Lecture Details

Criteria for identifying interictal epileptiform discharges
Sandor Benickzy

Sándor Beniczky is board-certified neurologist, clinical neurophysiologist and epileptologist. He is professor at Aarhus University Hospital, and he is the head of the Clinical Neurophysiology Department at the Danish Epilepsy Centre.
He is editor-in-chief of Epileptic Disorders, member of the Education Council,
Congress Council and Publication Council of the ILAE, and past-chair of the
joint EEG taskforce of the IFCN and ILAE. The main research interest of Dr. Beniczky is EEG and epilepsy, focusing on electromagnetic source imaging, seizure detection, standardisation and quality-assurance in clinical neurophysiology. He has supervised 11 Ph.D. students. He is author of 181 peer-reviewed papers and 22 book chapters.

Interictal epileptiform EEG discharges (IEDs) are the most commonly used biomarker for epilepsy. In skilled hands, identifying IEDs helps in diagnosing and classifying patients with epilepsy. However, over-reading EEG, i.e. misinterpreting normal phenomena as IEDs is the most frequent cause of misdiagnosing epilepsy. The International Federation of Clinical Neurophysiology (IFCN) proposed an operational definition of IEDs, consisting of six morphological criteria. The learning objective of this lecture is that the audience becomes familiar with the IFCN criteria and be able to apply them in clinical practice. We will review the evidence supporting the accuracy of the IFCN criteria, with emphasis on the number and types of criteria necessary for identifying the IEDs, and on the influence of repetition rate within the recordings. We will present a novel way of identifying IEDs in source space, as opposed to the conventional review of EEG in sensor space. Learning the operational criteria of IEDs has proved to improve the inter-rater agreement and the diagnostic accuracy of trainees in EEG reading. Learning these criteria and applying them in clinical practice will decrease misdiagnosis of epilepsy.