You are on page 1of 35

EEG for Sleep Technician

Tayard Desudchit, MD.


Chulalongkorn University
Pediatrics, Neurology & Clinical
Neurophysiology

TD. Chula

Hans Berger: father of EEG


Hans Berger was an Austrian physiologist. On July
6, 1924, he succeeded in making the worlds first
ever recordings of human brain waves through an
intact skull using his 15-year-old son Klaus as a
subject.

He worked in secrecy
until 1929 when he
finally published On the
Electroencephalogram
of Man.

In 1937 he was nominated for a Nobel Prize which


he was compelled to refuse because the Nazis
refused to allow him to travel to Stockholm to
TD. Chula
collect the award. He ultimately hanged himself.

1
EEG Soyrce :Brain Structure

cortex (grey matter)

white matter

thallamus

cerebellum

brainstem
TD. Chula

Pyramidal cell organization and synchronous


activation makes EEGs possible
Synaptic currents occur in vertically oriented neurons with a deep cell
soma and a superficial apical dendrite.

Radially symmetric (non-pyramidal), randomly oriented or asynchronously


activated
TD. Chula
neurons do not produce externally observable electric fields.

2
EEG
FREQUENCY AMPLITUDE
Beta > 13 Hz < 5 µV

Alpha 8-13 Hz 5-15 µV

Theta 4-7 Hz 10-50 µV

Delta < 4 Hz > 50 µV


TD. Chula

EEG Rhythms (cont.)

n Alpha (8-13 Hz): occur in quiet, restful mental state, most intense
over the occipital region, especially when the eyes are closed.
n Beta (14-30 Hz): recorded from parietal and frontal regions, two
types:
n Beta I: disappear during intense mental activity leaving low
frequency wave.
n Beta II: occur during intense mental activity.

n Theta (4-7 Hz): parietal and temporal regions in children.


n Delta (<3.5): deep sleep.
TD. Chula

3
EEG = Electroencephalograph
• The recording and analysis of electrical signal
generated by the brain
• The signals are small & in Noisy environments
• This involves 1) Good Equipments 2)
Meticulous recording techniques 3) Informed
interpretation of data

TD. Chula

A point about safety


• EEG Machine has to be tested for leakage.
• A functioning ground line is needed.
• Three pronged plug must be used
• Extension cord should be omitted or as short as
possible
• All equipments should be plugged to the same
set of outlet
TD. Chula

4
The EEG Equipments : Classical
• Electrodes
• Head Box
• Channel selector
• Amplifiers
• Filters(HP,LP,Notch)
• Pen driver
• Paper/pen unit
TD. Chula

The Electrodes : Man to Machine


• Many types of designs &
material
• Surface: Molded cup,
Nasopharngeal, needle
• Usually Silver/Gold
• **Use Safety Connector
(Female attach to el.)
• Ag/AgCl -> best waveform
esp DC/Low Frequency
TD. Chula

5
Electrical Basics : How big is EEG?
System Volts Amps
Lightning 100,000,000 10,000
Static Carpet 2,000 0.000001
Light Bulb 110 1
EKG 0.0015=1500uV 0.00001
EEG 0.00005=50uV 0.000001

TD. Chula

How do we deal with the noise ?


• We want to measure
50- 200 uV brain signal
from human body with
– EKG x 1500 uV
– Line Noise > 10 mv
– Is this possible ?

TD. Chula

6
EEG : Small but distinctive
• Brain Signal presents
only locally at A while
cardiac & line noises,
though larger affect A &
B almost equally !

TD. Chula

CMRR to the rescue !


• A special amplifier
“Differential Amplifier”
will allow only the
difference between two
measuring points (A &
B) to pass through,
hence “Common mode
rejection”
TD. Chula
• Ground is Needed

7
Polarity Convention
• A common convention
in EEG is “Negative to
grid 1 makes the out
put deflects up”
• Grid 1 (ขัวต่ อที 1)
usually is active, G2
usually is reference
• Signals can actually
TD. Chula enter either ends !

