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*Only for medical professionals to read for reference.
Keep up with the times and keep learning! At the 24th National Neurology Conference of the Chinese Medical Association in September 2021, Professor Wang Qun from Beijing Tiantan Hospital, Capital Medical University, shared with us the update of the American Society of Clinical Neurophysiology (ACNS) this year 2021 Second Edition Standard Terminology for Severe EEG Monitoring, and gave a detailed introduction and interpretation of the important updated content.
Let us follow in the footsteps of Professor Wang and learn the updated content together! Background introduction In 2012, the American Society of Clinical Neurophysiology (ACNS) first published the standard terminology for critically ill EEG monitoring, objectively and systematically describing the background activities, periodic/rhythmic discharge characteristics and additional waveforms of EEG; It has greatly promoted clinical communication and scientific research in different centers; as more rare characteristic waveforms have been reported in the past 10 years, further research needs to be based on standardized definitions
.
In May 2021, ACNS updated the terms related to severe EEG, and proposed the "2021 Second Edition Standard Terminology for Severe EEG Monitoring".
The main updates are reflected in: ①Additions to the terms proposed in the old version to further clarify The boundaries of different types of waveforms; ②Propose new terms, such as: electrical clinical seizures, short-onset rhythmic discharges, seizure-interictal continuum, cyclic encephalopathy-related waveforms, etc.
; ③description of waveform "parameters" Modifier changes include further quantification and correction of how to describe the degree or grade of a certain modifier
.
Figure 1: Screenshot of the cover of the paper.
Next, the "Medical Neurology Channel" will lead you to learn about the relevant updates in the second edition of 2021! 13 update points all in one go! 1.
New term: State Change Figure 2: State Change There are two states alternately appearing on the EEG.
State 1 has a better level of consciousness than State 2, and stimulation can induce a transition from EEG background state 2 to state 1 ( (See Figure 2); Professor Wang Qun pointed out that this state change may be a good phenomenon for the patient.
After a certain stimulus, the patient’s EEG changes, indicating that the patient has a certain degree of response to external stimuli.
Responsive
.
2.
New term: Cyclic Alternating Pattern of Encephalopathy (CAPE) Figure 3: Cyclic Alternating Pattern of Encephalopathy This term indicates that the EEG background wave continuously undergoes a cycle of transformation in pattern 1 and pattern 2: ①Each mode lasts at least 10 seconds; ②Spontaneously and regularly carries out the cycle of the two modes; ③There are at least 6 cycles
.
This kind of circulation is more common in patients with encephalopathy, such as encephalopathy caused by acute head injury
.
3.
Update terminology: update the stimulation mode to Stimulus-Induced (SI, stimulus-induced) and Stimulus-Terminated (ST, stimulus terminated) two modes.
This mode is spontaneous, namely Spontaneous, and it is not clear why and Clinical significance, after giving certain stimulation, brain electrical activity may intensify, improve or stop disappearing
.
4.
Add classification term: Unilateral Independent In the first edition of the guide in 2012, there were only four classifications based on location, namely: Generalized, Lateralized, Bilateral independent (bilateral independence), Multifocal (multifocal), this time Unilateral Independent (ipsilateral independence) was added to the second edition of the terminology, making the total classification into five
.
The term refers to the simultaneous occurrence of two independent periodic/rhythmic discharges in the same hemisphere, which are not synchronized with each other
.
The two waveforms must appear at the same time.
If there is no overlap in time, they should belong to two separate LDPS (Lateralized periodic discharges, unilateral periodic discharges)
.
5.
More detailed description of terms: Evolution describes the form of evolution in more detail, including frequency (frequency) (Figure 4), morphology (shape) (Figure 5), and location (location) ( Figure 6) Detailed classification of three aspects
.
Figure 4: The evolution of frequency Figure 5: The evolution of shape Figure 6: The evolution of position VI.
More detailed description of terms: Fluctuating (fluctuation) not only refines the form of evolution, but also refines the form of fluctuations.
The description is divided into three detailed categories: frequency (frequency), morphology (shape), and location (location)
.
Professor Wang Qun pointed out that the EEG that we see in EEG does not evolve in one direction, but fluctuates in different states.
