EEG spikes resembling cardiac M-shaped waves in the EKG: the cerebral M pattern

A.Bruce Janati; Naif S. ALGhasab; Tariq Aziz; Fazal Haq; Fahad Saad ALGhassab; Tariq Iqhbal; Rehab Khaleel Alenazy

doi:10.14253/acn.2017.19.1.58

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Janati, ALGhasab, Aziz, Haq, ALGhassab, Iqhbal, and Alenazy: EEG spikes resembling cardiac M-shaped waves in the EKG: the cerebral M pattern

Original Article

Ann Clin Neurophysiol 2017;19(1):58-63.

Published online: 5 January 2017

DOI: https://doi.org/10.14253/acn.2017.19.1.58

EEG spikes resembling cardiac M-shaped waves in the EKG: the cerebral M pattern

A.Bruce Janati¹, Naif S. ALGhasab², Tariq Aziz³, Fazal Haq³, Fahad Saad ALGhassab⁴, Tariq Iqhbal³, Rehab Khaleel Alenazy⁵

¹Neurology Center of Fairfax, Fairfax, USA

²Department of Internal Medicine, Hail University, KFSH&RC, Saudi Arabia

³Department of Neurology, King Khalid Hospital, Hail, Saudi Arabia

⁴Department of Dentistry, King Khalid Hospital, Hail University, Hail, Saudi Arabia

⁵Department of Internal Medicine, Hail University College of Medicine, Hail, Saudi Arabia

Correspondence to Naif ALGhasab Department of Internal Medicine, Hail University, P.O. Box 2440 81442, Saudi Arabia Tel: +966-507886878 Fax: +966-065333012 E-mail: Naifalghasab@gmail.com

Received 14 June 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

Studies of interictal epileptiform discharges are essential for improving the diagnosis, classifi-cation, and management of epilepsy. In this case series we sought to identify the clinical and neurophysiological significance of bifid spikes, whose pattern bears a strong resemblance to the cardiac M pattern. We hypothesize that, analogous to the cardiac M pattern, the cerebral M pattern is generated by a conduction defect associated with asynchronous spatiotemporal averaging of electrical signals in the cortex, resulting in the signals reaching the scalp with different latencies. Unlike the cardiac M pattern, the pathology underlying the cerebral M pattern is unknown, although congenital CNS anomalies may be a culprit.

Keywords: Interictal epileptiform discharges, Bifid spikes, Cerebral M pattern

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Fig. 1.

Nine-year-old female with partial motor (right-sided) seizures with secondary generalization. Patient asleep. The EEG shows quasi-pe-riodic "bifid spikes") in the left occipital-temporal area. EEG, electroencephalogram.

Fig. 2.

Thirteen-year-old male with generalized convulsive epileptic seizures preceded by fear. Patient asleep. The EEG sample shows "bifid spikes" in the right temporal-occipital region. EEG, electroencephalogram.

Fig. 3.

The patient is a 30-year-old female with mental retardation and generalized convulsive epileptic seizures. Patient asleep. The EEG shows "bifid spikes" in the left temporal-occipital region. Intermixed are focal, at times "notched" delta in the left temporal region. EEG, electroencephalogram.

Fig. 4.

Two-year-old female with psychomotor delay and multiple congenital anomalies. The EEG shows trains of "bifid spikes" in the left occipital region. Note depression of left hemispheric background and sleep parameters. EEG, electroencephalogram.

Fig. 5.

EKG showing cardiac M-wave pattern which represent RBBB in the chest leads (V1-V2). EKG, electroencephalogram; RBBB, right bundle branch block.

Table 1.

Pertinent data in four patients with EEG bifid spikes

Patient no.	Age (years)	Birth history	Family history	Seizure type	Neurology	Medications	Neuro-imaging	EEG
1	30	Neg.	Neg.	GCS	MR	VPA	N	MTF
2	13	Neg.	Neg.	PCS+GCS	N	CBZ	Ventriculomegaly	IED (RT)
3	9	Neg.	Neg.	SPS+GCS	N	DPH+	N	IED (L-OT)
4	2	Prematurity+	Neg.	One GCS at birth	MR spasticity quadriplegia	None	Right hemispheric porencephaly	MTF

EEG, electroencephalogram; Neg., negative; GCS, generalized convulsive seizure; MR, mental retardation; VPA, valproic acid; N, normal; MTF, multifocal; LMT, lamotrigine; PCS, partial complex seizure; CBZ, carbamazepine; IED, interictal epileptiform discharge; R, right; T, temporal; SPS, simple partial seizure; DPH, phenytoin; L-OT, left occipital temporal region.

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