Benign
Epileptiform Transients of Sleep (BETS) and Wicket Spikes are two distinct EEG
patterns that can be observed in recordings.
Distribution and
Occurrence:
o Both BETS and
Wicket Spikes have a similar distribution, often appearing in the temporal
regions.
o BETS are commonly
observed during light sleep, particularly in stages 1 and 2 of NREM sleep,
while Wicket Spikes occur in wakefulness.
2. Morphology and
Waveform:
o BETS are sharply
contoured, temporal region transients with a characteristically monophasic or
diphasic waveform, showing an abrupt rise and steeper fall. They typically have
an electronegative phase on the scalp.
o Wicket Spikes, on
the other hand, have a larger amplitude and a more variable waveform compared
to BETS. They often resemble fragments of the wicket rhythm, which occurs
within the background activity in the same distribution.
3. Symmetry and
Asymmetry:
o BETS typically
exhibit shifting asymmetry with a symmetric lateralization, showing an
equivalent number of transients on each side.
o Wicket Spikes
have a more symmetric waveform in the rise and fall, with the peak of the spike
representing the sharply contoured side of an arciform wave.
4. Clinical Context:
o BETS are commonly
considered a normal phenomenon and are often classified as benign, especially
with accumulating evidence supporting their non-epileptic nature.
o Wicket Spikes, on
the other hand, may raise concerns due to their occurrence in wakefulness and
their association with specific background activity patterns.
5. Additional
Features:
o Other EEG
patterns and activities, such as alpha rhythm changes, slow roving eye
movements, and rhythmic mid-temporal theta activity, may accompany BETS,
providing additional context for differentiation.
Understanding
these differences in distribution, morphology, waveform, and clinical context
is essential for accurately distinguishing between BETS and Wicket Spikes in
EEG recordings, ensuring appropriate interpretation and clinical
decision-making.
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