In this case, the diagnosis is the most difficult.
In clinical practice, we Discriminate more carefully, sometimes requiring drug intervention to determine
.
7.
New term: Electrographic Seizures (ESz, EEG seizure).
This term means: EEG seizures, or subclinical seizures, forms of seizures that can be detected on EEG
.
It is defined as: epileptic discharge frequency is greater than 2.
5Hz and lasts ≥10s; or any kind of evolution mode can be diagnosed as long as the duration is ≥10s
.
8.
New term: Electroclinical seizure (ECSz, electrical clinical seizure) refers to the appearance of clinical symptoms in addition to changes in EEG.
This situation is called electrical clinical seizure
.
Its EEG pattern can be diagnosed when it meets any of the following: ①Any pattern of EEG seizure or EEG evolution (regardless of EEG duration) that has an exact relationship with the clinic; ②After injection of antiepileptic drugs, the brain EEG and clinical symptoms were improved at the same time; ③After the injection of anti-epileptic drugs, any EEG pattern and clinical symptoms were improved at the same time
.
9.
New term: Electrographic Status Epilepticus (ESE, status epilepticus recorded by EEG) provides a more detailed explanation of its definition: an epileptic seizure recorded by EEG lasts> 10 minutes or is a continuous EEG recorded seizure.
Not more than 10 minutes, but the sum of the recorded seizure time within 60 minutes exceeds 20% of the total seizure time.
ESE can also be diagnosed
.
10.
New term: Electroclinical Status Epilepticus (ECSE, electrical clinical status epilepticus).
Its definition is the same as ESE.
It refers to an electrical clinical seizure lasting more than 10 minutes or an electrical clinical seizure does not exceed 10 minutes, but within 60 minutes The total electrical clinical seizure time exceeds 20% of the total seizure time, and ECSE can also be diagnosed
.
11.
New term: Brief Potentially lctal Rhythmic Discharges (BIRDs) Figure 7: Brief Potentially lctal Rhythmic Discharges EEG seizures do not reach 10 seconds, and the diagnosis of seizures cannot be made, but there may be transient rhythmic discharges of potential seizures, which are also called minor seizures
.
12.
Determine the term: The Ictal-Interictal Continuum (IIC, Interictal Interictal Continuum) has redefined the definition of the term, and it can be diagnosed if it meets any of the following conditions: ①A.
Any frequency between 1.
0~2.
5Hz Within the range, the periodic or rhythmic discharge lasts more than 10s (Figure 8); ②B.
Any frequency in the range of 1.
0~2.
5Hz, the periodic discharge lasts more than 10s, and there may be other volatility and discharge similar to the onset period.
Evolutionary characteristic waveform (Figure 8); Figure 8: Interictal continuum ③C.
Any rhythmic discharge with a frequency in the range of 0.
5~1.
0Hz and lasting more than 10s, and there may be superimposition of other waveform components (Figure 8); ④D.
Any unilateral rythmic delta activity (rythmic delta activity, RDA), including LRDA, BIRDA, UIRDA, MfRDA, the frequency is greater than 1.
0 Hz and lasts for more than 10 seconds, and there may be other similar episodes of discharge at the same time Waveforms with characteristics of volatility and evolution (Figure 9); Figure 9: Interictal continuum ⑤E.
Any unilateral rythmic delta activity (RDA), including LRDA, BIRDA, UIRDA , MfRDA, the frequency is greater than 1.
0Hz and lasts for more than 10 seconds, and there may be superposition of other waveform components (Figure 9); Figure 9: Onset-Interictal continuum 13.
Propose a new concept: Plus (+) additional features : And need to distinguish the special subtype of +F-Extreme Delta Brush (EDB) (Figure 10) EDB emphasizes: +F has a high frequency of occurrence (>50%): There is a fixed relationship between +F and delta wave discharge The positional relationship
.
Figure 10: Recognition of extreme delta brushes.
