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Recommendations for the Practice of Clinical Neurophysiology:

Guidelines of the International Federation of Clinical Physiology (EEG Suppl. 52)


Editors: G. Deuschl and A. Eisen
q 1999 International Federation of Clinical Neurophysiology. All rights reserved.
Published by Elsevier Science B.V.

Chapter 1.1

The tentwenty electrode system of the International Federation


George H. Klem* (USA), Hans Otto Luders (USA), H.H. Jasper (Canada)
and C. Elger (Germany)

During the First International EEG Congress,


London in 1947, it was recommended that Dr.
Herbert H. Jasper study methods to standardize
the placement of electrodes used in EEG (Jasper
1958). A report with recommendations was to be
presented to the Second International Congress in
Paris in 1949. The electrode placement systems in
use at various centers were found to be similar, with
only minor differences, although their designations,
letters and numbers were entirely different.
Dr. Jasper established some guidelines which
would be established in recommending a specic
system to the federation and these are listed below.
1. The position of electrodes placed should be based
on specic measurements of standard skull landmarks. The measurements should be proportional
to the size and shape of the skull.
2. Adequate coverage of all parts of the head should
be provided with standard electrode placement.
3. Electrode designations would be expressed in
terms of brain areas covered rather than only in
numbers. This would make communications more
meaningful to the non-specialist, as well as
workers in other laboratories.

* Correspondence to: George H. Klem, Cleveland Clinic


Foundation, EEG Section (S-51), 9500 Euclid Avenue,
Cleveland, OH 44195 (USA).

Deceased.

4. Finally, anatomical studies would be carried out


which would provide additional documentation
correlating the electrode placement with the
cortical areas which they record from.

Technique of measurement
The measurement technique is based on standard
landmarks of the skull. Namely, the nasion, inion,
and the left and right preauricular points. The
preauricular points are felt as depressions at the
root of the zygoma, just anterior to the tragus.
The rst measurement is in the anterior-posterior
plane through the vertex, taken from the nasion to
the inion. This measurement is divided into 5 separate areas (see Fig. 1). The rst mark is placed at
10% of the total measurement and labeled Fp. The
second, third, fourth and fth marks are placed at
20% intervals of the total measurement and labeled
F, C, P, and O. Note that the O mark would be
located at 10% of the measurement above the
inion. The expression Fp, F, C, P and O represent
the fronto polar, frontal, central, parietal and occipital areas, respectively.
Lateral measurement of the central coronal plane
starts at the left preauricular point through the C
vertex mark to the right preauricular point (Fig.
2). A mark is placed at 10% of this measurement
over the preauricular points and labeled T. The

Fig. 1. Lateral view of skull to show methods of measurement from nasion to inion at the midline. Fp is frontal pole
position, F is the frontal line of electrodes, C is the central
line of electrodes, P is the parietal line of electrodes and O is
the occipital line. Percentages indicated represent proportions of the measured distance from the nasion to the inion.
Note that the central line is 50% of this distance. The frontal
pole and occipital electrodes are 10% from the nasion and
inion, respectively. Twice this distance, or 20% separates
the other lines of electrodes.

expression T represents the temporal area. Marks


are then located at 20% of the lateral measurement
and labeled left and right C, and the C vertex location is crossed.
A circumferential measurement (Fig. 3) is then
taken over the temporal lobes from the midline Fp

Fig. 2. Frontal view of the skull showing the method of


measurement for the central line of electrodes as described
in the text.

Fig. 3. Superior view with cross section of skull through the


temporal line of electrodes illustrating the 1020 system
applied in this direction as described in the text.

position to the midline O position. A mark is made


at 10% of this measurement indicating the left or
right Fp electrode position. Marks are then made at
20% of the measurement and are labeled inferior
frontal, mid-temporal, and posterior temporal and
left or right occipital (note that the mid-temporal
electrode positions are crossed). The remaining
10% measurement from the left and right occipital
marks would be the midline O position. Variations
of this measurement have been described by Harner
and Sannit (1974).
Antero-posterior measurements are taken from
the left and right Fp position through the lateral C
position to the left and right O position. This
measurement is then divided equally by 25%
marks and labeled lateral F, lateral C, and lateral
P. Anterior coronal measurements are taken from
the left and right inferior frontal position through
the midline F position and divided into 25%
segments, making crosses at the left lateral frontal,
F vertex and right lateral frontal positions. A
posterior coronal measurement is taken from the
left posterior temporal mark through the midline

Fig. 4. The lateral view of left and right hemispheres showing all standard electrode positions, omitting intermediate positions
(such as C5 and C6) which are used only for special studies with more closely spaced electrodes. These drawings were made
from a series of X-ray projections with true lateral views. The location of principal ssures was determined by silver clips
placed at operation and by other anatomical studies described in the text. The location of pharyngeal electrodes (Pg1 and Pg2)
was also obtained from X-ray studies with these electrodes in place.

