EEG normal variants: A prospective study using the SCORE system

Objective: To determine the prevalence and characteristics of normal variants in EEG recordings in a large cohort, and provide readers with typical examples of all normal variants for educational purposes. Methods: Using the SCORE EEG system (Standardized Computer-Based Organized Reporting of EEG), we prospectively extracted EEG features in consecutive patients. In this dataset, we analyzed 3050 recordings from 2319 patients (mean age 38.5 years; range: 1–89 years). Results: The distribution of the normal variants was as follows: sharp transients 19.21% (including wicket spikes), rhythmic temporal theta of drowsiness 6.03%, temporal slowing of the old 2.89%, slow fused transients 2.59%, 14-and 6-Hz bursts 1.83%, breach rhythm 1.25%, small sharp spikes 1.05%, 6-Hz spike and slow wave 0.69% and SREDA 0.03%. Conclusions: The most prevalent normal variants are the sharp transients, which must not be over-read as epileptiform discharges. Significance: EEG readers must be familiar with the normal variants to avoid misdiagnosis and misclassification of patients referred to clinical EEG recordings.