The main update content of the Take home message includes: the main terminology of the old version: Unilateral Independent; new term: Brief Potentially lctal Rhythmic Discharges (BIRDs) ); New definition: "Subclinical epileptic seizures (ESz)", "Subclinical status epilepticus (ESE)", "Electrical clinical epileptic seizures (ECSz)", "Electrical clinical status epilepticus (ECSE)" "Onset period- Interictal continuum (IIC)"; EEG background descriptors increased: State Changes, cyclic encephalopathy-related waveforms (CAPE); changes in main modifiers: Two stimulation modes: Stimulus- Induced, SI) and Stimulus-Terminated (ST); and extreme delta brush (EDB)
.
Expert profile Professor Wang Qun Wang Qun is a doctor of medicine, chief physician, professor, and doctoral supervisor
.
Director of Epilepsy Department, Neurology Center, Beijing Tiantan Hospital, Capital Medical University
.
Beijing's overseas high-level introduction of talents (Haiju Project) and Beijing's special experts
.
Deputy leader of the EEG and Epilepsy Group of the Neurology Branch of the Chinese Medical Association, member of the Epilepsy Specialty Committee of the Neurology Branch of the Chinese Medical Doctor Association and member of the Standing Committee of the Neuromodulation Specialty Committee
.
Standing director of the Chinese Anti-Epilepsy Association and Deputy Chairman of the Committee on Drug Therapy, Committee on Neuromodulation, and Committee on Epilepsy Community Management
.
Member of the Standing Committee of the EEG and Neuroelectrophysiology Branch of the Chinese Anti-Epilepsy Association and deputy leader of the critical brain function monitoring group
.
Chairman of the Epilepsy Committee of the Beijing Neurological Society, Vice President of the Beijing Anti-Epilepsy Association, and Deputy Leader of the Epilepsy Group of the Neurology Branch of the Beijing Medical Association
.
"Chinese Journal of Neurology", "Journal of Clinical Neurology", "Chinese Journal of Modern Neurology", Acta Neurologica Scanidnavica, Acta Epileptologica editorial board
.
The content of this article is compiled from the lecture of Professor Wang Qun at the 24th National Neurology Conference of the Chinese Medical Association-"2021 Severe EEG Monitoring Terminology Update"
.
Keep up with the times and keep learning! At the 24th National Neurology Conference of the Chinese Medical Association in September 2021, Professor Wang Qun from Beijing Tiantan Hospital, Capital Medical University, shared with us the update of the American Society of Clinical Neurophysiology (ACNS) this year 2021 Second Edition Standard Terminology for Severe EEG Monitoring, and gave a detailed introduction and interpretation of the important updated content.
Let us follow in the footsteps of Professor Wang and learn the updated content together! Background introduction In 2012, the American Society of Clinical Neurophysiology (ACNS) first published the standard terminology for critically ill EEG monitoring, objectively and systematically describing the background activities, periodic/rhythmic discharge characteristics and additional waveforms of EEG; It has greatly promoted clinical communication and scientific research in different centers; as more rare characteristic waveforms have been reported in the past 10 years, further research needs to be based on standardized definitions
.
In May 2021, ACNS updated the terms related to severe EEG, and proposed the "2021 Second Edition Standard Terminology for Severe EEG Monitoring".
The main updates are reflected in: ①Additions to the terms proposed in the old version to further clarify The boundaries of different types of waveforms; ②Propose new terms, such as: electrical clinical seizures, short-onset rhythmic discharges, seizure-interictal continuum, cyclic encephalopathy-related waveforms, etc.
; ③description of waveform "parameters" Modifier changes include further quantification and correction of how to describe the degree or grade of a certain modifier
.
Figure 1: Screenshot of the cover of the paper.
Next, the "Medical Neurology Channel" will lead you to learn about the relevant updates in the second edition of 2021! 13 update points all in one go! 1.
New term: State Change Figure 2: State Change There are two states alternately appearing on the EEG.
State 1 has a better level of consciousness than State 2, and stimulation can induce a transition from EEG background state 2 to state 1 ( (See Figure 2); Professor Wang Qun pointed out that this state change may be a good phenomenon for the patient.
After a certain stimulus, the patient’s EEG changes, indicating that the patient has a certain degree of response to external stimuli.
Responsive
.
2.
