Electroencephalography and Clinical Neurophysiology, 1976, 41 : 513--529
© Elsevier Scientific Publishing Company, Amsterdam -- Printed in The Netherlands
AUTOMATIC R E C O G N I T I O N AND Q U A N T I F I C A T I O N O F INTERICTAL
EPILEPTIC ACTIVITY IN THE H U M A N SCALP EEG *
J. G O T M A N ** and P. G L O O R
Department of Neurology and Neurosurgery, McGiU University and the Montreal
Neurological Institute, Montreal, Quebec H3A 2B4 (Canada)
(Accepted for publication: March 19, 1976)
The value o f the traditional EEG interpreta-
tion in the diagnosis of various types of epi-
lepsy has been clearly demonstrated. But the
primarily qualitative and impressionistic na-
ture of the EEG interpretation has motivated
several workers to a t t e m p t a quantification of
the EEG manifestations of epilepsy, in order
to make more accurate the correlations
between EEG and clinical or pharmacological
conditions. The relationship between the
number of interictal epileptiform events in
the EEG and the occurrence of actual seizures,
for instance, has n o t been clearly established;
the effect of anti-epileptic medication on
background and interictal epileptic activity is
n o t well documented.
The morphology of interictal activity in the
EEG is used as a diagnostic tool b u t its rela-
tionship to the possible focus of seizure ac-
tivity is still n o t completely known. These
problems can be better approached if a quan-
tification m e t h o d is available. It is our pur-
pose to present here a m e t h o d for the auto-
matic recognition and quantification of inter-
ictal epileptiform activity in the scalp EEG of
epileptic patients. After describing the meth-
*This work was supported in part by Research
Grants MT-3140 and MA-3821 of the Medical Re-
search Council of Canada. The compute r system
was purchased through Major Equipment Grant
ME-3822 of the Medical Research Council of Cana-
da.
** Supported by a Scholarship from the I.W. Killam
Memorial Fund of the Montreal Neurological In-
stitute.
513
od, we will try to demonstrate that the results
are reliable and not misleading, when com-
pared to the traditional interpretation.
Systems aimed at the recognition of actual
seizures, including 3/sec spike and wave dis-
charges, will not be reviewed here since these
events are, from a signal processing point of
view, very different from the interictal spikes
and sharp waves. Some attempts have been
made to give quantitative definitions of spikes
and sharp waves, from the paper record.
Jasper and Kershman (1949) divided focal
epileptiform activity into spikes (10--50 msec
duration) and sharp waves (50--500 msec
duration). Chatrian et al. (1974) presented
slightly different numbers: spikes from 20 to
70 msec duration and sharp waves from 70 to
200 msec duration. The remaining parts o f
the definitions are purely qualitative, and the
m e t h o d of measurement of the duration was
never stated. But the definitions remind us
that interictal epileptiform activity does n o t
only include sharp transients of short dura-
tion, since sharp waves m a y last up to several
hundred milliseconds. Kooi (1966) has con-
cluded, from a study of paper records, that
epileptic activity was characterized b y seg-
mental velocities of more than 2 pV/msec.
This is an interesting finding, b u t it clearly is
n o t a sufficient one.
Automatic methods, analog or digital, are
usually based on the "sharpness" feature of
the epileptic activity. The most obvious
correlate of sharpness is the second derivative
514
of the signal. It was first used in EEG analysis
by Saltzberg et al. (1967). Walter et al. (1973)
describe an analog implementation of this
idea, Variations o f this m e t h o d are given by
Hill and Townsend (1973) and Smith {1974).
Carrie (1972) presents a m e t h o d where a
measure of amplitude complements the sec-
ond derivative; both measures are taken
relative to a running average of the back-
ground activity, removing the necessity to
adjust thresholds for each subject. Gevins et
al. (1975) also use a measure of curvature at
the peak of a wave, relative to a fixed 4 sec
calibration period; the drawback is to make
the results of the analysis dependent on the
choice of t h a t section, but the combination of
curvature with other features (duration o f
following wave, presence of spikes in other
channels, artifact rejections) makes this
system quite complete. Goldberg et al. (1973)
present a m e t h o d based only on the amplitude
and duration of individual waves and their
relationship to background activity, after
high-pass filtering of the data. The authors
conclude that the system is efficient for spike
detection, but t h a t sharp waves are not de-
tected a n d t h a t muscle artifacts greatly de-
crease the performance. This is true of most
of t h e above methods. From these various
examples, it may be concluded t h a t the sec-
ond derivative is n o t a sufficient measure to
detect epileptiform activity, but that it
characterizes one of its most important as-
pects.
Saltzberg et al. (1971) used a matched
filtering technique to detect, in the scalp of
monkeys, particular wave shapes which
appeared within the cortex. This is a very
powerful m e t h o d when a wave shape is
known in advance and only this wave shape is
to be detected, However, such is obviously
n o t the case in clinical electroencephalog-
raphy, where the same subject may present a
variety of interictal wave shapes, and none
are clearly known in advance. More recently
Lopes da Silva e t a l . (1975) have used an auto-
regressive model to represent a section of
EEG; by reverse filtering, it is possible to find
J. GOTMAN, P. GLOOR
non-stationarities in the signal. When EEGs
were recorded from the scalp and from under-
lying subdural electrodes, this m e t h o d ap-
peared to detect m a n y events on the scalp not
looking like traditional spikes, but occurring
at the same time as spikes in the subdural
electrodes. This is a potentially very powerful
m e t h o d since it might reveal epileptic activity
n o t seen by the human observer. But much
more work needs to be done using the EEGs
of epileptic and non-epileptic subjects in
order to distinguish the non-stationarities
which are definitely of epileptic origin, from a
variety of other non-stationarities which ap-
pear in scalp EEGs. If such a distinction can
be made reliable, this method will be very
useful. At present the autoregressive model
has the disadvantage of requiring a relatively
large a m o u n t of computation.
The m e t h o d to be described is an a t t e m p t
at incorporating several of the ideas mentioned
above and some original ideas into a system
capable o f reliably giving quantitative informa-
tion about the interictal activity of a subject.
The design criteria are the following: (1) the
system, to be implemented on a small com-
puter, should be able to process 16 channels
in real time in order to allow the analysis of
prolonged recordings (up to several hours);
(2) the system should not be disturbed by the
most c o m m o n artifacts (EMG and eye move-
ments) as they usually appear in clinical
recordings; (3) the system should give, as its
final result, a relatively simple picture, with
quantitative information, regarding the spatial
distribution and the type of epileptiform ac-
tivity which occurred during the period of
analysis; (4) a classification of events detected
according t-'o" clinical significance should be
included if possible. These criteria follow the
basic ideas described in a previous work on
slow wave abnormalities (Gotman et al. 1973).
The approach is a heuristic one, whereby
empirically derived features are incorporated
into as efficient a computer program as possi-
ble. In the following text, spikes and sharp
waves will be referred to jointly as SSW.
RECOGNITION OF INTERICTAL EPILEPTIC EEG ACTIVITY 515

