Absolute Epilepsy and EEG Rotation Review Essentials for Trainees Mona Sazgar Michael G. Young 123 Absolute Epilepsy and EEG Rotation Review Mona Sazgar • Michael G. Young Absolute Epilepsy and EEG Rotation Review Essentials for Trainees Mona Sazgar Michael G. Young Department of Neurology Department of Neurology University of California Riverside, CA Irvine, CA USA USA ISBN 978-3-030-03510-5 ISBN 978-3-030-03511-2 (eBook) https://doi.org/10.1007/978-3-030-03511-2 Library of Congress Control Number: 2018963216 © Springer Nature Switzerland AG 2019 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recita- tion, broadcasting, reproduction on microfilms or in any other physical way, and transmission or infor- mation storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publica- tion does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland To Behrouz, my love To Neema, my pride and joy To mom and dad, my guides Mona Sazgar To Kieu, for her patience and unwavering support; to my parents, Michael and Karina; and to all those in the medical field who continue to inspire me, especially Kieu, Joe, Shaun, and Sergio. Michael G. Young Foreword Dear reader, Oh, how far we have come and thankfully so since I was a neurology trainee! Without revealing my exact vintage, my neurophysiology rotation involved turning the pages of stacks of electroencephalograms (EEGs). As a second year resident in neurology, I remember my attending pointing to sharp-appearing waves in temporal lobe areas and asking me whether the patient has epilepsy. Although the answer seemed obvious, I knew there was a trick to it, otherwise why the question. I was thinking that my guess would have a 50% chance of being correct. This remarkable volume by Drs. Sazgar and Young will ensure that neurology residents and fellows are not at a loss when asked this question and will be able to answer correctly and, further, to understand why. This simple question remains relevant and instructive because human electroencephalography has not fundamentally changed since it was standardized in the 1920s. However, the formats for evaluating and interpreting EEG data have become myriad, to the great benefit of patient care. The educational endeavor of the authors is similarly to evolve a classic approach into something new. They are incorporating into one volume two fields that have been traditionally taught separately, EEG reading and epilepsy care. In the era of epilepsy monitoring units, prolonged ambulatory EEGs and quantitative EEG, as well as syndrome- specific epilepsy treatments, the two topics are completely intertwined; the clinical implications of one are not understood without knowledge of the other. Most train- ees participate in both epilepsy patient care and EEG reading during their rotations, and until this book, there was no single resource for such. Drs. Sazgar and Young have addressed an important gap in neurology training by providing the EEG and epilepsy “essentials” for trainees. This book will be impor- tant and truly essential for trainees and for neurologists beyond training who are seeking to advance their skills. The concise format, with the effective use of bullets, allows for quick and ready translation of the educational pearls to clinical imple- mentation. Such a reliable, comprehensive yet circumscribed scholastic source is sought out in this information age. Dr. Mona Sazgar is a valued friend and academic colleague. She is an esteemed and respected neurology educator and a gifted clinician. She has a keen and dedi- cated interest in furthering the best care for women with epilepsy. I had the great pleasure of writing and editing a book with Dr. Sazgar, and during that collabora- tion, I experienced her persistence and grace firsthand. She once told me that one of ix x Foreword her character flaws is to be “pathologically early” for every appointment, which is one of the most laudable traits I can think of. Her timing for publishing this book could not be better, given that many academic programs are onboarding the ACGME-accredited epilepsy fellowship. Dr. Sazgar had the insight to involve a recent epilepsy fellowship graduate and current junior attending, Dr. Michael G. Young, as a co author for the Essentials. His perspective ensures that the educa- tional content meets the “boots-on-the-ground” needs, in a manner that connects knowledge with practicality. It is my great honor to be part of this publication. And finally, as to answer my attending’s question, the trick was that the sharp waves were actually normal variants called wicket spikes explained in Chap. 7 of the book, and the patient did not have epilepsy. New York, NY, USA Cynthia L. Harden Preface Throughout my academic career as an epileptologist, I had the pleasure of teaching epilepsy and EEG to more than 30 epilepsy and clinical neurophysiology fellows and hundreds of neurology residents and students. I passionately encouraged train- ees to take up a career in epilepsy and attempted to make the subject simplified and desirable. My goal was that the trainees do not treat learning epilepsy and EEG as another hurdle to overcome before they graduate. I wanted them to enjoy their learn- ing experience. One question that consistently came up in every encounter was which textbook to read as a reference. Of course, there are many comprehensive textbooks of epilepsy and atlases of EEGs published by my accomplished col- leagues over the years. However, for trainees with extremely busy schedule who spend a month or a couple of weeks doing a clinical rotation, it is almost impossible to read through a comprehensive textbook. Their consistent feedback was that my lectures and take-home information they received during my rounds were most practical and what they needed to learn. It occurred to me that I can help thousands of residents, fellows, students, and clinicians to have access to my years of experi- ence in teaching epilepsy and EEG by giving them a concise, yet comprehensive collection of the crucial points they need to know when time is short. I invited my young and astute colleague, Dr. Michael G. Young, to join me in this endeavor as co author and to contribute his invaluable fresh perspective. We hope that our book will put the readers at ease and give them confidence that they have learned what they needed to know about epilepsy and EEG in an uncomplicated way. Together, we offer this simplified, bullet format collection of the essentials of epilepsy and EEG to the trainees and clinicians to take home. Irvine, CA, USA Mona Sazgar xi Acknowledgment We would like to express our sincere appreciation to Dr. Anton Hasso, professor of radiologic sciences and director of neuroimaging research at the University of California, Irvine, for his contribution to some of the neuroimaging cases used in this book. Also, our appreciation goes to our dear colleagues at the UCI Comprehensive Epilepsy Program for their suggestions regarding patient cases including Dr. Lilit Mnatsakanyan, Dr. Indranil Sen-Gupta, Dr. Jack Lin, and Dr. Xiaoying Lu. xiii Conten ts Part I Epilepsy 1 What Is Not a Seizure? ������������������������������������������������������������������������������ 3 1.1 Evaluating a Spell . 3 1.2 Seizure Mimickers ������������������������������������������������������������������������������ 3 1.2.1 Syncope . 3 1.2.2 Migraine ���������������������������������������������������������������������������������� 4 1.2.3 Transient Ischemic Attacks (TIAs) . 4 1.2.4 Sleep Disorders . 4 1.2.5 Paroxysmal Movement Disorders (PMD) . 5 1.2.6 Psychogenic Non-epileptic Events or Seizures (PNES) . 5 References ���������������������������������������������������������������������������������������������������� 7 2 Seizures and Epilepsy �������������������������������������������������������������������������������� 9 2.1 Definition of Seizure and Epilepsy . 9 2.2 Seizure Types and Classification . 10 2.2.1 ILAE 2017 Basic Classification of Seizures Types ���������������� 10 2.2.2 ILAE 2017 Expanded Classification of Seizures Types . 11 2.3 Risk Factors for Epilepsy �������������������������������������������������������������������� 12 2.4 Causes of Seizures ������������������������������������������������������������������������������ 12 2.4.1 Genetic ������������������������������������������������������������������������������������ 12 2.4.2 Metabolic ��������������������������������������������������������������������������������