		7.2	 Electrode Placement and Control
		7.3	 EEG Recording
		7.4	 Ictal Event Recordings and EEG report
		7.5	 Networked EEG Laboratory.
		References
	8: Artifacts
		8.1	 Artifact Classification
			8.1.1	 Physiological Artifacts
				8.1.1.1	 Eye Movement Artifacts
				8.1.1.2	 Muscle Artifacts
				8.1.1.3	 Glossokinetic Artifact
				8.1.1.4	 Electrocardiogram Artifact
				8.1.1.5	 Pulse Artifact
				8.1.1.6	 Cardiac Pacing Artifact
				8.1.1.7	 Electrodermogram Artifacts
				8.1.1.8	 Respiratory Artifacts
				8.1.1.9	 Tremor Artifact
				8.1.1.10	 Other Movement Artifacts
			8.1.2	 Artifacts due to the Acquisition System
				8.1.2.1	 Interelectrode “Salt Bridge” Artifact
				8.1.2.2	 Bad Skin-Electrode Contact Artifact
				8.1.2.3	 Electrode Pressure Artifacts
				8.1.2.4	 Bad Electrode-Clamp and Connector-Headbox Contact Artifacts
				8.1.2.5	 Artifacts Generated from Rhythmic Oscillations of the Cables
			8.1.3	 Electrical Interference and External Equipment Artifacts
				8.1.3.1	 Alternating Current Artifact
				8.1.3.2	 Telephone Artifact
				8.1.3.3	 Switch Artifacts
				8.1.3.4	 Mechanical and Device-Related Artifacts
					Mechanical Ventilation
					Hemodialysis and Hemofiltration Devices
					Electrosurgical Devices
					Swan-Ganz Catheter
					External Cardiac Pacemaker Artifact
		References
	9: Normal Awake Adult EEG
		9.1	 General Characteristics of the EEG Signals
		9.2	 EEG Frequencies
		9.3	 The Physiological Rhythms and Normal Graphoelements
			9.3.1	 Alpha Rhythm
				9.3.1.1	 Genesis of the Alpha Rhythm
			9.3.2	 Mu Rhythm (μ)
			9.3.3	 Breach Rhythm
			9.3.4	 Lambda Waves
		9.4	 Intraindividual and Interindividual Variability of the Normal Awake Adult EEG
		9.5	 Age Effect on the EEG of Wakefulness
		9.6	 The Concept of Normality of EEG
		References
	10: Normal Sleep EEG
		10.1	 Sleep EEG Recordings, Why and When
		10.2	 General Rules of Sleep Stages Scoring
		10.3	 Bases of Sleep Regulation
		10.4	 EEG Changes During Sleep, General Concepts
		10.5	 Sleep Onset
		10.6	 Deep Drowsiness (Stage N1 Sleep)
			10.6.1	 Vertex Sharp Waves (V Wave)
				10.6.1.1	 Vertex Sharp Waves Across the Life Span
			10.6.2	 POSTs (Positive Occipital Sharp Transients of Sleep)
		10.7	 Light Sleep (Stage N2 Sleep)
			10.7.1	 K-Complexes
				10.7.1.1	 KC Across the Life Span
				10.7.1.2	 KC as Arousal Phenomena
				10.7.1.3	 KC as Slow Wave
			10.7.2	 Sleep Spindles
				10.7.2.1	 Sleep Spindles Across the Life Span
				10.7.2.2	 Spindles and Slow-Wave Activity (SWA)
		10.8	 Deep Sleep (Stage N3 Sleep)
			10.8.1	 Slow-Wave Activity (SWA)
				10.8.1.1	 SWA Across the Life Span
		10.9	 REM Sleep
			10.9.1	 SWTs (Sawtooth Waves)
		10.10	 Microstructure of Sleep and the Cyclic Alternating Pattern (CAP)
			10.10.1	 Definitions of CAP and Non-CAP
				10.10.1.1	 CAP Phase A Boundaries
					Amplitude Limits
					Temporal Limits
				10.10.1.2	 Phase A EEG Events and Subtypes
			10.10.2	 Measures of CAP and CAP trend During Age Span
		References
	11: Normal Neonatal EEG
		11.1	 Neonatal EEG Features
		11.2	 Historical References
		11.3	 Qualitative Analysis of the Signal
		11.4	 Registration Techniques
		11.5	 Preparation of the Newborn
		11.6	 Positioning of the Electrodes
		11.7	 Polygraphic Parameters
		11.8	 Digital Video EEG
		11.9	 Maturation of Behavioral and EEG Patterns: From Prematurity to the End of the Neonatal Period
