ELECTROENCEPHALOGRAPHY EEG Dr Shaikh Mujeeb Ahmed M B

ELECTROENCEPHALOGRAPHY (EEG) Dr. Shaikh Mujeeb Ahmed M. B. B. S. MD. (PHYSIOLOGY)

EEG o The electroencephalogram (EEG) is a recording of the electrical activity of the brain from the scalp. o The first recordings were made by Hans Berger in 1929

Origin of EEG waves

Electroencephalogram o EEG is the record of electrical activity of brain( superficial layer i. e. the dendrites of pyramidal cells) by placing the electrodes on the scalp.

Generation of large EEG signals by synchronous activity

Objectives of EEG practical o Familiarize with the principles of techniques involved o Count frequencies and measure the amplitudes of the record obtained. o Categories the records into appropriate rhythms – α, β, θ, and δ. Cont…

Objectives of EEG practical o Identify and describe changes produced by provocation tests. e. g. eye opening & closing, intermittent photic stimulation (IPS) clapping sound, induce thinking & hyperventilation. o Appreciate clinical uses of EEG

EEG Waves o o Alpha wave -- 8 – 13 Hz. Beta wave -- >13 Hz. (14 – 30 Hz. ) Theta wave -- 4 – 7. 5 Hz. Delta waves – 1 – 3. 5 Hz. §D T A B

Different types of brain waves in normal EEG

EEG Recording From Normal Adult Male

Alpha wave o o o rhythmic, 8 -13 Hz mostly on occipital lobe 20 -200 μ V normal, relaxed awake rhythm with eyes closed

Beta wave o o irregular, 14 -30 Hz mostly on temporal and frontal lobe mental activity excitement

Theta wave o rhythmic, 4 -7 Hz o Drowsy, sleep

Delta wave o slow, < 3. 5 Hz o in adults o normal sleep rhythm

Different types of brain waves in normal EEG Rhythm Frequency Amplitude (Hz) (u. V) Recording & Location Alpha(α) 8 – 13 50 – 100 Adults, rest, eyes closed. Occipital region Beta(β) 14 - 30 20 Adult, mental activity Frontal region Theta(θ) 5– 7 Above 50 Children, drowsy adult, emotional distress Occipital Delta(δ) 2– 4 Above 50 Children in sleep DTAB

Requirements o EEG machine (8/16 channels). o Silver cup electrodes/metallic bridge electrodes. o Electrode jelly. o Rubber cap. o Quiet dark comfortable room. o Skin pencil & measuring tape.

Computerized EEG Machine

Electrode Positioning system

EEG Electrodes Sliver Electrodes Cap

Procedure of EEG recording o A standard EEG makes use of 21 electrodes linked in various ways (Montage). o Ask the subject to lie down in bed. o Apply electrode according to 10/20% system. o Check the impedance of the electrodes.

10 /20 % system of EEG electrode placement

Procedure of EEG recording o Ask the subject to close his/her eyes. o Select a montage. o Press run switches on to run the paper.

Procedure of EEG recording o Press the calibration knob to check voltages & time constant. o Always observe subject for any abnormal muscle activity. o Ask the subject to open eyes for 10 sec. and ask him/her to close eyes. (do this procedure for several times in each montage)

EEG Electrodes o Each electrode site is labeled with a letter and a number. o The letter refers to the area of brain underlying the electrode e. g. F - Frontal lobe and T - Temporal lobe. o Even numbers denote the right side of the head and o Odd numbers the left side of the head.

Two types of recording o Bipolar – both the electrodes are at active site n Bipolar montage are parasagital montage. o Unipolar – one electrode is active and the other is indifferent kept at ear lobe. o Always watch for any abnormal muscle activity. o Ask the subject to open eyes for 10 sec. then ask them to close the eyes.

Montage o Different sets of electrode arrangement on the scalp by 10 – 20 system is known as montage. o 21 electrodes are attached to give 8 or 16 channels recording.