In-phase Cancellation
Out-of-phase Summation
• Upward deflection =
Negative at G1 or
Positive at G2
• Wide Spread activity=>
Inphase=> no output
• Simultaneous signal of
opposite polarity
=>bigger output
TD. Chula

8
Filter: Choose what you want to see
• Four types: Low Freq.(HP),
High Freq.(LP),Band pass
& Band reject (Notch is
band rejects)
• Can be done by hardware
& software
• “Cutoff Freq” = where
1
f = ------------------------
2*Pi*RC power dec to a
Time Constant =R*C, @ 0.1 Sec = 1.6Hz predetermine value(~70%)
TD. Chula

Effect of filters:
Make unwanted waves smaller

TD. Chula

9
Effect of filter: 15 Hz can harm you!

TD. Chula

Filter Setting:
Write it down&Check the calibration

Normal EEG use 1-70 Hz with or without notch filter


TD. Chula

10
What is “Normal” EEG?
• The EEG is
– Lack of abnormal patterns that is known to associated
with clinical disorders
– “Normal” EEG does not garuntee “normal brain” c/o not
all ab. Structire/funtion produce EEG abnormality
– “Abnormal” EEG can be seen in some normal individual
eg relative of Pt. with absence, ie, it does garuntee that
the person has “clinical” diseases.

TD. Chula

Electrode Placement 10:10 & 10:20


• Location is place at 10-
20% of the head
circumference, nasion to
inion & from tragus to
tragus, name brain lobes
• Colloidion & gel, EEG
paste, (+-) Cap
• **Good contact (<5K Ohm)
& reproducible location
TD. Chula

11
10-20 System Of Electrode
Placement

TD. Chula

10-10 System Of Electrode


Placement

TD. Chula

12
The 10-20 system of EEG electrode placement

The ‘International Electrode Placement System’ or ‘10–20 system’ was


developed in 1947.
Electrodes are placed at 10 and 20 per cent values of a measured distance.
Each site on the scalp has a letter (to identify the lobe) and a number or
another letter to identify the hemisphere location. Electrodes positioned over
the frontal (F), temporal (T), parietal (P) and occipital (O) lobes are
represented by the corresponding letter. Odd (1, 3, 5, 7) and even (2, 4, 6, 8)
numbers refer to the left and right hemispheres, respectively. The closer the
position is to the midline, the smaller the number. A 'z' refers to an electrode
TD. Chula
placed on the midline.

Uses Of EEG In The Management of


Seizure Disorders
• To support a clinical diagnosis of epilepsy
• To help to classify seizures
• To help localize epileptogenic focus, especially in presurgical
candidates
• To quantify seizures
• To aid in the decision of whether to stop AED treatment
• Not a good guide to the effectiveness of treatment, except in
absence seizures

TD. Chula

13
Analyzing EEG Activities
• Morphology
• Distribution
• Frequency
• Voltage
• Duration
• State of the patient
• Background from which activity is arising from
• Similarity or dissimilarity to the other ongoing
TD. Chula
background rhythms

Guidelines To EEG Interpretation


• Each EEG should be read with maximum possible
objectivity
• Ideally an EEG’er should describe the findings and
make an EEG diagnosis without knowledge of the
patient's history
• Clinical significance of the findings can then be
judged by integrating the EEG diagnosis with the
history
TD. Chula

14
EEG Interpretation
• Normal
– Lack of Abnormality
• Abnormal
– Non-epileptiform Patterns
– Epileptiform Patterns
TD. Chula

TD. Chula

15
TD. Chula

Photoparoxysmal Response
• Photic stimulation may elicit posterior dominant or generalized
epileptiform discharges in patients suspected of having
photosensitive seizure disorders
• Photo-paroxysmal response:
– complex waveform
– repeat at a frequency which is independent of the flash rate
– field extends beyond the usual posteriorly-situated photic
driving region and may be frontally dominant
– Time-locked with stimulus or not time-locked / self-sustained
TD. Chula

16
TD. Chula
Photoparoxysmal Response

Physiologic Activities That Can Be Confused


With Epileptiform Activities
• Vertex transients of light sleep
• Hypnagogic hypersynchrony
• Positive occipital sharp transients of sleep
(POST)
• Mu rhythm
• Lambda waves
• Breach rhythms
TD. Chula

17
Impedance testing
• Using AC 10-30 Hz
• Ohm’s Law
– V/I =R
• Higher Impedance =>
Higher Amplitude

TD. Chula

Reading EEG
• How is the EEG recorded ?
– What is the montage ?
– Sensitivity and speed

TD. Chula

18
EEG Montages
• Digital EEG usually
recoreded to a common
reference, then
reformatted to desired
montages for display
• Paper EEG is recorded
as is, tech. has to
selecet & monitor lives.
TD. Chula

EEG Montages
• Referential montage = G2
are conncted to a common
reference
• Bipolar montage = G2 of
the first Ch are connected
to the same el. as G1 of
the next ch
– Fp1-F7,F7-T3, T3-T5,
T5-O1
TD. Chula

19
Unipolar and Bipolar EEG measurement

Bipolar or unipolar electrodes can be used in the EEG measurement.

In the unipolar method the potential difference between a pair of electrodes


is measured.