			11.9.1	 Behavioral Patterns
			11.9.2	 Physiological EEG Patterns
		11.10	 Amplitude-Integrated EEG (aEEG)
		Appendix
		References
	12: Normal Variants and Unusual EEG Patterns
		12.1	 Normal Variants
			12.1.1	 Slow Physiological Posterior Activities
				12.1.1.1	 Slow Alpha Variant
				12.1.1.2	 Posterior Theta Rhythm
				12.1.1.3	 Posterior Slow Waves
				12.1.1.4	 Lambda Waves
			12.1.2	 Mu Rhythm
		12.2	 Unusual Benign Epileptiform Patterns
			12.2.1	 Midline Theta Rhythm
			12.2.2	 Rhythmic Theta Bursts of Drowsiness or Rhythmic Mid-temporal Discharges or Psychomotor Variant
			12.2.3	 Subclinical Rhythmic Electrographic Discharges of Adults
			12.2.4	 Wicket Spikes or Wicket Rhythms
			12.2.5	 14- and 6-Hz Positive Bursts
			12.2.6	 Phantom Spikes and Waves or 6-Hz Spikes and Waves
			12.2.7	 Small Sharp Spikes
		12.3	 Conclusion
		References
	13: Pathological EEG Patterns
		13.1	 Changes in Background Rhythms
		13.2	 Slowings
		13.3	 Epileptiform Abnormalities
		13.4	 Periodic and Rhythmic Patterns
			13.4.1	 Periodic Patterns
			13.4.2	 Rhythmic Patterns
				13.4.2.1	 Rhythmic Delta Activity
				13.4.2.2	 Stimulus-Induced Rhythmic, Periodic, or Ictal Discharges
		13.5	 Attenuation/Suppression and Electrocerebral Inactivity
		References
	14: Activation Procedures
		14.1	 Hyperventilation
			14.1.1	 Normal EEG Changes Induced by HV
			14.1.2	 Abnormal EEG Changes Induced by HV
			14.1.3	 Pathophysiological Changes Induced by HV
		14.2	 Intermittent Photic Stimulation
			14.2.1	 Methodology
			14.2.2	 IPS-Induced EEG Changes
				14.2.2.1	 Photic Driving Response
				14.2.2.2	 Photomyogenic Response
				14.2.2.3	 Photoparoxysmal Response
		14.3	 Other Methods of Visual Stimulation
			14.3.1	 Pattern Stimulation
			14.3.2	 Low-Luminance Visual Stimulation
			14.3.3	 Fixation-Off Sensitivity
		14.4	 Sleep and Sleep Deprivation
		14.5	 Other Stimulation
		References
	15: Polygraphic Techniques
		15.1	 Polygraphy Room
			15.1.1	 Equipment
		15.2	 Polygraphic Parameters
			15.2.1	 Capturing Signals with Electrodes
			15.2.2	 Bioelectrical Parameters
				15.2.2.1	 EEG
				15.2.2.2	 EOG
				15.2.2.3	 EMG
				15.2.2.4	 ECG
				15.2.2.5	 SSR
		15.3	 Non-electrical Parameters
			15.3.1	 Breathing
				15.3.1.1	 Oronasal Flow
				15.3.1.2	 Thoracic and Abdominal Activity
				15.3.1.3	 Endoesophageal Pressure
			15.3.2	 Noise
			15.3.3	 Body Position
			15.3.4	 Pulse Oximetry
			15.3.5	 Plethysmogram
		15.4	 Ambulatory Monitoring
			15.4.1	 Actigraph
		15.5	 Conclusion
		References
	16: Polygraphic Investigations and Back-Averaging Techniques in the Study of Epileptic Motor Phenomena
		16.1	 Introduction
		16.2	 Polygraphic Features of Epileptic Motor Manifestations
			16.2.1	 Myoclonus
			16.2.2	 Spasms
			16.2.3	 Tonic Contractions
			16.2.4	 Clonic Contractions
			16.2.5	 Atonic Phenomena
		16.3	 Polygraphic Patterns in Different Types of Epileptic Seizures or Syndromes
			16.3.1	 Generalized Tonic-Clonic Seizures
			16.3.2	 Tonic Seizures
			16.3.3	 Myoclonic Absences
			16.3.4	 Juvenile Myoclonic Epilepsy
			16.3.5	 Epilepsia Partialis Continua
			16.3.6	 Progresive Myoclonus Epilepsies
		16.4	 Some Reflections on EEG-EMG Correlations in Epileptic Seizures
		16.5	 Back-Averaging Techniques Applied to the Analysis of Polygraphic Signals
