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Approach to visual analysis of EEG

Essential characteristics of EEG analysis y


1. Waveform 2 Frequency 2. F ( (wavelength) l th) 3. Amplitude 4. Locus (distribution) 5 Persistence (manner of occurrence) 5. 6. Rhythmicity (repetition) 7. Interhemispheric coherence (symmetry, synchrony) 8. Reactivity (eye opening, photic stimulation, hyperventilation, mental calculation, sensory stimulation, etc.)

NormalEEG
ySpontaneouswakingactivity yElicited Eli it dwaking ki activity ti it yNormalEEGduringsleep yBenignvariant

Spontaneouswakingactivity
y Alpharhythm:reactivity,asymmetry,elderlyperson,

slowalpha p variant, ,lowvoltage g EEG y Betaactivity:frontocentral,drugeffect,breachrhythm y Murhythm y Thetaanddeltaactivity:healthyyoungadults, posteriorslowwaveofyouth, youth Intermittentslowingin elderlysubjects(lefttemporal)

Elicitedactivityawake
y Lambdawave y Buildup y Photicstimulation

NormalEEG fromDrowsiness rowsinesstoSleep


y Drop poutofalpha p rhythm y y Changeofdistributionofalpharhythm y Burstofdiffusetheta y SEM y Vertexsharptransientwaves y POST y Sleep Sl spindles i dl and dKcomplexes l

Benignvariants
y SREDA y SSS y RMTD y Wicketspikes y 6Hzspikeandwave(phantom) y 14and6Hzpositivespikes

NormalwakingEEG
I.Alpha p rhythm y
alpharhythmalphafrequencyoralphaactivity backgroundslow

1.Definition :sinusoidal813Hzwavesmaximaloverthepost.head
region during d waking, k relaxed l dstate,blocked bl k dby b eyeopening &various alertingmaneuvers,disappearindrowsiness& sleep

2.Frequency
1yr:<5Hz 3(4)yr:<6Hz 5yr:<7Hz 8yr:<8Hz

Alpharhythm
3.Distribution, Di t ib ti amplitude, lit d reactivity ti it paradoxicalalpharhythm 4.The Th effect ff tof feyeopening i in i routine ti EEGrecording di studythereactivityandsymmetryofalphablocking demonstrate d t t artifacts tif t produced d dby b eyeopening i bringoutrhythmshiddenbythealpharhythm test t tthe th reactivity ti it of fother th EEGactivity ti it precipitateabnormalreactionstoeyeopening&closing 5.Alpha Al h variant i t slowalphavariant(posteriorslowofadultsvs.youth) fastalphavariant

Slow alpha variant

M/11. Posterior slow of youth

Betarhythm
1.Distribution Frontalbetarhythm Widespreadbetarhythm y (fastalpha p variant) Posteriorbetarhythm 2.Amplitude,persistence >35%asymmetryorunilateralorfocalappearance: abnormal increasewithage excessiveprominentbetarhythm yfrombenzodiazepines p orbarbiturates usually

Murhythm h h
A Arch hshaped h dwaves,711Hz H Overthecentralorcentroparietalregions Diminish Di i i hunilaterally il ll with i hmovementortactile il stimulation i l i ofthecontralateral extremity Less L th than5% %of fnormal ladults d lt Physiologicsignificance somatosensory processassociated i dwith i hmovement representtheidlingasensorysystemnotprocessing specificinputfromthethalamicnuclei

Murhythm(asymmetrical)

Lambdarhythm
Sawtooth shape&positivepolarityinoccipitalarea D i looking During l ki atimages i containing i i visual i ld detail il ResembleVEP

L bd waves Lambda

Normal lSleep l EEG


Elementsofnormalsleepactivity
1.Slowwaves 2.Postive P ti occipital i it lsharp h t transients i t (POST (POSTs) ) 3.Vertexsharptransients(Vwaves) maximalonvertexbut,frontalorparietalregions cautiousinterpretationinthebipolarmontages 4.Sleepspindles 1115Hz,usuallyfor0.5 3sec maximaloverthecentralregions 5.Kcomplex comple resembleVwavesindistribution,reactiontosensory stim &polarityofthemajorcomponent longerinduration,lesssharplycontoured

