normal eeg in adult
DESCRIPTION
Normal EEG in adult. นพ.รังสรรค์ ชัยเสวิกุล. Talk. Definition of normal/abnormal EEG Descriptors of EEG activity Normal EEG of wakeful resting adults (20-60 years) Normal sleep EEG of adults (over 20 yr) Normal EEG of the elderly (over 60 yr) Activation procedures. - PowerPoint PPT PresentationTRANSCRIPT
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Talk
Definition of normal/abnormal EEG Descriptors of EEG activity Normal EEG of wakeful resting adults
(20-60 years) Normal sleep EEG of adults (over 20
yr) Normal EEG of the elderly (over 60 yr) Activation procedures
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Definition of Definition of normal/abnormal EEGnormal/abnormal EEG
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Definition
EEG usually called “normal” Not because it contains normal
patterns Because it lacks abnormal patterns
EEG called “abnormal” Contain abnormal components Regardless of whether contain normal
components
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Definition
A wide “variety” of normal EEG patterns seen between persons of the same age greater among different age groups more in waking than in sleep record
Normal variants
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Definition
There are only a few definitely abnormal EEG components in any age group Spikes, sharp waves abnormal slow waves abnormal amplitude changes
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Definition
Normal EEG not guarantee the absence of brain pathology Not all brain pathology / dysfunction
produce EEG abnormalities Abnormal EEG not always indicate
cerebral abnormality Few specific mild EEG abnormalities
seen in some instances in normal persons
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Descriptors Descriptors of EEG of EEG activityactivity
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Descriptors of EEG activity
Wave form Repetition Frequency Amplitude Distribution
Phase relation Timing Persistence Reactivity
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Wave formWave form
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Wave form
Wave = any change in difference of electrical potential between two recording electrodes ☺
Sequence of waves = activity ☺
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Wave form
Monophasic wave Single deflection: up or down ☺
Diphasic wave 2 components on opposite sides ☺
Triphasic wave 3 components alternating about baseline ☺
Polyphasic wave 2 or more components of different direction
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Wave form
Transient wave Single wave or complex waves Clearly standing out against background Regarding “not definitely abnormal”
Sharp transient Sharply contoured waveform Not abnormal epileptiform waveform ☺
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Wave form
Paroxysmal activity One or more wave Begin abruptly Reach maximum amplitude abruptly Disappear suddently Clearly standing out of background Usually abnormal
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RepetitionRepetition
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Repetition Regular or rhythmic repetitive waves
Similar intervals between individual waves Often, similar shape ☺
Irregular or arrhythmic repetitive waves Variable, irregular intervals between
individual waves Sequence of waves of different frequency Often, irregular shape ☺
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Regular or rhythmic repetitive waves
Sinusoidal waves Sine-wave shape ☺
Spindles Gradually increase and then decrease
in amplitude ☺
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FrequencyFrequency
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Frequency
Number of times a repetitive wave recurring in one second ☺
Frequency of a single wave Calculated from wave length ☺
Periodic wave or complex “Period” being calculated from “time
interval” between them ☺
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Frequency bands Delta frequency band
Under 4 Hz ☺ Theta frequency band
From 4 to under 8 Hz ☺ Alpha frequency band
From 8 to 13 Hz ☺ Beta frequency band
Over 13 Hz ☺
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Frequency Fast activity
Over 13 Hz Slow activity
Under 8 Hz Frequency not regarded as
cerebral activity Less than 0.5 Hz More than 20 Hz
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AmplitudeAmplitude
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Amplitude
Measured in microvolt (μV) Measuring total vertical distance of
wave Range
Low, under 20 μV Moderate or medium, 20-50 μV High, over 50 μV ☺
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Amplitude
Asymmetry Comparing between corresponding
parts of two sides Simultaneous time Abnormal
If persist For alpha rhythm; different more
than two times
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Amplitude
Affected by Spacing Impedance
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DistributionDistribution
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Distribution
Occurrence of electrical activity recorded by electrodes positioned over different parts of head
Practically used distribution Widespread, diffuse or generalized ☺ Lateralized ☺ Focal or localized ☺
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TimingTiming
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Timing
Timing of waves in different areas Similar
Simultaneous: broadly precise coincidence Synchronous: definitely precise coincidence
Bilaterally synchronous or bisynchronous Different
Asynchronous Independent
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Persistence
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Persistence
To describe how often activity occurs Occasionally Sporadic: irregular and infrequent Intermittently Periodic Throughout Persistent
May be calculated as “index”
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ReactivityReactivity
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Reactivity
Changes produced by various maneuvers Increased Diminished Blocked
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Reactivity
Maneuvers Opening or closing eyes Hyperventilation Photic stimulation Sensory stimulation Changes in level of alertness Movements, e.g. arm movement Others, e.g. simple calculation
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Normal EEG of Normal EEG of wakefulwakeful resting adults resting adults(20-60 years)(20-60 years)
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Normal EEG of wakeful resting adults (20-60 years)
Alpha rhythm Beta rhythms Mu rhythm Lambda waves Vertex sharp
transient
Kappa rhythm Intermittent
posterior theta rhythms
Low voltage activity
Composed of various types of activity alone or in combination
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Alpha rhythm defined by frequency, distribution and reactivity
Frequency : alpha activity, 8-13 Hz Fairly constant Equal in both sides
Distribution : posterior part Greatest amplitude and most persistent in
occipital and parietal areas Seen in temporal and central in the young