			16.5.1	 Back-Averaging Applications to the Study of Myoclonus
				16.5.1.1	 EMG correlates of Positive and Negative Myoclonus
				16.5.1.2	 EEG Correlates of Positive and Negative Myoclonus
			16.5.2	 Averaging Techniques to Study Negative Motor Phenomena
		16.6	 Conclusions
		References
	17: Ambulatory EEG
		17.1	 Ambulatory EEG Equipment
			17.1.1	 Electrode Placement and Instructions for the Patient
			17.1.2	 Clinical Utility of Ambulatory EEG
			17.1.3	 Limitations and Pitfalls
		References
	18: Video-Electroencephalography (Video-EEG)
		18.1	 General Indications
		18.2	 Methodology
		18.3	 Indications and Limits
		18.4	 Technical Features
			18.4.1	 Electrodes
			18.4.2	 Maintenance
			18.4.3	 EEG Amplifiers
			18.4.4	 Montage
			18.4.5	 Online Computed Analysis
			18.4.6	 Video Recordings
			18.4.7	 Activation Techniques
			18.4.8	 Testing the Patient during Seizures
			18.4.9	 Pharmacological Treatment
			18.4.10 Safety
			18.4.11 Guidelines for Video-EEG Monitoring Laboratory
			18.4.12 Storage
			18.4.13 Report
		18.5	 Conclusion
		References
	19: Invasive EEG
		19.1	 General Indications
		19.2	 Introduction
		19.3	 Methodologies
		19.4	 The Epileptogenic Zone: Meaning and Definition
		19.5	 Subdural Electrodes and Combination of Subdural/Depth Electrodes
			19.5.1	 Surgical Technique
			19.5.2	 Recordings
			19.5.3	 Strong Points and Limits
			19.5.4	 Risks
		19.6	 Stereo-EEG
			19.6.1	 Surgical Technique
			19.6.2	 Recordings
			19.6.3	 Strong Points and Limits
			19.6.4	 Risks
		19.7	 Intraoperative Electrocorticography (ECoG)
			19.7.1	 Technique
			19.7.2	 Strong Points and Limits
			19.7.3	 Electrical Stimulations (ES)
		19.8	 Conclusion
		References
	20: Electromagnetic Source Imaging, High-Density EEG and MEG
		20.1	 Introduction
		20.2	 Cortical Generators of Epileptiform Discharges
		20.3	 Topographic Maps
		20.4	 Source Reconstruction
			20.4.1	 Forward Solution
			20.4.2	 Inverse Solution
		20.5	 High-Density EEG (HD-EEG) Recordings
		20.6	 Magnetoencephalography (MEG) Recordings
		20.7	 Methodological Steps of Source Imaging
		20.8	 Evidence from Clinical Validation Studies
		20.9	 Limitations and Future Direction
		References
	21: Simultaneous Recording EEG and fMRI
		21.1	 Neural Basis of BOLD Signal and Rationale of Simultaneous Recording EEG and fMRI
		21.2	 EEG-fMRI in Epilepsy
		21.3	 EEG Artefacts due to Recording in the MR Scan
		21.4	 MRI Artefacts due to EEG Equipment
		21.5	 Modelling the EEG Signal to Inform fMRI Analysis
		21.6	 Variability of the Haemodynamic Response Function
		21.7	 The Negative BOLD Response
		21.8	 Sensitivity and Reproducibility in Epilepsy Studies
		21.9	 EEG-fMRI in Children and Adolescents
		21.10	 Clinical Utility of EEG-fMRI Studies
		References
Part II: Pathological EEG Patterns
	22: Abnormal Neonatal Patterns
		22.1	 Abnormal Neonatal EEG
		22.2	 Introduction
		22.3	 Extra Cerebral Artifacts
		22.4	 The Abnormal EEG Recording: Historical References
		22.5	 Methodological Approach
			22.5.1	 EEG Recording
		22.6	 Essential Terminology
		22.7	 Iconography of the Abnormal EEG
		References
	23: Early-Onset Epileptic Encephalopathies
		23.1	 Introduction
		23.2	 Ohtahara Syndrome
		23.3	 Early Myoclonic Encephalopathy
		23.4	 Other Early-Onset Epileptic Encephalopathies due to Specific Genetic Aetiology
