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(See also Chap 2) The EEG provides con rmation of Hughlings Jackson s concept of epilepsy that it represents a recurrent, sudden, excessive discharge of cortical neurons The EEG is undoubtedly the most sensitive, indeed indispensable, tool for the diagnosis of epilepsy; but like other ancillary tests, it must be used in conjunction with clinical data In patients with idiopathic generalized seizures and in a high proportion of their relatives, interictal spike-and-wave abnormalities without any clinical seizure activity are common, especially if the EEG is repeated several times Contrariwise, a proportion of epileptic patients have a perfectly normal interictal EEG; occasionally, using standard methods of scalp recording, the EEG may even be normal during a simple or complex partial seizure Furthermore, a small number of healthy persons (approximately 2 to 3 percent) show paroxysmal EEG abnormalities; some of them have a family history of epilepsy (particularly of absence seizures) and may themselves later develop seizures EEG abnormalities that characterize a spreading epileptogenic focus and generalization of seizure activity, both the grand mal and absence types, have been described in the preceding section and are illustrated in Chap 2 At rst there was thought to be a characteristic EEG picture for seizures, but further studies have not con rmed this, many patterns being possible One consistent observation, however, has been that the region of earliest spike activity corresponds best to the epileptogenic focus This rule guides epilepsy surgery The postseizure or postictal state following generalized seizures also has its EEG correlate, taking the form of random generalized slow waves Following partial or focal seizures, the EEG shows focal slowing With clinical recovery, the EEG returns to normal or to the preseizure state A single EEG tracing obtained during the interictal state is abnormal to some degree in 30 to 50 percent of epileptic patients; this gure rises to 60 to 70 percent if patients are subjected to three or more studies utilizing standard activating measures (hyperventilation, photic stimulation, and sleep; see Chap 2) With structural lesions, focal slow and sharp activity, which is not clearly epileptiform, may be the only clue to a seizure focus A higher yield of abnormalities and a more precise de nition of seizure types can be obtained by the use of several special EEG procedures Overnight EEG recording is particularly helpful because focal abnormalities, particularly in the temporal lobes, may become prominent in stage II sleep Sphenoidal leads have been used to detect inferomedial temporal seizure activity, but they are uncomfortable and probably add little more information than can be obtained by the placement of additional subtemporal scalp electrodes In our experience, nasopharyngeal electrode recordings are too contaminated by artifact to be clinically useful Activating procedures such as hyperventilation, photic stroboscopic stimulation, and sleep increase the yield of EEG recordings, as detailed in Chap 2 Beyond dependably identifying artifacts in the EEG recording, one of the main challenges for the electroencephalographer is to differentiate between normal patterns that simulate seizures and true epileptic discharges These paroxysmal but ostensibly normal patterns appear mostly during sleep, each with a highly characteristic morphology These include small sharp spikes, 14 and 6 polyspike activity, lambda and posterior occipital mu rhythm, and occipital sharp transients These are pictured in most standard textbooks on the subject of EEG.

Several methods of long-term EEG monitoring are now in common use and are of particular value in the investigation of patients with surgically removable epileptogenic foci The most common of these makes use of telemetry systems, in which the patient is attached to the EEG machine by cable or radio transmitter without unduly limiting his freedom of movement The telemetry system is joined to an audiovisual recording system, making it possible to record seizure phenomena (even at night, under dim infrared light) and to synchronize them with the EEG abnormalities An alternative is the use of a small cassette recorder that is attached to a miniature EEG machine worn by the patient at home and at work The patient is instructed to push a button if he experiences an event, which can later be correlated with EEG activity The role of intensive neurodiagnostic monitoring in the investigation and treatment of seizures, which is also a necessary part of the evaluation for epilepsy surgery, is described in detail in the monographs of Engel and of Niedermeyer The EEG changes in epilepsy are discussed further in Chap 2

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There is one more aspect of the Database Machine that helps to improve OLTP workloads OLTP systems are frequently stand-alone systems, where the database servers are completely dedicated to these systems But these systems are also frequently tied into some type of shared storage arrangement, such as SAN disk arrays Because of this, the owners of the system have to negotiate to ensure that the needs and priorities of the systems are properly handled by the shared resources, whether storage resources or network resources Unfortunately, these negotiations are not always totally successful OLTP systems may not be able to get enough of these crucial resources, so their operations can suffer as the resources become inadequate under particular workloads The Oracle Exadata Database Machine is a self-contained unit, with all computing resources included This ownership means that developers and administrators can allocate resources to best address the needs of their workloads Of course, the allocation tools available for Oracle and the Database Machine, including Database Resource Manager and the I/O Resource Manager, mean that you have a tremendous amount of flexibility in assigning resources dynamically Without the need to compromise allocations based on reasons outside the immediate database environment, you will have the freedom to give your systems what they need to deliver optimal performance In this way, the self-contained implementation of the Database Machine means that you can avoid some of the external political issues that can interfere with your attempts to provide the highest levels of service for your customers

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