New term: Cyclic Alternating Pattern of Encephalopathy (CAPE) Figure 3: Cyclic Alternating Pattern of Encephalopathy This term indicates that the EEG background wave continuously undergoes a cycle of transformation in pattern 1 and pattern 2: ①Each mode lasts at least 10 seconds; ②Spontaneously and regularly carries out the cycle of the two modes; ③There are at least 6 cycles
.
This kind of circulation is more common in patients with encephalopathy, such as encephalopathy caused by acute head injury
.
3.
Update terminology: update the stimulation mode to Stimulus-Induced (SI, stimulus-induced) and Stimulus-Terminated (ST, stimulus terminated) two modes.
This mode is spontaneous, namely Spontaneous, and it is not clear why and Clinical significance, after giving certain stimulation, brain electrical activity may intensify, improve or stop disappearing
.
4.
Add classification term: Unilateral Independent In the first edition of the guide in 2012, there were only four classifications based on location, namely: Generalized, Lateralized, Bilateral independent (bilateral independence), Multifocal (multifocal), this time Unilateral Independent (ipsilateral independence) was added to the second edition of the terminology, making the total classification into five
.
The term refers to the simultaneous occurrence of two independent periodic/rhythmic discharges in the same hemisphere, which are not synchronized with each other
.
The two waveforms must appear at the same time.
If there is no overlap in time, they should belong to two separate LDPS (Lateralized periodic discharges, unilateral periodic discharges)
.
5.
More detailed description of terms: Evolution describes the form of evolution in more detail, including frequency (frequency) (Figure 4), morphology (shape) (Figure 5), and location (location) ( Figure 6) Detailed classification of three aspects
.
Figure 4: The evolution of frequency Figure 5: The evolution of shape Figure 6: The evolution of position VI.
More detailed description of terms: Fluctuating (fluctuation) not only refines the form of evolution, but also refines the form of fluctuations.
The description is divided into three detailed categories: frequency (frequency), morphology (shape), and location (location)
.
Professor Wang Qun pointed out that the EEG that we see in EEG does not evolve in one direction, but fluctuates in different states.
In this case, the diagnosis is the most difficult.
In clinical practice, we Discriminate more carefully, sometimes requiring drug intervention to determine
.
7.
New term: Electrographic Seizures (ESz, EEG seizure).
This term means: EEG seizures, or subclinical seizures, forms of seizures that can be detected on EEG
.
It is defined as: epileptic discharge frequency is greater than 2.
5Hz and lasts ≥10s; or any kind of evolution mode can be diagnosed as long as the duration is ≥10s
.
8.
New term: Electroclinical seizure (ECSz, electrical clinical seizure) refers to the appearance of clinical symptoms in addition to changes in EEG.
This situation is called electrical clinical seizure
.
Its EEG pattern can be diagnosed when it meets any of the following: ①Any pattern of EEG seizure or EEG evolution (regardless of EEG duration) that has an exact relationship with the clinic; ②After injection of antiepileptic drugs, the brain EEG and clinical symptoms were improved at the same time; ③After the injection of anti-epileptic drugs, any EEG pattern and clinical symptoms were improved at the same time
.
9.
New term: Electrographic Status Epilepticus (ESE, status epilepticus recorded by EEG) provides a more detailed explanation of its definition: an epileptic seizure recorded by EEG lasts> 10 minutes or is a continuous EEG recorded seizure.
Not more than 10 minutes, but the sum of the recorded seizure time within 60 minutes exceeds 20% of the total seizure time.
ESE can also be diagnosed
.
10.
New term: Electroclinical Status Epilepticus (ECSE, electrical clinical status epilepticus).
Its definition is the same as ESE.
It refers to an electrical clinical seizure lasting more than 10 minutes or an electrical clinical seizure does not exceed 10 minutes, but within 60 minutes The total electrical clinical seizure time exceeds 20% of the total seizure time, and ECSE can also be diagnosed
.
11.
New term: Brief Potentially lctal Rhythmic Discharges (BIRDs) Figure 7: Brief Potentially lctal Rhythmic Discharges EEG seizures do not reach 10 seconds, and the diagnosis of seizures cannot be made, but there may be transient rhythmic discharges of potential seizures, which are also called minor seizures
.