			23.4.1	 CDKL5-Related Epileptic Encephalopathy (OMIM 300672)
			23.4.2	 KCNQ2-Related Epileptic Encephalopathy (OMIM 613720)
			23.4.3	 SCN2A-Related Epileptic Encephalopathy (OMIM 613721)
			23.4.4	 SCN8A-Related Epileptic Encephalopathy (OMIM 614558)
		References
	24: Epileptic Encephalopathies of Infancy and Childhood
		24.1	 Introduction
		24.2	 West Syndrome
		24.3	 Dravet Syndrome
		24.4	 Lennox-Gastaut Syndrome
		24.5	 Epilepsy with Myoclonic-Astatic Seizures (Doose Syndrome)
		24.6	 Progressive Myoclonic Epilepsies
		24.7	 Landau-Kleffner Syndrome
		24.8	 Electrical Status Epilepticus During Slow Sleep
		References
	25: Focal “Idiopathic” Epilepsies of Infancy
		25.1	 Introduction
		25.2	 Rolandic Epilepsy (or Benign Childhood Epilepsy with Centrotemporal Spikes)
			25.2.1	 Interictal EEG
			25.2.2	 Ictal EEG
			25.2.3	 Atypical Evolution
		25.3	 Early-Onset Epilepsy with Occipital Paroxysms (Panayiotopoulos Syndrome)
			25.3.1	 Interictal EEG
			25.3.2	 Ictal EEG
			25.3.3	 Atypical Evolution
		25.4	 Late-Onset Childhood Epilepsy with Occipital Paroxysms (Gastaut Type)
			25.4.1	 Interictal EEG
			25.4.2	 Ictal EEG
		25.5	 Other “Minor” Localization-Related Self-Limited Genetic Epilepsies
		25.6	 Non-familial and Familial Benign Infantile Seizures (Watanabe-Vigevano Syndrome)
			25.6.1	 Interictal and Ictal EEG
		References
	26: Non-age-Related Focal Epilepsies
		26.1	 Introduction
		26.2	 Temporal Lobe Epilepsy
			26.2.1	 Mesial Temporal Lobe Epilepsy (MTLE)
				26.2.1.1 Interictal EEG Features
				26.2.1.2 Ictal Clinical EEG Semiology
			26.2.2	 Lateral Neocortical Temporal Lobe Epilepsy (LNTLE)
				26.2.2.1 Interictal EEG Features
				26.2.2.2 Ictal Clinical EEG Semiology
		26.3	 Frontal Lobe Epilepsies
			26.3.1	 Interictal and Ictal EEG Features
		26.4	 Occipital Lobe Epilepsies
			26.4.1	 Interictal and Ictal EEG
		26.5	 Parietal Lobe Epilepsies
			26.5.1	 Interictal and Ictal EEG Features
		26.6	 Epilepsy with Gelastic Seizures
		26.7	 Rasmussen’s Syndrome
		26.8	 Conclusions
		References
	27: Genetic Generalized Epilepsies
		27.1	 Childhood Absence Epilepsy (CAE)
			27.1.1	 EEG Features
		27.2	 Juvenile Absence Epilepsy (JAE)
			27.2.1	 EEG Features
		27.3	 Juvenile Myoclonic Epilepsy (JME) (Janz Syndrome)
			27.3.1	 Neurophysiology
		27.4	 Epilepsy with Generalized Tonic-Clonic Seizures Alone (GTCSa)
		27.5	 Eyelid Myoclonia with/Without Absences (EMA) (Jeavons Syndrome)
		27.6	 Lifestyle and Drugs Can Influence EEG in GGE
		27.7	 Conclusion
		References
	28: Reflex Seizures and Reflex Epilepsies
		28.1	 Introduction to Reflex Seizures and Reflex Epilepsies
		28.2	 Epileptic Seizures and Reflex Epilepsy Related to Visual Stimuli
		28.3	 Reflex Epilepsy Calculation or Other Higher-Level Cortical Processes and by Complex Motor Performances
		28.4	 Primary Reading Epilepsy
		28.5	 Startle Epilepsy
		28.6	 Eating Epilepsy
		28.7	 Musicogenic Epilepsy
		28.8	 Hot Water Epilepsy
		28.9	 Other Unusual Seizure Triggers
		28.10	 Reflex Seizures in Patients with Malformations of Cortical Development
		28.11	 Conclusions
		References
	29: Photosensitivity and Epilepsy
		29.1	 Introduction
		29.2	 Important Issues
			29.2.1	 Why Do We Use Intermittent Photic Stimulation? How Was It Discovered to Be a Valuable Tool in Epilepsy Diagnostics and Research?