Method A Original EEG

1. Data acquisition and c o m p u t e r system

Sixteen channels of EEG are recorded,

after being filtered at 70 c/sec with a 4-pole
analog filter, on a 7-track analog tape recorder
b y 4 : 1 time-division multiplexing. The signal
is sampled at 200 samples/sec/channel and
B - Representation
either analyzed on-line or written on digital by segments F
magnetic tape for later use. The c o m p u t e r
system consists of a PDP-12 with 28K of
m e m o r y , disk, magnetic tape, and Tektronix B H
4002 storage terminal with hard copy unit.

2. The basic features

SSWs are detected through a sequential I

pattern recognition technique. The signal is
first broken d o w n into simple features. A
simple test on these features allows for the
rejection of a large proportion o f the data
(the rejected sections have a high probability
of n o t containing any epileptic activity). The
sections which are kept are tested with more
refined features and possibly rejected. The
analysis proceeds in this fashion, making more
and more refined measurements on less and
less data. This allows for both a fast processing
and a detailed analysis of meaningful sections.
a. Segments and sequences
According to the classical m e t h o d of wave
analysis, the EEG signal is broken d o w n into
segments: a segment is the section between
t w o consecutive extrema of amplitude. It is
characterized by its duration, amplitude and
direction. Hence segments alternate in direc-
tion. An example is given in Fig. 1, B. This
m e t h o d causes difficulties when small ampli-
tude " n o i s e " (beta, muscle) is superimposed
on waves o f longer duration, as the latter do
n o t appear as a single segment in the decom-
position. Leader et al. (1967) eliminated over-
riding waves b y imposing a minimum differ-
ence between consecutive maxima and minima.
Gevins et al. (1975) used a digital filter at
20 c/sec to eliminate the fast activity. We
C - Representation
k
A
1
Fig. 1. A, B, C: Segments, sequences, waves: upgoing
sequence A F terminates at F because downgoing seg-
m e n t FG cannot be included, being larger than prece-
ding segment EF. Downgoing sequence FI terminates
at I because upgoing segment IJ cannot be included,
being followed by downgoing segment JK of smaller
amplitude. Upgoing sequence IL terminates at L be-
cause it cannot include a downgoing segment of very
large amplitude, LM. Waves: ABC, BCD, EFG, GHI,
HIJ are examples of waves composed of 2 segments;
AFI, FIL are waves composed of 2 sequences; A F G ,
EFI, FIJ are waves composed of a segment and a
sequence.
have designed a w a y of regrouping segments
into sequences of segments, recreating the
slow frequency wave in the presence of low
amplitude fast activity. A sequence ends when
a segment which may n o t belong to that
sequence is found. A sequence of direction X
(up or down) may n o t include a segment S of
516
direction --X larger than either of the two seg-
ments immediately adjacent to S. Further-
more, a sequence of direction X may not in-
clude a segment of direction --X of duration
equal to or larger than 30 msec or of relative
amplitude equal to or larger than 2 (see below
for relative amplitude). This is to ensure t h a t
a sequence of direction X only includes small
segments of d i r e c t i o n - - X (superimposed fast
activity). Fig. 1 gives examples of the re-
grouping of segments into sequences.
b. A wave
A wave is defined here as a set of two seg-
ments, two sequences or a segment and a se-
quence; both elements must be adjacent and
of opposite direction. As it becomes part of a
wave, a segment or sequence is called a half-
wave. Fig. 1 gives examples of different types
of waves. By allowing waves to be composed
of segments or sequences, both the underlying
slow wave and the fast activity may be ex-
amined, It should be noticed that in the case
of a simple rhythmic activity, delta or alpha
for instance, sequences and segments will be
identical (every sequence having one segment),
and the waves as defined here coincide with
the traditional waves. R~mond and Renault
(1972) and Schenk (1973) have proposed
related m e t h o d s for the decomposition of
EEG into waves.
c. A m p l i t u d e o f background activity
One EEG channel is a voltage v ~ i n g with
time. Some time characteristics have b e e n
defined and are ~ e e d upon, such as the fre-
quency o f the alpha activity. But the ampli-
tude characteristics are n o t defined in absolute
terms (in pV) but only relative to a back-
ground. Chatrian et al. (1974) define back-
ground activity as " a n y EEG activity re-
presenting the setting in which a given normal
or abnormal p a t t e r n appears and from which
such pattern is distinguished". Since a spike
or a sharp wave is "clearly distinguished from
background activity" (Chatrian et al. 1974),
a precise definition of the background ampli-
tude is required. We therefore define the
J. GOTMAN, P. GLOOR
background amplitude at every instant as the
average amplitude of the sequences from the
5 sec directly preceding that instant. (A sec-
tion comprising activity before and after that
instant might be preferred, but this presents
technical difficulties of implementation.}
The need for a constantly updated back-
ground, as opposed to a fixed calibration
period, is demonstrated by the fact that the
value of the background activity of one sub-
ject, c o m p u t e d over 5 sec, was found to vary
frequently by 100% and occasionally by
400% over a 2 min period. Such variations are
present in normal subjects and in patients. A
duration of 5 sec is a compromise: a stable
background is required but it is also necessary
to adapt rapidly to a slowly changing back-
ground {onset of alpha activity or of drowsi-
ness, for instance}.
In practice the background amplitude is
not updated at every sample point, as this
would require important amounts of m e m o r y
and computation, but every 1/3 sec. Further-
more, the amplitude of the background ac-
tivity is not a true average of the amplitudes
of sequences over a 5 sec interval. It is biased
towards a smaller value in the presence o f
slow wave activity, because SSWs of similar
amplitude can more easily be distinguished in
a predominantly delta background than in a
faster one. If N is the number of sequences in
an interval of 320 msec and A is the sum of
the amplitudes of these sequences, A/{N + 6)
is computed; the constant 6 achieves the
desired bias (N is usually between 1 and 15).
The 16 numbers from 16 consecutive 320
msec sections are truly averaged to constitute
the background amplitude (16 × 0.320 =
5.12 sec}. Because of the addition of the con-
stant 6, the background amplitude is smaller
than the true average: about 25% if the ac-
tivity is mostly fast, 2 or 3 times if it is
mostly delta and theta activity.
The amplitude of a half-wave (segment or
sequence) m a y now be defined in relative
terms, as the ratio of its absolute amplitude to
the background amplitude. It is an integer
number ranging from 0 to a rare maximum of
RECOGNITION O F I N T E R I C T A L EPILEPTIC E E G A C T I V I T Y 517

