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8/17/2019 Moore - EEG Academic Half-day 2009 Part 1 and 2
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EEG
For Neurology Residents2009
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Not exactly EEG, but…
…things you need to know.
1. Epilepsy and driving.
2. Epilepsy and pregnancy
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O!"#NE
#. $hat is an EEG and how is it recorded %
##. &ow do you read an EEG %
###. !he use o' EEG
#(. )lideshow*+ui
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-/! #
$&! #) N EEG N0 &O$ #)
#! /EO/0E0%
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/ecording procedure
20-30 minutes, relaxed patientEyes opened/closedPhotic stimulation,Hyperventilation
+/- sleep +/- pain, noise
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-/! ##
&O$ 0O O /E0 N EEG %
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$hy do you need to know this%
• Exa3s
•
E3ergencies
• !o understand the reports
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n organied approach
1. Orient yoursel'.
2. #s there nor3al brain activity present or
is it altered %
4. #s there abnor3al activity present %
5. $hat is the state %
6. #s it age 7 appropriate %8. re there any arti'acts present %
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1. O/#EN! O/)E"9
Montage !ipolar or re"erential# $%, $&!i3e scale
'ensitivity amplitude, positive*negative:Other channels ;E
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2. #s there nor3al brain activity or is
it altered%
• Is the stuff that is supposed to be there
actually there ?
• #s there evidence o' a structural lesion or a
toxic*3etabolic process that has altered
the nor3al EEG background activity%
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Nor3al brain activity
• $aves= 0elta 1>4 &!heta 5>? &
lpha @>12 &
Aeta B 12 &
• -osterior do3inant alpha rhyth3 with eyeclosure.
• lpha rhyth3 C alpha 'reDuency
• "ow a3plitude, 'rontal Aeta activity.
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!he typical EEG
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Nor3al deviations 'ro3 nor3al
;:1. 0rowsiness
2. )leep
4. ge ;young and old:5. ctivation procedures
;a: &yperventilation
;b: -hotic sti3ulation
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Aackground abnor3alities
• )lowing ;theta or delta:• 9ocal or di''use
• Ailaterally synchronous or not
• /hyth3ic vs. irregular*poly3orphic
• &igh vs. low a3plitude
• #nter3ittent vs. continuous
• an be 3ore subtle• ttenuation o' a3plitude
• sy33etry o' alpha
Etc…
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$ocal slo(ing
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)enerali*ed slo(ing E!ersole Pedley
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)u33ary
• 9ocal slowingF rule out structural lesion
•
Generalied rhyth3ic slowing F consider deep structural lesion ordestructive process
• -oly3orphic generalied slowing F very nonspeci'ic
0isturbance o' the background activityH
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4. bnor3al activity
Is there any stuff there that should not bethere at all ?
Not simply alteration of the background
sually, we are asking i' there is epileptic
activity ;interictal or ictal:.
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9ocal #nter>ictal activity
• )pikes and sharp waves
• -hase reversal
•
/ecurrent and consistent• $ith a 'ield
• 9ollowed by slow wave
•
sy33etrical• Not explained by arti'act
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9ocal epileptic activity
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$ocal epileptic activity
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!er3inology
-otentially epileptic abnor3alityH
Epilepti'or3 abnor3alityH
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-hase /eversal
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Non>epileptic phase reversal ;nor3al background activity:
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Generalied #nter>ictal ctivity
Generalied spike and wave
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#ctal ctivity ;)eiures:
• Electrographic lasts B 1I sec
•
)eiures not de'ined by single patternJspikes, spike and wave, slowing,
attenuation etc…
• Rhythmic activity that changes with time
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-artial co3plex seiure with secondary generaliation
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Neonatal seiure
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Neonatal seiure cont…
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4 & spike and wave ;'ro3 Ebersole and -edley:
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)u33ary
• #nterictal epileptic activity
F spikes and sharp waves
• #ctal epileptic activity
F evolving rhyth3ic activity
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5. )tate
• 5 )leep stages, plus /EK
1. "ose L, slow EOK, v>waves
2. )pindles, co3plex, v>waves
4. 0elta M 6I5. 0elta B 6I
/EK= >looks nor3al ;i.e. awake:, need EOG, EKG etc…
•
)leep onset• Kost consider stage 1 sleep F drowsiness• Aut…so3e de'ine sleep onset as appearance o' v>
waves, others as sleep spindles.
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0ont 9orget…
6. ge• -rior to birth, continuous evolution o' EEG• -osterior>do3inant rhyth3 by 8>12 3onthsJ
alpha 'reDuency by 5>@ years
8. rti'acts• E
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Electrode arti"act
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Eye Movements
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E) rti"act
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Head movement arti"act during a pseudosei*ure
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)o how do you read an EEG%
“Plan and scan”
Organized Approach
OrientNor3al
bnor3al
ge and )tate
rti'acts
Scanning(ertical
&oriontal
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)canning
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$ocal slo(ing
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#' all else 'ails…
Describe what you see
$rom $isch and 'pehlmann