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Introduction to Pediatric EEG

Philip J. Holt, M.D.
Pediatric Neurology    Emory University School of Medicine

This is a basic introduction to Pediatric EEG and part of the Neurophysiology Fellows teaching lecture series. This covers from 1 month to age 20. There is another presentation for Neonatal and Newborn EEG. Pediatric EEG like Pediatric Neurology differs from Adult EEG and Adult Neurology because the electrical activity of the brain changes during growth and development. Therefore, children develop different pathological conditions from adults that are often age specific. The EEG recording itself is different in children than adults because the brain, meninges, skull, scalp, head size as well as the child's behavior and ability to cooperate all change over time. Therefore, Pediatric EEGs must be recorded and interpreted with special attention given to the child's age and developmental level. An EEGer must possess knowledge of normal as well as abnormal features for each age. Interpretation of pediatric EEGs requires the understanding of what Blume calls:

  1. Normalities
  2. Curiosities
  3. Abnormalities

I. Normalities: Normal Pediatric EEG

Gestational Age(GA) = time in weeks from conception based on LMP
Conceptual Age (CA) = gestational age + chronological age(time from birth)


Infancy: Age 1 month to 12 months
Toddler/Early Childhood: 1-3 Years of Age:

Pre-school and Early Childhood: 3 to 6 Years of Age

Elementary School Age/Late Childhood: 6 to 12 Years
Adolescence: 13 to 19 years:
II. Pediatric EEG Curiosities



Photic Stimulation:
Photic stimulation (PS) is a very useful and important activation procedure in Pediatric EEG because of the activation of Generalized Spike-Wave activity. This is a common finding in children wiht Primary Generalized Epilepsy. Of note, children investigated after seizures caused by Pokemon TV episode in Japan were found to have partial (focal onset) seizures induced by photic stimulation.
The Photoparoxysmal Response (PPR) is bilaterally synchronous, generalized spike-and-slow-wave and can have multiple spike and slow wave complexes to repetitive flash stimulation (Chatrian et al., 1983), poly-spike waves are the most significant abnormality. Reilly and Peters (1973) report Prolonged PPR (spike-wave discharges outlasts the flash stimulus) associated with seizures in a significantly higher incidence than Self-Limited PPR (spike wave ceases when the flash stops).Jayakar and Chiappa (1990) found no difference in clinical seizures for individuals with prolonged PPS and self-limited PPS on EEG.
Puglia, Brenner and Soso: (Pittsburgh University and Western Psychiatric Institute) reviewd 9,738 EEGs recorded over 6 years for the effect of PS. 85 records in 71 patients contained a PPR (0.9%). Charts of 68 patients were analyzed (charts lost in 3): ages ranged from 7 years to 60 years. They also looked at age matched controls with EEGs performed in the same month. Overall conclusion was that individual with PPR and other Epileptiform EEG abnormalities are more likely to have seizures.

Puglia JF. Brenner RP. Soso MJ., Relationship between prolonged and self-limited photoparoxysmal responses and seizure incidence: study and review. Journal of Clinical Neurophysiology. 9(1):137-44, 1992 Jan.

Photoparoxysmal responses (PPRs) are generalized epileptiform abnormalities occurring during photic stimulation. Prolonged PPRs, which outlast the stimulus, can be distinguished from self-limited PPRs, which cease spontaneously or when the flashes stop. Reilly and Peters (1973) found a higher incidence of seizures in patients with prolonged, rather than self-limited, PPRs. More recently, Jayakar and Chiappa (1990) reported a similar seizure incidence in the prolonged and self-limited groups. In order to assess these discordant results, we reviewed EEG records performed in our laboratory from 1983 to 1988. Sixty-eight EEGs had PPRs (19 prolonged and 49 self-limited). Patients with PPRs had a significantly higher incidence of seizures than controls (total patients versus controls, p less than 0.001; prolonged subgroup compared to controls, p less than 0.001; self-limited subgroup versus controls, p less than 0.01). Comparing PPR groups, we found that a prolonged PPR was associated with a higher incidence of seizures than a self-limited response (p less than 0.05); however, patients with a prolonged PPR more often had other epileptiform abnormalities than the self-limited group (p less than 0.001). There was no difference in seizure incidence between the PPR groups when comparing patients whose EEGs also contained other epileptiform abnormalities. Meta-analysis suggests apparent differences among the three studies are superficial.


III. Pediatric EEG Abnormalities

Pediatric EEGs contain different abnormalities than adults because of the different pathological processes and different clinical epileptic syndromes that occur in childhood. Many of the pathological processes produce seizures. Therefore, most of the recognized pathological patterns in Pediatric EEG contain spike and spike-wave activity.

Abnormal Pediatric EEG patterns and Clinical Correlations

Topics from the Pediatric Neurology Teaching Syllabus on Seizures and Epilepsy


References: