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Normal Awake, Drowsy, and Sleep EEG Patterns That Might Be Overinterpreted as Abnormal

Asadi-Pooya, Ali A.*,†; Sperling, Michael R.*

Journal of Clinical Neurophysiology: July 2019 - Volume 36 - Issue 4 - p 250–256
doi: 10.1097/WNP.0000000000000585
Invited Review

Summary: Knowledge of normal patterns is essential for correct EEG interpretation. The overinterpretation of EEG (i.e., ascribing abnormality to EEG patterns that are not associated with disease) is a common problem and can contribute to misdiagnosis and mismanagement. Here, the authors concisely review normal patterns that might be improperly interpreted as abnormal. These include posterior slow waves of youth, central theta, K complexes, asymmetric sleep spindles, hypnagogic and hypnopompic hypersynchrony, arousal patterns, rhythmic midtemporal theta of drowsiness, and the wicket rhythm. Recognition of these patterns will lead to greater accuracy in EEG interpretation and help avoid incorrect management.

*Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.; and

Neuroscience Research Center, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran.

Address correspondence and reprint requests to Ali A. Asadi-Pooya, MD, Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, 901 Walnut St, Suite 400, Philadelphia, PA 19107, U.S.A.; e-mail:

A. A. Asadi-Pooya: Honoraria from Cobel Daruo; Royalty: Oxford University Press. M. R. Sperling: Consulting: Medtronic; Research contracts with Thomas Jefferson University: UCB Pharma, SK Life Science, Medtronic, Takeda, Neurelis, Engage, Cavion, Eisai; Royalty: Oxford University Press.

© 2019 by the American Clinical Neurophysiology Society