Reactivity : blocked by eye opening, sudden alerting, attention and mental concentration
☺
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Alpha rhythm Wave form : regular, often sinusoidal Phase relation : may vary over
different parts Timing : simultateous on both sides Persistence :
Vary among normal subject Prominent, waxes and wanes, rare
occurrence, complete absence Decrease with age
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Beta rhythms
Defined by only frequency: over 13 Hz
Distribution Frontal beta rhythms Widespread beta rhythm Posterior beta rhythm or fast alpha
variant Reactivity: disappear in drowsiness/sleep
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Beta rhythms
Amplitude : Usually lower than alpha activity Symmetry, different less than 35% in
amplitude Persistence : increase with age
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คลื่��นไฟฟ�าสมองปกติ�ขณะพั�กแลื่ะหลื่�บติา (alpha rhythm, posterior slow wave of youth, frontal beta activity)
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Normal Normal sleepsleep EEG EEG of adults (over 20 yr)of adults (over 20 yr)
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Normal sleep EEG of adults (over 20 yr)
Elements of sleep EEG Slow wave ☺ Sleep spindles ☺ Positive occipital sharp transients
of sleep (POSTs) ☺ Vertex sharp wave ☺ K complexes ☺
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Normal sleep EEG of adults (over 20 yr)
Eye movements during sleep Slow lateral eye movements ☺ Rapid eye movement ☺
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Normal sleep EEG of adults (over 20 yr)
Sleep stages Drowsiness ☺ Stage I ☺ Stage II ☺ Stage III Stage IV ☺ Stage REM ☺
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Normal EEG Normal EEG of the of the elderlyelderly (over 60 yr)(over 60 yr)
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Normal EEG of the elderly (over 60 yr)
Similar to that of younger adults except
Alpha rhythm May be slower, less persistent, less
reactive Beta activity
Often more prominence Sporadic generalized slow wave
Slightly more common
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Normal EEG of the elderly (over 60 yr)
Intermittent temporal slow waves Appear in some apparently normal
subjects Sleep
Less deep, more often interrupted by wakefulness
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Activation proceduresActivation procedures
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Activation procedures
To induce, enhance or better define abnormal EEG patterns
However, they may induce normal patterns that are not seen in spontaneous EEG.
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Activation procedures
Hyperventilation Photic stimulation Sleep recordings Other stimuli, e.g. patterned light,
startling noise, musical sounds, reading, tactile stimuli, etc.
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EXAMPLE OF EEG
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Wave = any change in difference of electrical potential between two recording electrodes ☻
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“wave
”
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Activity = Sequence of waves
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☻
activit
y
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Monophasic wave(Single deflection: up or
down)
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monophasic wave
☻
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Diphasic wave Diphasic wave ☻
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Triphasic wave ☻
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Sharp transientSharp transient ☻
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Regular or rhythmic repetitive waves
☻
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Regular or rhythmic repetitive waves
☻
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Irregular or arrhythmic repetitive waves
Irregular or arrhythmic activity ☻
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Sinusoidal wave form ☻
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SpindlesSpindles ☻
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Frequency is number of times a repetitive wave recurring in one second. ☻
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1 sec
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Frequency of a single wave is calculated from wave length.
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Periodic wave or complex“Period” being calculated from “time interval” between them ☻
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1 sec
Periodic sharp wave every 0.5 second
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Delta frequency band ☻
1 sec
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Theta frequency bandTheta frequency band ☻
1 sec
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Alpha frequency band ☻
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Beta frequency bandBeta frequency band ☻
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Amplitude measurement
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Wide spread or generalized distribution ☻
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Lateralized distributionRight hemisphere, lateralized distribution ☻
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Focal or localized distribution
Localized distribution, central area ☻
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Alpha rhythm blocked by eye closure
Alpha rhythm blocked by eye opening ☻
eye openingeye closing
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Beta rhythmBeta activity in both frontal areas ☻
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Beta frequency bandWidespread beta activity ☻
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Slow waves in non-REM sleep
Slow waves in NREM sleep ☻
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Sleep spindleSleep spindle ☻
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POSTs ☻POSTs ☻
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Components of non-REM sleep
Non-REM sleep ☻
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K complexes ☻
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Slow lateral eye movements
Slow lateral eye movement ☻
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Rapid eye movementRapid eye movement ☻
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EEG in drowsiness : A. Slow lateral eye movement and B. Waxing and waning of posterior alpha rhythm ☻
A
A
B
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Sleep stage 1: sleep vertex sharp wave
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☻
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Sleep stage II ☻Sleep stage II ☻
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Sleep stage II : K-complex and sleep spindle ☻
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K-complex
sleep spindle
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Sleep stage III-IV
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☻
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Normal EEG in adult 90
Stage REM ☻
REM sleep ☻