12.
Determine the term: The Ictal-Interictal Continuum (IIC, Interictal Interictal Continuum) has redefined the definition of the term, and it can be diagnosed if it meets any of the following conditions: ①A.
Any frequency between 1.
0~2.
5Hz Within the range, the periodic or rhythmic discharge lasts more than 10s (Figure 8); ②B.
Any frequency in the range of 1.
0~2.
5Hz, the periodic discharge lasts more than 10s, and there may be other volatility and discharge similar to the onset period.
Evolutionary characteristic waveform (Figure 8); Figure 8: Interictal continuum ③C.
Any rhythmic discharge with a frequency in the range of 0.
5~1.
0Hz and lasting more than 10s, and there may be superimposition of other waveform components (Figure 8); ④D.
Any unilateral rythmic delta activity (rythmic delta activity, RDA), including LRDA, BIRDA, UIRDA, MfRDA, the frequency is greater than 1.
0 Hz and lasts for more than 10 seconds, and there may be other similar episodes of discharge at the same time Waveforms with characteristics of volatility and evolution (Figure 9); Figure 9: Interictal continuum ⑤E.
Any unilateral rythmic delta activity (RDA), including LRDA, BIRDA, UIRDA , MfRDA, the frequency is greater than 1.
0Hz and lasts for more than 10 seconds, and there may be superposition of other waveform components (Figure 9); Figure 9: Onset-Interictal continuum 13.
Propose a new concept: Plus (+) additional features : And need to distinguish the special subtype of +F-Extreme Delta Brush (EDB) (Figure 10) EDB emphasizes: +F has a high frequency of occurrence (>50%): There is a fixed relationship between +F and delta wave discharge The positional relationship
.
Figure 10: Recognition of extreme delta brushes.
The main update content of the Take home message includes: the main terminology of the old version: Unilateral Independent; new term: Brief Potentially lctal Rhythmic Discharges (BIRDs) ); New definition: "Subclinical epileptic seizures (ESz)", "Subclinical status epilepticus (ESE)", "Electrical clinical epileptic seizures (ECSz)", "Electrical clinical status epilepticus (ECSE)" "Onset period- Interictal continuum (IIC)"; EEG background descriptors increased: State Changes, cyclic encephalopathy-related waveforms (CAPE); changes in main modifiers: Two stimulation modes: Stimulus- Induced, SI) and Stimulus-Terminated (ST); and extreme delta brush (EDB)
.
Expert profile Professor Wang Qun Wang Qun is a doctor of medicine, chief physician, professor, and doctoral supervisor
.
Director of Epilepsy Department, Neurology Center, Beijing Tiantan Hospital, Capital Medical University
.
Beijing's overseas high-level introduction of talents (Haiju Project) and Beijing's special experts
.
Deputy leader of the EEG and Epilepsy Group of the Neurology Branch of the Chinese Medical Association, member of the Epilepsy Specialty Committee of the Neurology Branch of the Chinese Medical Doctor Association and member of the Standing Committee of the Neuromodulation Specialty Committee
.
Standing director of the Chinese Anti-Epilepsy Association and Deputy Chairman of the Committee on Drug Therapy, Committee on Neuromodulation, and Committee on Epilepsy Community Management
.
Member of the Standing Committee of the EEG and Neuroelectrophysiology Branch of the Chinese Anti-Epilepsy Association and deputy leader of the critical brain function monitoring group
.
Chairman of the Epilepsy Committee of the Beijing Neurological Society, Vice President of the Beijing Anti-Epilepsy Association, and Deputy Leader of the Epilepsy Group of the Neurology Branch of the Beijing Medical Association
.
"Chinese Journal of Neurology", "Journal of Clinical Neurology", "Chinese Journal of Modern Neurology", Acta Neurologica Scanidnavica, Acta Epileptologica editorial board
.
The content of this article is compiled from the lecture of Professor Wang Qun at the 24th National Neurology Conference of the Chinese Medical Association-"2021 Severe EEG Monitoring Terminology Update"
.