			29.2.2	 Photomyoclonic, Photoconvulsive, and Photoparoxysmal Responses: How to Use the Respective Terms Nowadays?
			29.2.3	 Photoparoxysmal Responses (PPRs) Outlasting the Stimulus or Not: Is It Relevant?
			29.2.4	 Does a PPR Equals a Seizure?
			29.2.5	 Does Photosensitivity Mean “Automatically” that the Patient Has Genetic Generalized Epilepsy (Formerly Known as Idiopathic Generalized Epilepsy)?
			29.2.6	 Is any Type of Photostimulator Appropriate?
			29.2.7	 Why Testing Different Eye Conditions with IPS?
			29.2.8	 How Can You Be Sure that a Patient Is Photosensitive?
			29.2.9	 Use of PPR Ranges in Evaluation of Epileptogenic Threshold and Treatment
		29.3	 Conclusions
		References
	30: Febrile Seizures and Febrile Status Epilepticus
		30.1	 Introduction
		30.2	 EEG in FS and FSE
		30.3	 Other Conditions with Seizures Induced by Fever
		30.4	 Conclusions
		References
	31: Paediatric Status Epilepticus
		31.1	 Introduction
		31.2	 Classification of SE
			31.2.1	 Convulsive Status Epilepticus
			31.2.2	 Nonconvulsive Status Epilepticus
			31.2.3	 SE Occurring in Neonatal and Infantile-Onset Epilepsy Syndromes
			31.2.4	 SE Occurring in Childhood and Adolescence
		31.3	 Ring Chromosome 20
		31.4	 Angelman Syndrome
		31.5	 Rett Syndrome
		31.6	 Epilepsy with Myoclonic-Atonic Seizures
		31.7	 Myoclonic Status in Nonprogressive Encephalopathy (MSNPE)
		31.8	 SE in Other Childhood Myoclonic Encephalopathies (Mitochondrial Diseases Causing SE)
		31.9	 Atypical Absence SE and Tonic Status in Lennox-Gastaut Syndrome
		31.10	 ESESS/CSWSS/Epilepsy-Aphasia Spectrum
		31.11	 Myoclonic Status in Progressive Myoclonus Epilepsies
			31.11.1	 SE Occurring Mainly in Adolescence and Adulthood
		References
	32: Status Epilepticus in Adults
		32.1	 Introduction
			32.1.1	 Epidemiology
			32.1.2	 Etiology
			32.1.3	 Definition and Diagnosis
		32.2	 EEG Pattern According to Clinical Manifestation
			32.2.1	 Generalized SE with Prominent Motor Signs
				32.2.1.1	 Tonic-Clonic SE
				32.2.1.2	 Tonic SE
				32.2.1.3	 Myoclonic SE
			32.2.2	 Focal SE
				32.2.2.1	 Focal Motor SE
				32.2.2.2	 Dysphasic or Aphasic SE
				32.2.2.3	 Focal Sensory Status Epilepticus
				32.2.2.4	 SE with Visual Seizures
				32.2.2.5	 Autonomic SE
				32.2.2.6	 Unilateral or Erratic SE
		32.3	 Diagnostic Criteria of Nonconvulsive Status Epilepticus (NCSE)
			32.3.1	 Historical Background
				32.3.1.1	 Generalized NCSE
				32.3.1.2	 Focal Status Without Prominent Motor Symptoms (Partial Complex SE)
			32.3.2	 Current Diagnostic Criteria
		32.4	 Suspected Epileptic Status or the “Ictal-Interictal Continuum”
			32.4.1	 Intermittent Rhythmic Delta Activity
			32.4.2	 Generalized or Lateralized Rhythmic Activity (RDA or LRDA)
			32.4.3	 Generalized Periodic Discharges (GPDs)
			32.4.4	 Lateralized Periodic Discharges (LPDs or PLEDs)
			32.4.5	 Triphasic Waves (TWs)
			32.4.6	 Stimulus-Induced Rhythmic, Periodic, or Ictal Discharges (SIRPIDs)
			32.4.7	 Burst-Suppression Patterns
		32.5	 EEG and Therapy in Status Epilepticus
		32.6	 Conclusion
		References
	33: Chromosomal Abnormalities and Cortical Malformations
		33.1	 Chromosomal Abnormalities
			33.1.1	 1p36 Deletion Syndrome
			33.1.2	 2q24.4 Deletion Syndrome
			33.1.3	 4p− Syndrome (Wolf-Hirschhorn Syndrome)
			33.1.4	 5q14.3 Deletion Syndrome