20. The m e t h o d of detection of a SSW will Pseudo-Duration

be given below, but it is important to notice Y2 duration duration
t h a t a SSW is n o t included in the c o m p u t a t i o n i
I
of the background activity. This makes it
possible to detect SSWs even when t h e y are
frequent. 1
Ic
d. The sharpness
The second derivative of the signal is the I
I I
simplest measure o f the sharpness of a wave.
E B e~
Since the second derivative is measured in p V / T Pseudo- D- ~r T dTT
sec/sec it is necessary to normalize it in order I duration i I Pseudo.duration i~I
I-
to have a measure independent of the subject. I I
I
I
!~ Duration I!, Duration 1,~
The background amplitude, derived from the
past 5 sec of signal, is used for the normaliza- Fig. 2. Computation of the pseudo-duration of seg-
tion of the second derivative as it was used for ment AB with respect to A: the line joining A to the
that o f the amplitude. To reduce the computa- point at middle duration (C) intersect the horizontal
tion, the second derivative is c o m p u t e d only line passing through B in D. The pseudo-duration of
for the apex of a wave (using 15 msec before segment AB is ED, and similarly that of segment ab is
ed.
and after the apex), and n o t for every sample
point. The relative second derivative is called
the relative sharpness. It is scaled (in arbitrary
units) and ranges from 0 to a rare m a x i m u m than the duration, while remaining easy to
of 5. compute.

e. Pseudo-duration f. The basic attributes o f wave

It is now necessary to define the duration
o f a half-wave (made of a segment or a se-
quence). The simplest choice is of course to
use the actual duration of the half-wave. But
for the purpose of spike recognition, it is easy
to define a simple measure which will be more
efficient than the duration in distinguishing
between spike or sharp waves and other waves.
The definition of the pseudo-duration of a
half-wave relative to its beginning point is
given in Fig. 2. The amplitude of the point at
middle duration is used in order to incorporate
information a b o u t the convexity of the half-
wave. Fig. 2 illustrates t h a t two half-waves of
same duration and amplitude can be differen-
tiated: ab has a larger pseudo-duration and is
less likely than AB to be part of a spike or a
sharp wave (notice t h a t the curvatures at A
and a on one hand, B and b on the other hand
are similar). By incorporating some informa-
tion about the shape o f the half-wave, the
pseudo-duration appears more appropriate
We have seen t h a t a wave is a set of two
half-waves (segments or sequences). The attri-
butes o f a wave are the relative amplitude and
the pseudo-duration of its two half-waves, the
relative sharpness at its apex, and its total
duration (the sum of the durations of the
half-waves). To these features are added the
relative amplitude and the duration of the
third half-wave; the latter is defined as the se-
quence directly following a wave. Its use
originates in the importance given, for the
visual interpretation, to the presence of a
slow potential following a SSW. Having defined
the attributes of a wave, it is necessary to
explain their use in the detection of SSW.
3. Detection algorithm
The channels are first processed inde-
pendently o f each other. The signal is decom-
posed into segments and sequences. When a
segment or sequence is complete, the following
 518 J. GOTMAN, P. GLOOR

