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CLUES TO ANATOMIC LOCATION The 10-20 system or International 10-20 system is

RELATED TO an internationally recognized method to describe and
apply the location of scalp electrodes in the context of
EEG INTERPRETATION
an EEG test or experiment.
This method was developed to ensure standardized
reproducibility so that a subject's sludies could be
Kurnia Kusumastuti compared over time and subjects could be compared
School of Medicine, Airlangga University.
Surabaya to each other.

This system is based on the relationship between

the location of an electrode and the underlying area of
cerebral cortex
The "10" and "20" refer to the fact that the actual
distances between adjacent electrodes are either i 0%
or 20% of the total front-back or right-left distance
of the skull.
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There are 2 kinds of recording

1. Extracranial recording
2. Intracranial recording
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To find the location

Self Reporting :
Advantages:
Audio recording : record of clinical episodes such as
Simple
verbalization
Requires little special equipment
Behavioural monitoring
Easy to implement
- Self reporting : daily diary or log
- Observer reporting : use of a pushbutton Practical, useful for Infrequent seizures and
event marker by the bedside have warning and memory
- Video recording

Disadvantages
Correlation is subjective
Observer reporting :
Temporal correlation may be inaccurate even when Advantage
event marker is used
Practical way to monitor patients with
Not possible for the patients who have no warning
infrequen seizure for which they have no
and memory
warning or memory
lctal discriptions may not be obtained Disadvantages
Record of behaviour may be not detail
Temporal correlation may be inaccurate
Seizure may be missed
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Video recording
Principal and the most effective means of behaviour
monitoring in patient setting
Patient behaviour is continously recorded on video
simultaniously with EEG

Advantages Associated direct EEG correlation

Objective record of behaviour
Available for replay
Interaction between monitoring personnel and patient,
when properly structured , define the events more
explicitly
Associated direct EEG correlation
Temporal correlations accurate when
synchronization achieved with time code
generators or same tape recording
Useful in seizures of all types even if minimal
behavioural manifestations are initially
unrecognized
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Behaviour Data analysis

Disadvantages Event analysis
Specialized equipment required Pay attention to sequence and character of
When recording without personnel present, - Motor activity
interactive assessments of neurological function are
- Verbalization
unavailable
- Responsiveness to stimuli
Major problem : freedom of movement is limited by
the necessity for patient to stay in view of the camera - Any other noteworthy features

Correlation with EEG

EEG that is temporarily concurrent with the clinical
episode in question should be analyzed in detail for
significant change of progression in pattern, with
particular emphasis on those that are ictal in character

;
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Recognizing Ictal Pattern

Well-formed epileptiform spike-and-wave patterns

Presence of 'field'
e_ regional lateralized generalyzed
Typical ictal progression
eg low voltage fast activity slower with higher
amplitude
Other supporting EEG activities e.g Post ictal slowing
Appropriate interictal abnormalities in other portion
of the record

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2 types of epile ptiform activities

Interictal Epilept form Discharges (lEDs)

Ictal Epileptiform Discharges

( Electrographic Seizure Pattern )

2/22/1016 27
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Tipe Intcrictal Epileptiform Discharges

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Regional (fokal)
General
- Spikes (5p|
- Spikes (Sp)
- Sharp waves (SW|
- Spike & wave complexes
- Benign Epileptiform
(SWC)
Discharges of Childhood
(BFEDC) - 3 SWC

- Polyspikes (PSP) - Slow SWC

- Photo-paroxysmal Response - Polyspikes (PSP)

(PR) - Hypsarrhythmia (Hyp)
- Photo-paroxysmal
Response (PR)

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Take home massage

Ti> find the anatomical location of the lesion in relation to EE1G.
we have to get information of
- Event analysis
Pay attention to sequence and character of
- Motor activity
- Verbalization
- Responsiveness to stimuli
- Any other noteworthy features
- Correlation with EEG
EEG that is temporarily concurrent with the clinical episode in
question should be analyzed in detail for significant change of
progression in pattern, with particular emphasis on those that
are iclal in character

10