			33.1.5	 6q Terminal Deletion Syndrome
			33.1.6	 Trisomy 12p Syndrome
			33.1.7	 Ring Chromosome 14 Syndrome
			33.1.8	 Angelman Syndrome
			33.1.9	 Inv Dup (15) Syndrome
			33.1.10	 15q13.3 Deletion Syndrome
			33.1.11	 Ring Chromosome 20 Syndrome
			33.1.12	 Down Syndrome
			33.1.13	 Fragile X Syndrome
			33.1.14	 Klinefelter Syndrome
			33.1.15	 Xp11.22–11.23 Duplication Syndrome
			33.1.16	 XYY Syndrome
		33.2	 Cortical Malformations
			33.2.1	 Tuberous Sclerosis Complex
			33.2.2	 Focal Cortical Dysplasias Type II
			33.2.3	 Hemimegalencephaly
			33.2.4	 Lissencephaly
			33.2.5	 Subcortical Band Heterotopia (Double Cortex)
			33.2.6	 Bilateral Periventricular Nodular Heterotopia
			33.2.7	 Schizencephaly
			33.2.8	 Polymicrogyria
			33.2.9	 Focal Cortical Dysplasia Types I and III
		References
	34: Paroxysmal Nonepileptic Events
		34.1	 Syncope
			34.1.1	 Definition and Classification
				34.1.1.1	 Neurally Mediated Syncope (Reflex Syncope)
				34.1.1.2	 Orthostatic Hypotension Syncope
				34.1.1.3	 Cardiac Syncope
				34.1.1.4	 Syncope Secondary to Cerebrovascular Causes
			34.1.2	 Clinical Features
			34.1.3	 Diagnostic Work-Up
			34.1.4	 EEG Findings
			34.1.5	 Syncope in Epilepsy
		34.2	 Psychogenic Nonepileptic Seizures
			34.2.1	 Definition and Overview
			34.2.2	 Clinical Ictal Features
			34.2.3	 EEG Findings
				34.2.3.1	 Interictal EEG
				34.2.3.2	 Ictal EEG
				34.2.3.3	 Video-EEG Telemetry
			34.2.4	 Other Exams
		References
	35: Sleep Diseases
		35.1	 Insomnia
			35.1.1	 Insomnia and Instrumental Findings
			35.1.2	 CAP Role in Insomnia
		35.2	 Parasomnias
			35.2.1	 NREM Sleep Parasomnias (Disorders of Arousal)
				35.2.1.1	 Confusional Arousal
				35.2.1.2	 Sleepwalking
				35.2.1.3	 Sleep Terror (Pavor Nocturnus)
			35.2.2	 PSG Features of NREM Parasomnias
			35.2.3	 REM Parasomnias
				35.2.3.1	 REM Behavior Disorder
		35.3	 Sleep-Related Movement Disorders
			35.3.1	 Restless Legs Syndrome and Periodic Limb Movements
			35.3.2	 Propriospinal Myoclonus at Sleep Onset
			35.3.3	 Sleep-Related Bruxism
		35.4	 Epilepsy
			35.4.1	 Impact of NREM and REM Sleep
			35.4.2	 CAP and Epilepsy
			35.4.3	 Sleep-Related Hypermotor Epilepsy
		35.5	 Hypersomnia of Central Origin
			35.5.1	 Narcolepsy Types 1 and 2
			35.5.2	 Objective Findings
		35.6	 Sleep-Related Breathing Disorders
			35.6.1	 Obstructive Sleep Apnea
			35.6.2	 Central Sleep Apnea Syndromes
		35.7	 Conclusions
		References
	36: Traumatic Brain Injury
		36.1	 Introduction
		36.2	 EEG in the Acute Post-traumatic Phase
		36.3	 EEG in the Chronic Post-traumatic Phase
		36.4	 Breach Effect
		36.5	 Post-traumatic Epilepsy
		References
	37: Cerebral Tumors
		37.1	 The Role of EEG in Brain Tumors
		37.2	 EEG Patterns: Correlation with Site and Type of Brain Tumors
			37.2.1	 Cortical Tumors: Focus on Dysembryoplastic Neuro Ectodermal Tumors
			37.2.2	 Subcortical Tumors: Focus on Hypothalamic Hamartoma
			37.2.3	 Extra-axial Tumors: Focus on Meningioma
		37.3	 Tumor-Related Epilepsy: Neurophysiological Basis and Considerations
		37.4	 EEG After Brain Surgery
		References
	38: Cerebrovascular Diseases
		38.1	 Cerebral Blood Flow (CBF) and Electric Cortical Activity During Cerebral Ischemia
		38.2	 Acute Ischemic Stroke
		38.3	 Intraparenchymal Hemorrhage