operations take place sequentially (if the TABLE I

answer to any question is no, analysis pro- Relative sharpness and relative amplitude thresholds
ceeds to the next half-wave): for SSW detection. The absolute threshold 4 was sub-
i. Is the relative amplitude of the current tracted from the relative amplitudes.
half-wave and of the preceding one above
Sharpness Amplitude Amplitude Amplitude
preset thresholds? A relative amplitude of 4 is of 1st of 2nd of 3rd
necessary for a half-wave to be considered as a half-wave half-wave half-wave
possible part o f a SSW; this may appear high
but it must be remembered that the back- 0 ~3 >4 --
1 1 ~>4
ground amplitude is smaller than the true
~2 >3
average of sequence amplitudes, giving higher 2 0 l I>4
relative amplitude than otherwise expected. 1 1 i>2
ii. Are the pseudo-durations of both half- 0 2 I>2
waves under t h e appropriate limit? In order to 0 ~-3 --
i>1 I>2 --
belong to a SSW, a half-wave must have its
i>3 0 0 >14
pseudo-duration and relative amplitude satis- 0 I ~2
fying the requirements plotted in Fig. 3. Re- 0 2 --
gion ABCD is the region of validity for a first 1 1
half'wave and region A E F G H is for a second sum/> 3
half-wave. For short pseudo-durations the
amplitude limit is constant b u t it increases
linearly with longer durations. Note that for a
given pseudo.duration, a slightly smaller
amplitude is required for a second half.wave
than for a first one. Note also that longer if its relative amplitude is large enough; a
durations are acceptable for the second half- wave of larger relative sharpness requires a
wave. smaller relative amplitude to be declared a
iii. Given the relative sharpness of the wave, SSW. Table I indicates the thresholds of re-
are the relative amplitudes large enough? A lative amplitude of the first, second and third
wave of small relative sharpness is a SSW only half-waves for a given relative sharpness. The
table is interpreted as follows: to be a S S W , a
wave must h a v e a combination of its 3 relative
amplitudes in agreement with at least one
Relative horizontal line in the section of its relative
amplitude
sharpness. In the table the threshold value 4
ol N has been subtracted from the relative ampli-
2C tudes, leaving values in excess of the threshold.
It may be noticed that: (1) waves of high
s ~ G i sharpness (~>2) with first and second half-
10
waves of small amplitude require a third half-
5 ~ pseudo- wave of large enough amplitude; (2) thresh-
A E duration olds for the second half-wave are often larger
° 0 ;5 '
}00 200 msec than those for the first, reflecting the frequent
Fig. 3. Diagram of the limits of the relative amplitude asymmetry seen in SSWs.
as a function of the pseudo-duration. Region ABCD iv. Is the total duration of the wave larger
is for a first half-wave, and region A E F G H is for a or equal to a minimum value (35 msec.)?
second half, wave. The coordinates are: A(0,4),
B(50,4), C(150,I2), D(150,-), E(60,4), F(150,11), If yes is answered to all the above ques-
G(240,14), H(240,-). tions, the wave is declared a possible SSW. It
RECOGNITION OF INTERICTAL EPILEPTIC EEG ACTIVITY
is important to notice that the above features
(relative amplitude and sharpness, pseudo-
duration) are used in the detection algorithm
b u t are also useful after a wave has been de-
clared a SSW: they provide quantification of
the amplitude, sharpness and duration o f a
SSW.
4. Artifacts
Although n o t frequently, it happens that
a wave being detected following the above
m e t h o d is n o t a SSW. It is necessary to do
further processing in order to reject this wave.
By far the three largest categories of such
cases are muscle activity, rapid eye blinks and
onset o f sharp alpha activity. For the pur-
pose of this study, alpha activity is treated as
an artifact.
a. Muscle
When muscle activity is on-going, both the
relative amplitude and the relative sharpness
of most waves are small. But with a sudden
onset, both sharpness and amplitude become
very high relative to the background activity.
Most of these waves have a very short dura-
tion (30 msec or less) and are not detected as
SSW. Occasionally a wave (usually made of
several segments) has a longer duration and is
detected. It is rejected if its immediate sur-
rounding (1/3 sec) has a large number of high
amplitude segments, indicating onset of
muscle activity. This may n o t be sufficient as
shown in Fig. 4, A, when the muscle burst
A be rejected by determining that they are part
B 8--12 c/sec. This is done by computing the
J;O0 pv
I see
Fig. 4. A : E x a m p l e s o f short lasting bursts of muscle
activity. Their relat've a m p l i t u d e and sharpness are
large. S o m e waves m a y last 35 msec o r more. B:
E x a m p l e o f onset o f sharp alpha activity f r o m a low
a m p l i t u d e background. Normal subject, e y e s closed,
channel P4--O2.
519
lasts less than 1/3 sec. The autocorrelation
function is then c o m p u t e d , using 1/3 sec
centered at the apex of the detected wave. It
is possible to define a threshold for the rapidity
of decrease of the autocorrelation function
which differentiates b e t w e e n short muscle
bursts and genuine spikes (the decrease is
faster for muscle activity). These t w o modes
of rejection take care of practically all false
detection related to this artifact.
b. Eye blinks
Eye blinks are often of t o o long duration
to be considered as SSWs, but many present
the characteristics of sharp waves, i.e., very
steep rising phase, slower descending phase,
and a sharp apex. A detected SSW is rejected
as an eye blink if all of the following are true:
it occurs in a frontal channel; it is of positive
polarity; it has a duration larger than 150
msec; a wave o f similar amplitude occurs
simultaneously on the homologous contra-
lateral channel. These criteria allow for the re-
jection of most eye blinks; some are kept,
largely because of asymmetry between right
and left side. It has also occurred that a sharp
wave was erroneously declared an eye blink.
c. Onset of alpha activity
During recordings with eyes open or closed,
it is frequent that alpha activity comes and
goes. Since 5 sec of EEG are used to deter-
mine the background amplitude, a suddenly
appearing alpha burst may contain waves
having the characteristics of SSW, particularly
when the alpha is sharp. An example is given
in Fig. 4, B. Such waves detected as SSW can
of a section with a dominant frequency of
correlation functions of 1/3 sec centered at
the apex of the detected wave, and 1/3 sec
centered 100 msec before and after the a p e x
over a lag of 60 msec; a high correlation
(above 60%) indicates the presence of alpha
