This chapter describes the practical aspects of recognizing and managing electrographic patterns that may constitute an ictal–interictal injury continuum (IIIC) using a case-based approach. Plus [+] modifiers include superimposed fast activity (+F), spike/sharp activity (+S), or rhythmic delta activity (+R). If present, these features suggest the pattern is more likely associated with ictal activity. Evolution refers to at least two distinct changes in either frequency, morphology, or location with time and is an electrographic hallmark of seizures. Patterns that do not qualify for definite electrographic seizures but may still contribute to deterioration of neurological function may be referred to the IIIC and should be managed appropriately. Finally, the chapter describes nonictal and stimulus induced patterns.