		38.4	 Subarachnoid Hemorrhage
		38.5	 Subdural Hematoma
		38.6	 Other Cerebrovascular Diseases
		References
	39: Cerebral Infectious Diseases
		39.1	 Infectious Meningitis
			39.1.1	 Bacterial Meningitis
			39.1.2	 Viral Meningitis
		39.2	 Infectious Encephalitis
		39.3	 Prion Diseases
			39.3.1	 Sporadic Creutzfeldt–Jakob Disease (sCJD)
			39.3.2	 Genetic CJD (gCJD)
				39.3.2.1	 Variant Creutzfeldt-Jakob Disease (vCJD)
				39.3.2.2	 Iatrogenic CJD (iCJD)
		39.4	 Neurosyphilis
		39.5	 HIV-Related CNS Diseases
		39.6	 Brain Abscess and Subdural Empyema
		39.7	 Parasitic Brain Infections
			39.7.1	 Neurotoxoplasmosis
			39.7.2	 Neurocysticercosis
			39.7.3	 Neurotoxocariasis
			39.7.4	 Cerebral Cystic Echinococcosis (Cystic Hydatidosis)
			39.7.5	 Trypanosomiasis
			39.7.6	 Cerebral Malaria
		References
	40: Autoimmune and Inflammatory Encephalopathies
		40.1	 Autoimmune Encephalitides
			40.1.1	 Anti-intracellular Neuronal Antigen Encephalitides
			40.1.2	 Anti-cell-Surface Neuronal Antigen Encephalitides
				40.1.2.1	 Anti-NMDAR Encephalitis
				40.1.2.2	 Anti-VGKC-Complex Encephalitides: Anti-LGI1 and Anti-CASPR2 Encephalitis
					Anti-LGI1 Encephalitis
					Anti-CASPR2 Encephalitis
				40.1.2.3	 Anti-AMPAR Encephalitis
				40.1.2.4	 Anti-GABAB Receptor Encephalitis
				40.1.2.5	 Anti-GABAA Receptor Encephalitis
			40.1.3	 Hashimoto Encephalopathy or Steroid-Responsive Encephalopathy Associated with Autoimmune Thyroiditis
		40.2	 Inflammatory Encephalopathies
			40.2.1	 Rasmussen Encephalitis
			40.2.2	 Multiple Sclerosis
			40.2.3	 Primary CNS Vasculitis
			40.2.4	 Systemic Inflammatory Diseases: Neuropsychiatric Systemic Lupus Erythematosus, Neuro-Behçet’s Disease, and Neurosarcoidosis
				40.2.4.1	 Neuropsychiatric Systemic Lupus Erythematosus
				40.2.4.2	 Neuro-Behçet’s Disease
				40.2.4.3	 Neurosarcoidosis
		40.3	 Status Epilepticus in Autoimmune/Inflammatory Encephalopathies
			40.3.1	 New-Onset Refractory Status Epilepticus and Febrile Illness-Related Epilepsy Syndrome
		References
	41: Aging and Degenerative Disorders
		41.1	 EEG Changes in the Elderly
		41.2	 Use and Advantages of the EEG Recording in the Elderly
		41.3	 Dementia Syndromes
			41.3.1	 Alzheimer’s Disease
			41.3.2	 Dementia with Lewy Bodies
			41.3.3	 Frontotemporal Dementia
		41.4	 Multi-infarct Dementia
			41.4.1	 Subcortical Dementia
		References
	42: Systemic and Dismetabolic Disorders
		42.1	 Introduction
		42.2	 Liver Disease
		42.3	 Renal Disease
		42.4	 Cardiorespiratory Disease
		42.5	 Disorders of Glucose Metabolism
			42.5.1	 Hypoglycemia
			42.5.2	 Hyperglycemia
		42.6	 Electrolyte Disturbances
			42.6.1	 Hypocalcemia
			42.6.2	 Hypercalcemia
			42.6.3	 Hyponatremia
		42.7	 Thyroid Disorders
			42.7.1	 Hyperthyroidism
			42.7.2	 Hypothyroidism
			42.7.3	 Hashimoto Encephalopathy
		42.8	 Other Hormonal Disorders
			42.8.1	 Hypercortisolism and Cushing’s Syndrome
			42.8.2	 Hypocortisolism
			42.8.3	 Hypopituitarism and Hyperpituitarism
		42.9	 Eclampsia
		42.10	 Acute Porphyria
		References
	43: Migraine
		43.1	 Migraine and the Role of EEG
			43.1.1	 Interictal EEG Abnormalities
				43.1.1.1	 Background Activity Abnormalities
				43.1.1.2	 Intermittent Photic Stimulation-Induced Abnormalities
				43.1.1.3	 HV-Induced Abnormalities
				43.1.1.4	 Epileptiform Abnormalities