P position and this is also divided into 25%


segments and marks are labeled left lateral P,
midline P and right lateral P (Fig. 4).
These measurements provided for the location of
19 of the 21 electrodes used in the 1020 electrode
system (Fig. 5). The remaining two electrodes were
placed on the ear lobes and labeled auricular electrodes. The electrode positions were named in
anatomical terms for the cortical areas recorded,
with the exception of the ``C'' electrodes which
were termed central since they were located over

the central sulcus. A numbering system was added


to differentiate between left and right homologous
regions, odd numbers for the left hemisphere, Fp1,
F3, F7, C3, T3, P3, T5, and O1. Even numbers for
the right hemisphere, Fp2, F4, F8, C4, T4, P4, T6,
and O2. The original recommendation called the F,
C, and P vertex electrodes F0, C0, and P0, but later
changed to Fz, Cz, and Pz (z for zero). The numbers
selected allowed for additional electrodes to be
placed in the coronal plane and have suitable designations (e.g. F2 placed between Fz and F4, and F6

Fig. 5. Frontal superior and posterior views showing all the standard electrode positions as described in the text.

Fig. 6. A single plane projection of the head, showing all


standard positions and the location of the rolandic and
sylvian ssures. The outer circle was drawn at the level of
the nasion and inion. The inner circle represents the
temporal line of electrodes. This diagram provides a useful
stamp for the indication of electrode placements in routine
recording.

placed between F4 and F8). Other additional electrodes included pharyngeal and cerebellar electrodes which were termed Pg1, Pg2, Cb1 and
Cb2, respectively.
Anatomical studies
Anatomical studies were performed on the heads
of cadavers to determine the cortical areas covered
by each electrode position. Measurements were
taken and the 1020 system marked on the skulls,
and electrodes were applied. Drill holes were
placed through the skull and the underlying cortex
was marked with India ink before removing the
brain for examination. It was concluded that while
there was some variability, the two principle
ssures, central and sylvian, were within ^ 1 cm
of the marks shown on Fig. 6.
Comments
The 1020 electrode system was adopted for trial
and the meetings of the General Assembly of the

Fig. 7. Modied combinatorial nomenclature.

International Federation in Paris in 1949. A variety


of systems have been employed by others to include
additional electrodes in the AP plane. Recently the
American Electroencephalographic Society (American Electroencephalographic Society 1999a,b)
proposed and adopted Guideline 13: guidelines
for standard electrode position nomenclature. This
provided terminology for the use of additional electrodes placed in the sagittal plane. The location of
these electrodes is shown in Fig. 7. Electrode
nomenclature is also described in the latest IFCN
standards (Nuwer et al. 1998).

References
American Electroencephalographic Society. Guidelines for standard electrode position nomenclature, J. Clin. Neurophysiol.,
1991, 8(2): 200202.
American Electroencephalographic Society. Guideline 13: guidelines for standard electrode position nomenclature, J. Clin.
Neurophysiol., 1994, 11(1): 111113.
Harner, P.F. and Sannit, T. A Review of the International Ten
Twenty System of Electrode Placement. Grass Instrument
Company, Quincy, MA, USA, 1974.
Jasper, H.H., The tentwenty electrode system of the International
Federation, Electroenceph. clin. Neurophysiol., 1958, 10: 371
375.
Nuwer, M.R., Comi, G., Emerson, R., Fuglsang-Frederiksen, A.,
Guerit, J.-M., Hinrichs, H., Ikeda, A., Luccas, F.J.C. and
Rappelsburger, P. IFCN standards for digital recording of clinical EEG, Electroenceph. clin. Neurophysiol., 1998, 106: 259
261.