The EEG alterations are tricky. There are very evident signs of hyperexcitability on the EEG, like spikes or sharp waves or spiking waves. All neurologists, especially the epileptologists, are aware of these signs. Easy to find them, easy to identify them on the EEG. So those are the evident signs of pathological hyperexcitability. Now there are other signs on the EEG or other graphoelements on the EEG which are more debatable, which are more, you know, at the edge that they can be considered as signs of increased hyperexcitability, but they are seen in other patients as well without expected hyperexcitability...
The EEG alterations are tricky. There are very evident signs of hyperexcitability on the EEG, like spikes or sharp waves or spiking waves. All neurologists, especially the epileptologists, are aware of these signs. Easy to find them, easy to identify them on the EEG. So those are the evident signs of pathological hyperexcitability. Now there are other signs on the EEG or other graphoelements on the EEG which are more debatable, which are more, you know, at the edge that they can be considered as signs of increased hyperexcitability, but they are seen in other patients as well without expected hyperexcitability. But nowadays, more and more papers, case reports, and some consensus papers are coming out saying that those signs like intermittent rhythmic delta activity in the frontal or in the temporal region, these slowings, these focal slowings, can also be signs of increased hyperexcitability. And there is another sign called mid-temporal theta of drowsiness. It’s in parentheses. I would put in parentheses this of drowsiness. Because now we can say that a very early sign of, EEG sign of Alzheimer’s disease is the increased theta amount on the EEG, the theta frequency in the spectrum of the EEG. So what if this mid-theta is actually not a benign phenomenon on the EEG, but it has something to do with the increased hyperexcitability that’s going on in an epilepsy patient? And there is another debated graphoelement. It is called small sharp spikes. The amplitude is very small. They look like small spikes, but they’ve been considered as benign graphoelements of the EEG, also related to sleep to a certain extent. And they were not considered signs of hyperexcitability for a long time. But there is a paper saying that if you see these graphoelements, hundreds of them, or maybe several hundreds of them, on the EEG of a patient with neurodegenerative disease, then you should consider this as a sign of hyperexcitability. So there are the evident graphoelements and there are less evident graphoelements for increased hyperexcitability, which we who read the EEG, who assess the EEG, should look for. We should open our eyes and really try to find these. Because if you just scroll through an EEG, these are sometimes small amplitude spikes that you could miss easily if you’re not looking for them. So if you do not know what to look for, then you easily miss. But this is, I would say that this is not, at this moment, not a routine expectation from all EEG readers in all the hospitals and outpatient services to identify these elements. but we should start learning together with all of them how to focus on these, how to find these, because if you find these, then you might start thinking about intervention in terms of reducing hyperexcitability, and that is another question.
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