			43.1.2	 Ictal EEG Abnormalities
			43.1.3	 Quantitative EEG (qEEG)
		43.2	 Migraine and Epilepsy
		References
	44: Psychiatric Disorders
		44.1	 Depressive Disorders
		44.2	 Bipolar and Related Disorders
		44.3	 Anxiety Disorders
		44.4	 Schizophrenia Spectrum and Other Psychotic Disorders
		44.5	 Attention-Deficit/Hyperactivity Disorder (ADHD)
		44.6	 Autism Spectrum Disorder (ASD)
		References
	45: Effects on EEG of Drugs and Toxic Substances
		45.1	 Pharmaco-Electroencephalography: History, Methodology, and Basic Principles
		45.2	 Effects of Drugs on EEG
			45.2.1	 Antiepileptic Drugs (AEDs)
				45.2.1.1	 Effects of AEDs on Background Activity
				45.2.1.2	 Effects of AEDs on Ictal and Interictal Epileptiform Activity
			45.2.2	 Anxiolytic Drugs
			45.2.3	 Antidepressants
			45.2.4	 Antipsychotics
			45.2.5	 Anesthetics
				45.2.5.1	 Propofol
				45.2.5.2	 Dexmedetomidine
				45.2.5.3	 Ketamine
			45.2.6	 Recreational Drugs and Toxic Substances
				45.2.6.1	 Cannabinoids
				45.2.6.2	 Psychostimulant Substances
				45.2.6.3	 Ethanol
			45.2.7	 Antibiotics
				45.2.7.1	 Penicillins
				45.2.7.2	 Cephalosporins
				45.2.7.3	 Carbapenems
				45.2.7.4	 Fluoroquinolones
		References
	46: Disorders of Consciousness
		46.1	 Anatomo-Pathophysiology of Disorders of Consciousness
		46.2	 Coma, Vegetative State, and Minimally Conscious State
		46.3	 Differential Diagnosis Among Consciousness Disorders
		46.4	 Clinical Examination of Comatose Patients
		46.5	 Neurobehavioural Rating Scales
		46.6	 EEG Patterns in Coma
			46.6.1	 Background Activity
			46.6.2	 EEG Reactivity
			46.6.3	 Peculiar Coma EEG Patterns
				46.6.3.1	 Periodic and Rhythmic Patterns: Epileptiform Activity
				46.6.3.2	 Spindle Coma and Beta Coma
				46.6.3.3	 Alpha, Alpha-Theta, and Theta Coma Patterns
				46.6.3.4	 Burst-Attenuation and Burst-Suppression Patterns
				46.6.3.5	 Electrocerebral Inactivity
		46.7	 EEG Patterns in Vegetative State and Minimally Conscious State
		46.8	 EEG in Coma Prognosis
		References
	47: Brain Death
		47.1	 History of Brain Death Determination
		47.2	 Clinical Diagnosis of Brain Death
		47.3	 Ancillary Tests
			47.3.1	 EEG
				47.3.1.1	 Technical Standards for EEG Recording in Brain Death
			47.3.2	 Evoked Potentials
			47.3.3	 Assessment of Cerebral Blood Flow
				47.3.3.1	 Conventional Four-Vessel Angiography
				47.3.3.2	 Computed Tomography Angiography (CTA) and CT Perfusion
				47.3.3.3	 Magnetic Resonance Angiography (MRA) and MR Perfusion
				47.3.3.4	 Single-Photon Emission Computed Tomography (SPECT)
				47.3.3.5	 Transcranial Doppler
		47.4	 Pediatric Brain Death Determination
		47.5	 Brain Death Worldwide
		47.6	 Legal Aspects of Brain Death Determination in Italy
			47.6.1	 Modalities for the Execution of EEG
			47.6.2	 Donation of Organs in Italy
		References
	48: Neuromonitoring and Emergency EEG
		48.1	 Intraoperative EEG monitoring
			48.1.1	 EEG Monitoring During Carotid Endarterectomy
			48.1.2	 EEG Monitoring in Cardiothoracic Surgery
		48.2	 EEG Monitoring in ICU
			48.2.1	 Continuous EEG (cEEG)
		48.3	 Emergency EEG (eEEG)
		References
EEG Glossary
EEG Reporting
	Introduction
	EEG Description
	Interpretation
		Impression
		Clinical Correlation
	The Standardized Computer-Based Organized Reporting of EEG (SCORE)
	References