Sleepstages
Drowsystates

1.Slowlateraleyemovement(SEM) lessthan0.5Hz the h first f obvious b electrographic l h signof fdrowsiness d 2.Smallfastirregulareyemovements


Stage1sleep

1.Disappearanceofalpharhythm,appearanceof47Hz slow 2.PresenceofSEM 3.Reductionofm.artifacts 3 4.Vwaves 5.POSTs 6 Frontocentral 6. F t t l theta th t activity ti it

Stage2sleep
Sleep Sl spindle i dl :>0.5sec Kcomplex:

Stage3sleep
Highamplitudeslowdeltaactivity (>75uV,<2Hz,recordedin C3A2,C4A1)):2050%ofanepoch(30secofrecording) Kcomplex,sleepspindlemaybepresent

Stage4sleep
High Hi hamplitude lit d slow l delta d lt activity: ti it >50% %

Rapideyemovement(REM)sleep
>50%of30secepochlowvoltageEEGactivitywithprominent thetaactivityprecededbyrapideyemovements rapideyeballmovement Reduced d dmuscle l activity Resemblethepatternofstage1sleep exceptnoVwaves,sawtooth shapedwaveoncentral& frontalregions,alphawaves12Hzlessthanalpharhythm

SummaryofChangesinVisualRules
EEGchannels:frontal,M1 CommonReferenceofEOG(E1M2,E2M2) Newnomenclatureofstages
Stage

1 N1
2 N2 3&4 N3 REM R

DefinitionofREMduration(<500msec) Sleep Sl onset t:the th first fi tepoch hscored dasanystage t

otherthanstageW.(cf.3consecutiveepochs) Disuseof3minuterule Newterms


y y

Readingeyemovements, movements transientmuscleactivity Applicationofmajorbodymovementfortransitionof sleepstages

NormalEEGover60yearsold
Similar Si il t toEEGof fyoungeradults d lt with ithaf fewexceptions ti y Alpharhythmmaybeslower,lesspersistent,less reactive y Topographyofalphaactivity shiftingfromposterior tomorefrontocentral area y Betaactivityoftenmoreprominent y Sporadicgeneralizedslowwaves slightlymore commonthaninyoungeradults y Intermittenttemporal p slowwaves,esp. p frequent q in leftside(2/3) y Sleep p lessdeep p&moreofteninterrupted p by y wakefulness

M65,normalelderlyperson

Temporal slow of the elderly

Activationprocedure
Hyperventilation H til ti

- build up of generalized slow activity - most common & pronouncd d in i childern hild & teenagers - Abnormal pattern 1 prominent 1. i asymmetric i response 2. epileptiform discharge 3. Slow l waves Sleep - EDs in TLE: frequent during sleep - non-REM sleep > REM sleep

A ti ti procedure d (continued) ( ti d) Activation


Photic stimulation
photic driving Incidence&prominence p frequency,intensity,color&patternofthestimulus maybeentirelyabsentinnormalsubjects 1.Photomyoclonic Ph t l i orphotomyogenic h t i response 2.Photoparoxysmal response(PPR) post. post Dominantorgeneralizedepileptiform discharges elicitedbyphotic stimulation p region g &timelockedwiththe Limitedtotheoccipital stimulus Normal GeneralizedPPR,PPRpersistingaftertheendof stimulation l Abnormal b l

2. Photoparoxysmal response (PPR) continued Abnormal I (by EEG grade) 1) post. post dominant response not time-locked 2) generalized PPR not self-sustained (whether time-locked or not) Abnormal III Self-sustained Self sustained PPR (continue even after the end of the photic stimulation)

PPR, generalized

Benign variants

P d il if Di h Pseudoepileptiform Discharges
Midline theta of Ciganek

Hypnagogic hypersynchrony 6H Sp 6Hz S & slow l wave

6Hz Sp & slowwave

8 1 2 4 5 3

1 7 6
3. RMTD 4. SSS 5. Wicket spikes

SREDA 14 & 6Hz positive bursts

Occipital sp & SW of blind pt.

6Hz Sp & slow wave (phantom spike-wave, posterior dominant)

Rhythmic midtemporal discharge (RMTD, psychomotor variant)

Wicket spikes

Small sharp spikes (SSS)

14 & 6Hz positive bursts

Subclinical rhythmic EEG discharge of adults (SREDA)