activity. This m e t h o d allows for an almost
perfect solution of the problem.
It should be emphasized that muscle ac-
520
tivity, e y e blinks and o n s e t o f a l p h a activity
are difficulties w h i c h are n o t i n h e r e n t t o this
m e t h o d o f SSW r e c o g n i t i o n . B e c a u s e t h e i r
morphology and mode of appearance have
m u c h in c o m m o n w i t h real SSWs, t h e y are
likely t o p r e s e n t difficulties t o a n y time-
domain or frequency-domain detection meth-
od.
5. In ter-channet relations.
A s s u m i n g t h a t t h e d e t e c t e d w a v e is a SSW,
its relationships w i t h o t h e r c h a n n e l s are im-
p o r t a n t f o r t h e l o c a l i z a t i o n o f an epileptic
focus. O n l y b i p o l a r m o n t a g e s h a v e b e e n
s t u d i e d here, a n d a l t h o u g h t h e m e t h o d was
also i m p l e m e n t e d f o r o t h e r s , t h e p r e s e n t a t i o n
will use t h e m o n t a g e s h o w n in Fig. 5. A m a j o r
s o u r c e o f i n f o r m a t i o n lies in t h e relative
p o l a r i t y o f SSWs in n e i g h b o r i n g channels.
T w o SSWs o c c u r r i n g s i m u l t a n e o u s l y in t w o
c h a n n e l s o f a b i p o l a r chain, w i t h o p p o s i t e
p o l a r i t y , indicate a m a x i m u m o f t h e p o t e n t i a l
field o v e r t h e e l e c t r o d e s s i t u a t e d b e t w e e n t h e
t w o channels. T h i s is r e f e r r e d t o as a p h a s e
reversal f o r t w o c o n t i g u o u s b i p o l a r c h a n n e l s
~10Z2"NO ~2
F~2(~ £ \
) c A2
Fig. 5. Bipolar montage used in this study.
J. GOTMAN, P. GLOOR
Fp2"F8% ~ ~ 1 ~
T4-T6 ':c g
12oo~v
1 sec
Fig. 6. The letters a to h mark the SSWs detected by
the system. Phase reversals at electrode F8 are de-
tected by coincidence in time for a--b and e--f, by
computation of the cross-correlation for d and h
(since no SSW was found in channel F8--T4 at the
time of d orh).
(channels having an e l e c t r o d e in c o m m o n ) or
an e q u i p o t e n t i a l z o n e with p h a s e reversal f o r
b i p o l a r c h a n n e l s o f t h e s a m e chain n o t
i m m e d i a t e l y c o n t i g u o u s . E x a m p l e s are given
in Fig. 6 a n d 7.
I t m a y also o c c u r t h a t the m a x i m u m o f the
p o t e n t i a l field is s i t u a t e d in the area o f t h e
first or o f t h e last e l e c t r o d e o f a chain. If, as is
a s s u m e d h e r e , this is a u n i q u e m a x i m u m in
t h e chain, a SSW will be p r e s e n t in t h e first or
last b i p o l a r c h a n n e l o f t h e chain, a n d p o s s i b l y
in an a d j a c e n t channel, b u t n o SSW o f o p p o s i t e
p o l a r i t y m a y o c c u r in the chain. In o t h e r
words, a m a x i m u m o f t h e electrical field is
d e t e c t e d at t h e e x t r e m i t y o f a b i p o l a r c h a i n if
a SSW is f o u n d in the e x t r e m e c h a n n e l o f t h a t
c h a i n a n d if no p h a s e reversal or e q u i p o t e n t i a l
z o n e exists.
\ -e5%(
\--76% -- \ s
/ ,,e ~f
c
jlO0 pv
1 sec
Fig. 7. The letters a to f mark the SSWs detected by
the system. The equipot~ntial zone over F8--T4 is
found by coincidence in time at a--b and d--e, by
computation of the cross-correlation for c and f
(correlation more negative than--50%). Correlations
between channels T4--T6 and F8--T4 were also com-
puted at c and f, but found positive.
R E C O G N I T I O N O F I N T E R I C T A L EPILEPTIC E E G A C T I V I T Y
Although the above cases do n o t include all
possible configurations of the electrical field
of an interictal epileptic event, they cover the
most frequent ones. The actual existence of
the opposition of polarity between two SSWs
is determined by coincidence in time of the
apexes (occurrence within 10 msec of each
other) or by the computation of the cross-
correlation function between the t w o chan-
nels. If only one SSW is detected in a chain, it
is cross-correlated with all channels of the
chain. The cross-correlation is also c o m p u t e d
if the apexes o f two SSWs do n o t occur
within 10 msec of each other. A section of
duration equal to twice the duration of the
only SSW or of the sharpest of the two SSWs
is used in order to incorporate the immediate
vicinity o f the event. If the cross-correlation is
more negative than --50%, an opposition of
polarity is said to be present. As shown in
Fig. 6 and 7, this method allows the detection
of phase reversals and equipotential zones
even when only one spike is detected (the
adjacent channel presenting t o o small a wave
to be automatically recognized).
6. Events
The analysis proceeds by discrete time units
of a b o u t 1/3 sec. If several SSWs are found
during this time, only the sharpest is retained.
Therefore only one SSW per 1/3 sec per chan-
nel can appear in the final results. If SSWs are
found in one or more channels within the
time unit, an event is said to have occurred.
An event is c o m p o s e d of all SSWs and of all
phase relations which were detected during a
time unit.
Results
1. Examples
It is difficult to present a large number o f
examples of SSWs detected by the system,
because a long enough section of background
activity must also be presented. Examples of
521
classic spikes are found in Fig. 6 and 7. Fig. 8
shows sharp waves of long duration (180 and
200 msec). Sharp waves of up to 400 msec
can be detected, and have been detected in
one subject. Fig. 9 shows a section of EEG
with different shapes of SSWs recognized by
this system. Fig. 4 and Fig. 8 also indicate
that beginning sharp alpha activity and inter-
mittent EMG bursts are usually not recog-
nized as SSWs. This m a y be shown in quanti-
tative terms by counting h o w often a clearcut
spike is declared an artifact and h o w often a
clearcut artifact is declared a spike. Nearly
100 subjects (normal, non-epileptic patients
and epileptic patients) were recorded with
eyes closed for a b o u t 2 min (16 channels,
montage given in Fig. 5). No recordings were
rejected for excess of artifacts after a subject
had been selected. Table II shows that the
number of false positives and false negatives
related to artifacts (muscle, eye blinks, onset
of alpha activity) is small. More details on
these results will be given when a systematic
global evaluation of the method is available.
2. Display o f final results
The results of an analysis are presented in
Fig. 10. The picture is meant to present quan-
F3 - C 3 .,.~"'~'~~ ~ ~ ~, ~ -
C3 - P3 ~ ~ J ~ - ~ ' ~
P3 - 0 1
F7- T3 ~ ~ - v - ~ ' ~ j ~ . ~ ~ ~'~
100 ~v
1 sec
Fig. 8. Waves a and b, recognized by the system, are
examples of long duration sharp waves (respectively
180 and 200 msec).
522 J. G O T M A N , P. G L O O R

