Epileptiform Discharges Recorded as Monopoles and Dipoles in the EEG: A Practical Approach to Differentiate...

Differentiating dipoles (tangential generators) from monopoles (radial generators) in routine EEG reading can be difficult. The polarity of sharp waves seen on surface EEG will change depending on the generator being located at the wall of the sulcus versus the crown of a gyrus. In this article, the authors introduce visual rules that may be used to determine polarity and estimate the localization of potentials during analysis of the EEG. They also review a practical approach to differentiate monopoles (radial generators) from dipoles (tangential dipoles) in the surface EEG using "electrode position versus voltage graphs." Finally, the authors illustrate examples of dipoles and monopoles with focal spikes located in the following locations: (1) bipolar spikes located in the anterior bank of the central sulcus, (2) bipolar spikes located in the posterior bank of the central sulcus, (3) monopolar spikes located in the crown of the precentral gyrus, (4) bipolar spikes with a vertically oriented dipole originated within the temporal (inferior) bank of the Sylvian fissure, and (5) monopolar spikes located in the convexity of a temporal gyrus. In summary, this article discusses electrographic features of spikes localized in various fissures and gyri and provides practical rules that permit the identification and location of dipoles and monopoles in standard scalp EEG recordings.