Analysis o Electrical activity from the brain consist of primarily of rhythms. o They are named according to their frequencies (Hz) and amplitude in micro volt (μv). o Different rhythms at different ages and different conditions (level of consciousness) o Usually one dominant frequency (background rhythm)

Factor influencing EEG o Age n Infancy – theta, delta wave n Child – alpha formation. n Adult – all four waves. o Level of consciousness (sleep) o Hypocapnia(hyperventilation) slow & high amplitude waves. o Hypoglycemia Slow waves o Hypothermia o Low glucocorticoids

NORMAL EEG CHANGES

Desynchronization or Alpha block o Cause: o Eyes opening (after closure) o Thinking by the subject (mathematical calculation) o Sound (clapping)

Eye opening o Alpha rhythm changes to beta on eye opening (desynchronization / α- block)

Thinking o Beta waves are observed

Provocation test o Intermittent photic stimulation o Increase rate & decrease amplitude o Hyperventilation o Decrease rate & increase in amplitude

Use of EEG o Epilepsy § § Generalized (grandmal) seizures. Absence (petitmal) seizures. o Localize brain tumors. o Sleep disorders (Polysomnography) § § § Narcolepsy Sleep apnea syndrome Insomnia and parasomnia o Helpful in knowing the cortical activity, toxicity, hypoxia and encephalopathy & o Determination of brain death. n Flat EEG(absence of electrical activity) on two records run 24 hrs apart.

Sleep studies o The EEG is frequently used in the investigation of sleep disorders especially sleep apnoea. o Polysomnography : EEG activity together with n n n heart rate, airflow, respiration, oxygen saturation and limb movement

Sleep patterns of EEG o There are two different kinds of sleep: o Rapid eye movement sleep (REM-Sleep) o Non-REM sleep (NREM sleep)/ slow wave sleep o NREM sleep is again divided into 4 stages (I to IV). The EEG pattern in sleep is given in the following table:

Stages of sleep EEG pattern Somatic or Behavioral changes Alert Alpha activity on eye closed Desynchronization on eye opening Respond to verbal commands I (Drowsiness) Alpha dropout & appearance of vertex waves & theta. Reduced HR & RR II (Light sleep) Sleep spindles, vertex sharp waves & Kcomplexes Reduced HR & RR III ( Deep Sleep) Much slow background Kcomplexes Reduced HR & RR

IV (very deep sleep) Synchronous delta Reduced HR & RR waves, some Kcomplexes REM sleep (paradoxical sleep) Desynchronization with faster frequencies HR, BP & RR irregular Marked hypotonia Rapid eye movement 50 – 60 /min. Dreaming threshold of arousal

Changes in brain waves during different stages of sleep & wakefulness

Changes in brain waves during different stages of sleep & wakefulness

K - complex Sleep Spindle

EEG & Epilepsy

EEG in different types of epilepsy

Grandmal seizure

Petitmal seizure

Video monitoring o Simultaneous video monitoring of the patient during the EEG recording is becoming more popular. It allows the physician to closely correlate EEG waveforms with the patients activity and may help produce a more accurate diagnosis.

EEG Artifacts o Biological artifacts o Eye artifacts (including eyeball, ocular muscles and eyelid) o ECG artifacts o EMG artifacts o Glossokinetic artifacts (minor tongue movements) o External artifacts o o Movement by the patient settling of the electrodes Poor grounding of the EEG electrodes the presence of an IV drip

ECG Artifacts

LET’S ANSWER

What is EEG and what is montage? o The electroencephalogram (EEG) is a recording of the electrical activity of the brain from the scalp. o Arrangements of electrodes by 10/20% system is known as montage.

What is the advantage of provocation test while recording EEG? o Provocation test e. g. hyperventilation, intermittent photic stimulation are done to trigger the epileptic focus.

Compare & contrast Alpha & Beta waves of EEG o Alpha o In awake resting with eyes closed o Frequency 8 – 13 Hz. o Voltage – 50 u. V. o Beta o In awake thinking subjects. o Frequency - >13 Hz. (14 – 30 Hz. ) o Voltage – 20 u. V.

What stage of sleep is indicated by slow waves of EEG(4 – 7 Hz. ) ? o 4 – 7 Hz. (Theta) waves are seen during stage 2 & 3 (light and deep ) sleep

In the following tracing of EEG what changes do you observe after point “A”. What may be it’s possible cause? o Rhythm has changed from α toβ(at point “A”) , it is called alpha block or desynchronization. o Causes: n Eyes opening n Thinking e. g. mathematical calculations. n Sound (clapping)

What changes are seen in EEG of an epileptic child suffering from absence seizure (petit mal)? o In petit mal spike and wave (dome shaped) 3 cps. Pattern is seen.