F4-C4 ~ ~ d

C4 -P4

P4-02

F8,T4'

T4.T6
__ 1S e c I l O o ~ V , ,
T6-02~ .... -'~-,:.,--~'

Fig. 9. This section o f E E G illustrates s o m e e x a m p l e s o f SSWs d e t e c t e d b y t h e system. On-going or bursts o f

muscle activity d o n o t d i s t u r b t h e r e c o g n i t i o n . SSWs d e t e c t e d are m a r k e d a t o e:

38 VALID [UEHTS
/'I F2

I
n .= m
1 1 3 1 1 1

F~ /-2 FZ F¢ f8
CZ>

I Phase.reversals
2 5 2 3 /:afT4
7"3 C3 Ca* C¢
0

L i
1 1 I ? 7 1 16 4 4 2 ~ \
T5 P3 PZ p.¢
7"6 ~Results of
~ channel
T4,T6

z 1 ~ 1 1 7 1 Zi~ z

A O
RECOGNITION OF I N T E R I C T A L EPILEPTIC EEG ACTIVITY 523

PI /'2

Equipotentials between F4-P4

fZ

.r3 C3 CZ C¢--
!

P3 .. S
Equipotentials between C4-P4
T6

B 0./ 02

? VALID EVENTS
J.2
OR fJ
16
END
f7 F3 fZ F~ f@

T3 ~3 C£ C~ T¢

"r "
2
FJ" P3 PZ ~ T~

2 £,4 £ 2
OJ 02
C ~ ~

Fig. 10. Global results for a section of 3 min (Subject 66-5). A : The names of the electrodes of the 10--20 system
are in their usual location (note that F p l and Fp2 are labelled F1 and F2). The number of SSWs found in a bi-
polar channel is displayed between the corresponding electrodes, in the form of 4 columns. From left to right:
the number of SSWs sharp--large, sharp--small, less sharp---large, less sharp--small. No histogram is displayed if no
SSW is found in a channel. The number of phase reversals at one electrode is indicated just under that electrode,
surrounded by as many lines as phase reversals. This subject shows epileptic activity, predominantly in the right
temporal posterior areas, with some spread to the left hemisphere. B: Connecting lines indicate equipotential dis-
tribution between 2 electrodes, and adjacent numbers indicate the number of times each was found. C: Display
obtained by requesting all events having at least a SSW in left occipital channels (channels P3--O1 or T5--O1 ). It in-
dicates that the left occipital region presents activity often not simultaneous with activity in the right hemisphere
(moreover no event presents simultaneous SSWs in P3--O1 and P4--O2).
524
TABLE II
Data base and number of SSWs detected. Sixteen channels. (Note that the results are normalized for a duration
of 30 rain.) The number of "real SSWs" not detected by the system is unknown since there is no unambiguous
definition for a SSW.
No. of Total dura-
subjects tion of
recording
Normal subjects 30 63 min
Non-epileptic 20 43 rain
patients
Epileptic patients 43 107 min
titative information and to attract attention
to the most active areas. Fig. 10, A gives the
number and locations of SSWs, as well as the
phase reversals. Note that if a potential maxi-
m u m is located at the end of an electrode
chain (e.g., frontal or occipital pole) this ap-
pears in the display as if a phase reversal had
been detected there. Fig. 10, B presents the
distribution of equipotential zones. This sub-
ject presents widespread epileptiform abnor-
mality, with a clear focal maximum in the
right temporal and occipital areas. Because
the electrodes of the 10--20 system are in
their usual location, the spatial aspect of the
results is easy to comprehend.
One important drawback to the above dis-
play is that the time scale is almost lost, only
when channels present phase reversals or equi-
potential zones do their time relationships ap-
pear. They do not appear for channels not
belonging to the same electrode chain. When
several areas show abnormalities, it is impor-
tant to know if they are active simultaneously
or independently. One possibility is to give
histograms on a compressed time scale {Gevins
et al. 1975). But the time relationships are
difficult to see for channels which are n o t
adjacent on the display, and cannot be seen
precisely if the time analyzed is beyond a few
minutes. Instead, we use a system where the
user asks interactively specific questions for
resolving the particular ambiguities of an
EEG. As an example, Fig. 10, A shows a case
J. GOTMAN, P. GLOOR
No. of SSWs Artifacts de- SSWs rejected
detected tected as SSWs as artifact
(per 30 rain) (per 30 min) (per 30 rain)
4 3 0
13 1 0
605 1 4
in which one might like to know if activity in
the left occipital region occurs simultaneously
with activity in the right hemisphere. A possi-
ble answer is to ask for the display of all
evenus which include a SSW in the left occipi-
tal region (channels P3--O1 or T5--O1). The
results are shown in Fig. 10, C; the activity in
the left occipital region is largely, but not
totally, independent from that in the right
hemisphere; although both active, homologous
channels P3--O1 and P4--O2 are not active
simultaneously (the two maxima at 0 2
originate from SSWs in channel T6--O2).
A special syntax m u s t be used to formulate
the questions: it includes logical variables
(with values true or false) and logical opera-
tions, which together make a logical expres-
sion. This expression is evaluated (found true
or false) for every event and an event is in-
cluded in the display if its value is true. The
operations available are OR, AND and
ANDNOT (identical to NAND). The variables
can be a channel number (its value is true if a
SSW is present in that channel at a given
event) or an electrode name (true if a phase
reversal is present at that electrode). The ex-
pression may have any n u m b e r of variables, tn
the above example, the question is formulated
a s : " 1 2 OR 16" (channel numbers are found
in Fig. 5), meaning "all events having a SSW
in channel 12 or in channel 16". Other exam-
ples are: " P 3 " (events having a phase reversal
at P3), "1 AND 2 " (events having a SSW
RECOGNITION OF INTERICTAL EPILEPTIC EEG ACTIVITY 525

simultaneously in channels 1 and 2), "9 OR
10 OR 13 OR 14 A N D N O T 15 A N D N O T 16"
(events having a SSW in the left anterior re-
gion and no simultaneous activity in the left
posterior temporal area). At the end of the
analysis every SSW is available in the com-
puter memory in the form of a small number
of parameters, and questions may therefore
be answered within seconds. This method ap-
pears to resolve most ambiguities about time
relationships in a flexible manner: if the
global results are not ambiguous, no further
processing is performed, but questions, simple
or complex, may be formulated in difficult
cases.
Another example is shown in Fig. 11. The

39 VALID EUENTS
PJ

m B n ~ .

22 11 I I 1
FP /'3 rz P4 .tO

n
2 4 1 1012 1 1 5 1 S
I3 I'3 CZ C~ F4
CD

L
I010 2 1 2 1 1

l~ P3 PZ Pe

An I~ _.~ L
.2.2 ~'/3.4 I 1.1 .11
A ox 02

F,." /'2

PP PZ re ,'*0--

t C3 C¢ F¢

.3

-r-t
,/"S ,,°3 ,o2" 2"6--

a @2
Fig. 11. A and B (see legend o n next page).
526 J. GOTMAN, P. GLOOR

G3 VALID EVENTS

~'~ 411 I ~ ' 3 $ $ fZ E; 4 I 2 PC $ 4 4 3 f'@

0 c~ C~ CD

.L L ,

o
.2.$" ~ P3 1 2 1 P2' 1 PC 3 4 Z Z IS
C <2> ¢-~
$ VALtD EUENTS
F3
AND
d31)J__ gl
END F'..2 3 2 P~ I /'0

• L L
~1 .T3 2 C3 2 1 1~__~ 2 1 1 C$ 2"4 RZ

D .2.5 ,.~ ~z ~. F~

Fig. 11. Global results for two sections of 2 min (Subject 89-3). A : Antero-posterior montage. The display indicates
a generalized abnormality, more prominent in left fronto-central area. B: Equipotentialzones are more numerous be-
tween F3 and C3. C: Coronal montage (upper chain: F7--F8; middle: A1--A2; lower: TS--T6). Results indicate
most intensive activity around CZ, but also bifrontal. D: Answer to question, in coronal montage, "CZ AND F3"
indicates that most phase reversals occurring at F3 are simultaneous with phase reversals occurring at CZ.

