• Definition and Characteristics:
    • Small Sharp Spikes (SSS), also known as Benign Epileptiform Transients of Sleep (BETS), are benign EEG variants.
    • Typically characterized by brief, low amplitude spikes (<50 µV) lasting less than 50 milliseconds.
    • Occur predominantly in the temporal regions, frequently during drowsiness or early sleep.
  • Epidemiology:
    • Common in adolescents and adults but less frequent in young children.
    • Seen in approximately 10-20% of normal EEG recordings.
    • Not associated with an increased risk of epilepsy or other neurological disorders.
  • EEG Features:
    • Characteristically monophasic or diphasic sharp waveforms.
    • No associated slow-wave activity following the spikes.
    • Often occur sporadically and unilaterally, although bilateral occurrence can be seen independently.
    • No clear focal slowing or disruption of background EEG activity.
  • Differentiation from Pathological Spikes:
    • SSS do not exhibit the rhythmicity or evolution typical of epileptic spikes.
    • They do not propagate or generalize.
    • Not associated with clinical symptoms or seizures.
  • Clinical Significance:
    • Considered benign and typically do not require clinical intervention.
    • Important for clinicians to recognize to prevent misdiagnosis and unnecessary treatments.
    • Recognition contributes to accurate interpretation and reduces patient anxiety related to misdiagnosis.
  • Management and Recommendations:
    • No specific treatment required.
    • Patients with identified SSS should be reassured about the benign nature.