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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.)

ySpontaneouswakingactivity yElicited Eli it dwaking ki activity ti it yNormalEEGduringsleep yBenignvariant

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)

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

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

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

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

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

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


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

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


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


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

Sleep Sl spindle i dl :>0.5sec Kcomplex:

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

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

>50%of30secepochlowvoltageEEGactivitywithprominent thetaactivityprecededbyrapideyemovements rapideyeballmovement Reduced d dmuscle l activity Resemblethepatternofstage1sleep exceptnoVwaves,sawtooth shapedwaveoncentral& frontalregions,alphawaves12Hzlessthanalpharhythm

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

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

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


Temporal slow of the elderly

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)