Pediatric EEG Teaching Curriculum
Pediatric EEG Teaching Curriculum
John Giang, MD
Curriculum Structure
A. Foundations
1. Why pediatric EEG is different
Purpose: Orient learners to developmental EEG interpretation.
Key points:
- Pediatric EEG changes with brain maturation.
- Neonatal EEG cannot be interpreted like adult EEG.
- Different page reading speeds, i.e. slower page speed 15mm/sec vs older pediatrics or even adults
- Age is essential for interpretation.
2. How to read a pediatric EEG
Purpose: Teach a repeatable interpretation sequence.
Key points:
- Start with study quality.
- Assess background, symmetry, state, and reactivity.
- Then assess epileptiform activity and seizures.
- End with a concise impression.
3. EEG terminology for age and state
Purpose: Standardize developmental language.
Key points:
- Define gestational age, postmenstrual age, corrected age, and chronological age.
- Define active sleep, quiet sleep, drowsiness, and wakefulness.
- Use consistent reporting language.
Neonatal EEG
4. Normal neonatal EEG background
Purpose: Define age-expected neonatal EEG features.
Key points:
- Background maturation progresses with age.
- Continuity increases over time.
- Trace alternant and discontinuous patterns can be normal.
5. Neonatal sleep-wake cycling
Purpose: Teach state organization in the newborn EEG.
Key points:
- Sleep-state cycling is a key marker of maturation.
- Quiet sleep and active sleep differ in pattern.
- Absent or poor cycling may suggest dysfunction.
Purpose: Prevent overcalling normal neonatal sharp activity.
Key points:
- Sharp transients may be physiologic.
- Frontal and temporal sharp features are often benign.
- Morphology, field, and persistence matter.
7. Abnormal neonatal background
Purpose: Identify encephalopathic or pathologic background patterns.
Key points:
- Low voltage or suppression is concerning.
- Burst suppression is a major abnormality.
- Focal attenuation or asymmetry may indicate injury.
- ACNS neonatal definitions
8. Neonatal epileptiform discharges
Purpose: Define true epileptiform abnormalities in neonates.
Key points:
- Distinguish sharp transients from epileptiform discharges.
- Repetition, field, and state independence increase concern.
- Correlate discharges with background abnormality.
- ACNS neonatal definitions
Purpose: Teach electrographic seizure recognition.
Key points:
- Many neonatal seizures are electrographic-only.
- Seizures may be focal, multifocal, or migrating.
- Evolution in frequency, amplitude, and field is important.
10. Neonatal epilepsy syndromes by age
Purpose: Link neonatal EEG to syndrome recognition.
Key points:
- Organize syndromes by onset window.
- Highlight early infantile DEEs, migrating focal seizures, and epileptic spasms.
- Use age as a major diagnostic clue.
Pediatric EEG
11. Normal pediatric EEG background
Purpose: Define normal EEG from infancy through adolescence.
Key points:
- Background becomes faster and more organized with age.
- Posterior dominant rhythm develops over time.
- Some slowing is normal in young children.
12. Pediatric sleep architecture
Purpose: Teach normal sleep features in older infants and children.
Key points:
- Identify drowsiness, NREM, and REM-related changes.
- Recognize vertex waves, spindles, and K-complexes when age-appropriate.
- Sleep architecture changes with maturation.
Purpose: Build confidence in recognizing normal variants.
Key points:
- Wicket waves.
- Rhythmic mid-temporal theta of drowsiness.
- POSTS.
- Hypnagogic/hypnopompic hypersynchrony.
- Benign sleep transients.
14. Abnormal pediatric background
Purpose: Identify diffuse and focal cerebral dysfunction.
Key points:
- Generalized slowing is nonspecific but important.
- Focal slowing suggests regional dysfunction.
- Background abnormalities may matter even without seizures.
15. Interictal epileptiform discharges in children
Purpose: Teach recognition of spikes and sharp waves.
Key points:
- Identify epileptiform morphology.
- Distinguish focal, multifocal, and generalized discharges.
- Avoid confusing benign temporal variants with epileptiform activity.
16. Pediatric seizures on EEG
Purpose: Connect EEG patterns to ictal events.
Key points:
- Look for evolution in frequency, amplitude, and spread.
- Some seizures are subtle or EEG-only.
- Differentiate focal and generalized seizures.
17. Pediatric epilepsy syndromes by age
Purpose: Organize syndromes by age of onset.
Key points:
- Group syndromes into neonatal, infantile, childhood, adolescent, and variable-age categories.
- Highlight hallmark EEG findings.
- Use syndrome-age correlation for diagnosis.
Review and Practice
18. Artifact recognition
Purpose: Reduce false positives and improve technical awareness.
Key points:
- Recognize movement, muscle, eye, ECG, and electrode artifact.
- Artifact can mimic spikes, seizures, and attenuation.
- Study quality affects interpretation.
19. Pitfalls and overreading
Purpose: Teach common interpretation errors.
Key points:
- Overcalling age-appropriate sharp activity.
- Confusing artifact with seizure.
- Missing background abnormality.