results f r o m the analysis o f t w o d i f f e r e n t a r o u n d F3, seen in b o t h m o n t a g e s , o c c u r r i n g

bipolar m o n t a g e s are shown. In Fig. 11, A t h e
a n t e r o - p o s t e r i o r m o n t a g e shows a bilateral
a b n o r m a l i t y , m o r e p r o n o u n c e d on t h e left
side in t h e F 3 - C 3 - - P 3 region. Fig. 11, B
shows t h e e q u i p o t e n t i a l zones ( f r e q u e n t at
F3--C3). Fig. 11, C shows the results o f the
analysis o f the E E G o f the same subject, b u t
with a c o r o n a l m o n t a g e ( e q u i p o t e n t i a l zones
are o m i t t e d for simplicity). T h e a b n o r m a l i t y
appears n o w to be m a i n l y a r o u n d e l e c t r o d e
CZ and in b o t h f r o n t a l regions. One m i g h t ask
the following question: is the activity c e n t e r e d
at t h e same t i m e as t h a t c e n t e r e d a r o u n d CZ?
This q u e s t i o n m a y b e f o r m u l a t e d as " F 3 AND
C Z " (all events having a phase reversal simul-
t a n e o u s l y at F3 and CZ). T h e answer is s h o w n
in Fig. 11, D: m o s t o f t h e phase reversals
o c c u r r i n g at F3 (5 o u t o f 7) are s i m u l t a n e o u s
with phase reversals a t CZ.
3. Classification of SSW
It can b e seen in Fig. 9, A t h a t t h e d e t e c t e d
SSWs have b e e n clMaified in 4 categories
R E C O G N I T I O N O F I N T E R I C T A L EPILEPTIC E E G A C T I V I T Y
according to their relative amplitude and their
relative sharpness (sharp--large, sharp--small,
less sharp--large, less sharp--small). This is
of course a very simple classification, b u t it is
still useful because it is somewhat similar to a
classification into large and small spikes and
large and small sharp waves. It is anticipated
that a more refined classification will be de-
veloped, based on the morphology of SSWs,
their spatial relationships and their m o d e o f
occurrence (isolated or in bursts). This will b e
possible w i t h o u t changing the detection meth-
od, as all the parameters of every SSW de-
tected are readily available at the end of the
analysis; they include the durations, pseudo-
durations and relative amplitudes of the first,
second and third half-waves, the relative
sharpness, the values of cross-correlations
with related channels, the absolute amplitude
of the background activity and its number of
sequences. All of these parameters can be
used for classification.
Discussion
The results may n o w be reviewed in terms
of the design criteria stated in the introduc-
tion. (1) The system is able to analyze 16
channels of EEG in real time using a small
laboratory computer. (2) The system is practi-
cally n o t disturbed by the most c o m m o n
artifacts (continuous or intermittent EMG,
eye blinks), nor is it disturbed by onset of
sharp alpha activity. (3) Final results are given
in a simple picture containing quantitative in-
formation. Information not displayed in this
picture, regarding simultaneity of occurrence
in different locations, may be obtained if
needed b y asking simple specific questions.
(4) An elementary classification of SSW is
provided. Much remains to be done in this
respect, b u t the system was developed in such
a way as to make several potential parameters
available for classification. Future develop-
ments will also include: increase in the sensi-
tivity of detection, analysis of monopolar
527
recordings (often more noisy and presenting
EKG artifacts), study of the possibility of
merging the results from different montages.
However, the ability of the system to rec-
ognize only interictal epileptic abnormalities
and n o t to miss any such abnormalities has
n o t y e t been demonstrated. Only a relative
insensitivity to artifacts was shown. The
absence of a precise definition for an inter-
ictal epileptic event makes the validation diffi-
cult. We hope to demonstrate the validity o f
this m e t h o d in a later study, relying n o w on
our firm impression of its validity.
What are the potential uses of such a quan-
tification system? In clinical electroenceph-
alography, the results may be used in a way
similar to that o f the canonogram for slow
wave abnormalities (Gotman et al. 1973,
1975): to provide the electroencephalographer
with a simple quantitative picture giving
reliable information regarding the interictal
epileptic activity, its intensity and spatial
distribution. The task of the interpreter is
simplified since she/he does not have to ex-
amine the record with great attention to find
SSWs and their inter-channel relationships. It
was found in a few cases that a situation hard
to decipher on the paper record because of
complex inter-channel relationships, appeared
very clearly in the results of the automatic
analysis. The interpretation o f the clinical
significance of this activity is, of course, left
to the electroencephalographer and would
probably be similar to the traditional one.
The system could also be used, for instance,
to establish firmly the relationships between
interictal and ictal activity. Recordings of sev-
eral hours of EEG, including seizures, could
be analyzed and could possibly clarify the
variations o f interictal activity in relation to
the occurrence of seizures. Similarly the im-
portance of the morphology of SSWs could be
studied in relation to the starting point o f
focal seizures. The influence of plasma levels
o f anti-epileptic drugs on the EEG could also
be studied in a quantitative fashion. These are
just a few examples of the possible applica-
tions o f this method.
528
Summary
An a t t e m p t was made at using a small com-
puter to recognize and quantify interictal
epileptic activity (spikes and sharp waves) in
the human scalp EEG.
To perform the automatic recognition, the
EEG of each channel is broken down into
half-waves. A half-wave is characterized by its
duration and its amplitude relative to the
background activity, A wave is characterized