In the bipolar method the potential of each electrode is compared either to a


neutral electrode or to the average of all electrodes

TD. Chula

EEG activity description:


Wave form 010

TD. Chula

20
Artifacts
• Is the epileptiform activity real or an artifacts ?
– Artifacts do not have a field
– Artifacts have double phase reversal
– Artifacts can occurs from
• “Technical issue”
• “Elecectrical activity not generated by the brain”

TD. Chula

TD. Chula

21
Artifact Sources
• Non-cerebral signals in the data
– Measured data is brain signal + artifacts
• Biological:
– EOG
• The eye is a dipole
• Movement visible in EEG
• Blinking
– EMG
• Voluntary muscle activity, especially close to head
(neck, tongue, face etc)
• ECG (Heart)
• Electronic
– Bad electrode signals
• Bad connections
• Poor resistances
– 50Hz Induction Noise(60Hz in US)
– Amplifier issues

TD. Chula

Electrooculogram (EOG)

+ cornea retina

EOG is measured based on corneo-retinal potential. As


eyeballs move, the electrical potential field changes with
reference to electrodes.
TD. Chula

22
EEG Artifact 101:
Physiological artifacts

TD. Chula

EEG Artifact 101:


Physiological artifacts

TD. Chula

23
EEG Artifact 101:
Non-physiological artifacts

TD. Chula

EEG Artifact 102:


Artifacts testing : extra el./maneuver

TD. Chula

24
Digital EEG : technique & benefits
• All EEG done to a – Digital Filter
common reference – Voltage/Freq mapping
– Spike, seizure & event
• Analog=> digital detection
conversion at 200/sec, – Loop recording/Data
> 12 bits resolution reduction
• Benefit: – Time locked Video-EEG
– Reformating – Cheaper operating cost
– Smaller archive

TD. Chula

Digital EEG: Reformat of montage

EKG Artifacts AP run, AKG artifacts canceled out


TD. Chula

25
Computer techniques in EEG
• Amplitude mapping
• Coherence study

TD. Chula

Computer techniques in EEG


• Fast fourier transform
– Amp/time to power of
each frequency at one
location

TD. Chula

26
Modern views of epilepsy

TD. Chula

Normal EEG

TD. Chula

27
Normal Adult EEG Patterns

TD. Chula

EEG Interpretation

• Normal
– Lack of Abnormality
• Abnormal
– Non-epileptiform Patterns

TD. Chula
– Epileptiform Patterns

28
Alpha Rhythm
• The starting point of analysing awake EEG
• 8-13 Hz activity occurring during wakefulness
• 20-60 mV, max over posterior head regions
• Present when eyes closed; blocked by eye opening or alerting the patient
• 8 Hz is reached by 3 years of age and progressively increases in a
stepwise fashion until 9-12 Hz is reached by adolescence
• Very stable in an individual, rarely varying by more than 0.5 Hz.
• With drowsiness, alpha activity may decrease by 1-2 Hz
• A difference of greater than 1 Hz between the two hemispheres is
significant.
• 10% of adult have little or no alpha
TD. Chula

TD. Chula
Normal Alpha Rhythm

29
TD. Chula
Normal Alpha Rhythm

Alpha Rhythm: Reactivity


• Should attenuate bilaterally with
– eye opening
– alerting stimuli
– mental concentration
• Some alpha may return when eyes remain open for more than a
few seconds.
• Failure of the alpha rhythm to attenuate on one side with either eye
opening or mental alerting indicates an abnormality on the side that
fails to attenuate
TD. Chula

30
TD. Chula
Normal Alpha Reactivity

Eyes Closed

TD. Chula
Normal Alpha Reactivity

31
TD. Chula

EEG of Drowsiness
(Stage I Sleep)
• In adults, most sensitive signs of drowsiness is the
disappearance of eye blinks and the onset of slow
eye movements
• Slowing, dropout or attenuation of the background
• Occurrence of theta activity over the posterior regions
TD. Chula

32
TD. Chula
Drowsy

TD. Chula
Drowsy

33
TD. Chula
Drowsy

Other Activities During


Stage I Sleep

• Vertex Sharp Transients


• Positive Occipital Sharp
Transients of Sleep (POSTs)

TD. Chula

34
Post Occipital Sharp
Transients of Sleep (POSTs)
• Sharp-contoured, mornophasic, surface-positive transients
• Occurring singly or in trains of 4-5 Hz over the occipital
head regions
• May have a similar appearance to the lambda waves during
the awake record but are of higher voltage and longer
duration
• Usually bilaterally synchronous but may be asymmetric over
TD. Chula
the two sides

TD. Chula
POSTs

35