by the durations and amplitudes of its two
c o m p o n e n t half-waves, by the second deri-
vative at its apex measured relative to the
background activity, and by the duration and
amplitude of the following half-wave. Particu-
lar combinations of these parameters were
found to characterize spikes and sharp waves
and are used for their recognition and quanti-
fication. Specific methods are used for the
rejection of spike-like or sharp wave-like wave
forms such as eye blinks, muscle potentials
and sharp alpha activity and were found to
perform with a high level of reliability. Inter-
channel relationships are thoroughly ex-
amined to determine areas of maximal epilep-
togenicity.
Sixteen channels can be analyzed in real
time. Results are presented in a simple picture
containing localizing and quantitative informa-
tion. Specific questions regarding the time
relationships of spikes in different channels
can be asked interactively by the user. The
system is of potential use in clinical electro-
encephalography.
R6sumd
Reconnaissance automatique et quantification
de l'activitd dpileptique intercritique sur
I'EEG de scalp chez l'homme
Cet article d6crit un essai de reconnaissance
et de quantification de l'activit~ 6pileptique
interictale (pointes rapides et pointes lentes)
dans I'EEG humain enregistr~ sur Ie scalp.
Pour r~aliser la reconnaissance automatique,
J. GOTMAN, P. GLOOR
I'EEG de chaque d~rivation est d~compos~ en
demi-ondes. Une demi-onde est carac~ris~e
par sa dur~e et son amplitude relative au
rythme de fond. Une onde est caract~ris~e
par les dur6es et les amplitudes de ses deux
demi-ondes, par la d~rivde seconde ~ son
sommet, mesurde relativement au r y t h m e de
fond, et par la dur~e et t'amplitude de la
demi-onde suivante. On a pu ddterminer des
combinaisons particuli~res de ces param&res
pour la reconnaissance et ta quantification des
pointes. L'~limination d'ondes ressemblant fi
des pointes rapides ou lentes, tels que les
clignements d'yeux, les potentiels musculaires
et l'activit6 alpha pointue, se fait par des
m6thodes sp~cifiques d o n n a n t des r6sultats
tr~s satisfaisants. La d&ermination des r~gions
d'~pileptogdnicit~ maximale est possible grfice
fi l'examen d&aill~ des relations entre d6riva-
tions.
Seize d~rivations peuvent &re analys~es en
temps rdel. Les rdsu]tats sont pr~sentds sous
forme d'une image simple, d o n n a n t une in-
formation quantifi6e, particuli~rement utile
pour la localisation. Des questions sp~cifiques
sur les relations temporelles entre des pointes
situ6es sur des d~rivations diff~rentes peuvent
&re posdes d'une manidre interactive. L'utiti-
sation du systhme en dlectroenc6phalographie
clinique est envisag~e.
References
Carrie, J.R.G. A technique for analyzing transient
EEG abnormalities. Eleetroenceph. clin Neuro-
physiol., 1972, 32: 199--201.
Chatrian. G.E., Bergamini, L.. Dondey, M., Klass,
D.W., Lennox-Buchthal, M. and Petersen, I. A
Glossary of terms most commonly used by clinical
etectroencephalographers. Electroenceph. ctin.
Neurophysiol., 1974, 37: 538--548.
Gevins, A.S., Yeager, C.L., Diamond, S.L., Spire, J.P.,
Zeitlin, G.M. and Gevins, A.H. Automated analysis
of the electrical activity of the human brain (EEG).
A progress report. IEEE Proc., 1975, Vol. 63, No.
10: 1382--1399.
Goldberg, R., Samson-Dollfus, D. and Grimy, F. An
approach to an automatic pattern recognition of
the electroencephalogram: background rhythm
and paroxysmal elements. Meth. Inform. Med.,
1973, 12(3): 155--163.
RECOGNITION OF INTERICTAL EPILEPTIC EEG ACTIVITY
Gotman, J., Gloor, P. and Ray, W.F. A quantitative
comparison of traditional readings of the EEG and
interpretation of computer-extracted features in
patients with supratentorial brain lesions. Electro-
enceph, clin. Neurophysiol., 1975, 38: 623---639.
Gotman, J., Skuce, D.R., Thompson, C.J., Gloor, P.,
Ires, J.R. and Ray, W.F. Clinical applications of
spectral analysis and extraction of features from
electroencephalograms with slow waves in adult
patients. Electroenceph. clin. Neurophysiol., 1973,
35: 225--235.
Hill, A.G. and Townsend, H.R.A. The automatic
estimation of epileptic spike activity. Biomed.
Comput., 1973, 4: 149--156.
Jasper, H. and Kershman, J. Classification of the EEG
in epilepsy. Electroenceph. clin. Neurophysiol.,
1949, 1: 123--131.
Kooi, K.A. Voltage-time characteristics of spikes and
other rapid electroencephalographic transients:
semantic and morphological considerations. Neu-
rology (Minneap.), 1966, 16 : 59---66.
Leader, H.S., Cohn, R., Weihrer, A.L. and Caceres,
C.A. Pattern reading of the clinical electroenceph-
alogram with a digital computer. Electroenceph.
clin. Neurophysioi., 1967, 23: 566--570.
Lopes da Silva, F.H., Dijk, A. and Smits, H. Detec-
tion of nonstationarities in EEGs using the auto-
529
regressive model -- an application to EEGs of
epileptics. In H. Kunkel and G. Dolce (Eds.),
CEAN -- Computerized EEG analysis. Gustav
Fischer Verlag, Stuttgart, 1975.
R~mond, A. et Renault, B. La th~orie des objets
~lectrographiques. Rev. EEG Neurophysiol., 1972,
2,3 : 241--256.
Saltzberg, B., Heath, R.G. and Edwards, R.J. EEG
spike detection in schizophrenia research. Digest
of the 7th Int. Conf. Med. Biol. Engng., Stockholm,
1967, p. 266.
" Saltzberg, B., Lustick, L.S. and Heath, R.G. Detec-
tion of focal depth spiking in the scalp EEG of
monkeys. Electroenceph. clin. Neurophysiol.,
1971, 31: 327--333.
Schenk, G.K. Die Quantifizierung des EEG mittels
vektorieller Iterationstechnik, einer Simulations-
methode der visuellen Analyse. Die Quantifizie-
rung des Eiectroencephalogramms. AEG Telefun-
ken, Jongny sur Vevey, 1973: 307--343.
Smith, J.R. Automatic analysis and detection of EEG
spikes. IEEE Trans. biomed. Engng., 1974, BME-
21: 1--7.
Walter, D.O., Muller, H.F. and Jell, R.M. Semiauto-
matic quantification of sharpness of EEG pheno-
menon. IEEE Trans. biomed. Engng., 1973,
BME 20: 53--54.