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Understanding Electroencephalography
The Dipole
Theoretically, the current flows in a 3dimensional ellipse with the greatest current density along a straight line connecting the positive pole to the negative pole The complex arrangement of the brain and head, differences in cell type and function within a region, and physical differences between brain areas result in an approximate dipole that is not a perfect model.
2 O- 6 T
6 T- 4 T
4 T- 8 F
2 O- 4 P
8 F- 2 p F
1 O- 5 T
4 P- 4 C
5 T- 3 T
4 C- 4 F
3 T- 7 F
7 F- 1 p F
4 F- 2 p F
2 O- 4 P
1 O- 3 P
4 P- 4 C
4 C- 4 F
3 P- 3 C
4 F- 2 p F
3 C- 3 F
1 O- 3 P
3 F- 1 p F
3 P- 3 C
3 C- 3 F
3 F- 1 p F
2 -4P O
4P-4 C
4 -4F C
4F-2pF
1 -3P O
3P-3 C
3 -3F C
3F-1pF
Neuronal Synchronization
The interictal spike may be initiated by a spontaneous burst in one or a few cells Each cell has excitatory connections to a number of other cells Excitatory connections will allow burst propagation if inhibition is decreased, absent or simply overcome Loss of effective dendritic inhibitory synapses may occur over time
Generalized Spike-and-Wave
A pathological exaggeration of cortical excitability is the basic disturbance and appears to initiate the process Cortical spikes precede epileptiform discharges in depths Thalamocortical connections are necessary for triggering and phasing the spike-and-wave bursts The brainstem reticular formation appears to modulate spike-and-wave activity by modifying the level of cortical excitability. Substantia nigra involvement in some way is essential in the production of generalized convulsions.
EEG Frequencies
Delta Theta Alpha Beta 0 - 4 Hertz 4 - 7 Hertz 8 - 13 Hetrz > 13 Hertz
EEG in Neonates
Premature newborn due to the incomplete development of neuronal connections, synapse formation, myelination, etc., EEG activity prior to 30 weeks estimated gestational age (EGA) is disccontinuous and very abnormal appearing Focal sharp discharges in frontal and temporal regions are normal to some extent until about 44 weeks EGA
2 -T O6
6 -F T8
8-p F2 F
2 -P O4
4 -F P4
4-p F2 F
1 -P O3
3 -F P3
3-p F1 F
1 -T O5
5 -F T7
7-p F1 F
2 month old with Enterococcal meningitis and left posterior temporal focal electrographic seizure
FP1-F7 F7-T5 T5-O1 FP1-F3 F3-P3 P3-O1 Fp2-F4 F4-P4 P4-O2 Fp2-F8 F8-T6 T6-O2 1 sec 50 V
2 month old with Enterococcal meningitis with an electrographic seizure discharge, maximal right frontal
FP1-F7 F7-T5 T5-O1 FP1-F3 F3-P3 P3-O1 Fp2-F4 F4-P4 P4-O2 Fp2-F8 F8-T6 T6-O2 1 sec 50 V
2 month old with Enterococcal meningitis and right posterior temporal focal electrographic seizure
FP1-F7 F7-T5 T5-O1 FP1-F3 F3-P3 P3-O1 Fp2-F4 F4-P4 P4-O2 Fp2-F8 F8-T6 T6-O2 1 sec 50 V
2 month old with Enterococcal meningitis and bilateral independent focal electrographic seizures
FP1-F7 F7-T5 T5-O1 FP1-F3 F3-P3 P3-O1 Fp2-F4 F4-P4 P4-O2 Fp2-F8 F8-T6 T6-O2 1 sec 50 V
Stage II sleep
Increased intermixed theta and delta slowing Vertex waves, sleep spindles and K-complexes Positive occipital sharp transients of sleep (POSTs)
Progression of Sleep
Stage III sleep
Increased delta slowing Central vertex activity diminishes
Stage IV sleep
Marked delta slowing Absence of vertex activity
2 -6T O
6T-4T
4T-8 F
8 -2p F F
1 -5T O
5T-3T
3T-7 F
7 -1p F F
2 -4 O P
4 -4 P C
4 -4 C F
4 -2p F F
1 -3 O P
3 -3 P C
3 -3 C F
3 -1p F F
REM Sleep
Low voltage mixed frequency activity with faster components Absent vertex activity Decreased EMG activity
Each channel records the potential difference between two electrodes G1 G2 Negative is up If G1 is more negative than G2, the deflection will be up If G2 is more negative, the deflection will be down
2O-6 T
6 T-4 T
4 T-8F
8F- 2pF
1O-5 T
5 T-3 T
3 T-7F
7F- 1pF
2O-4P
4P-4C
4C-4F
4F- 2pF
1O-3P
3P-3C
3C-3F
3F- 1pF
Generalized Spike-Wave
2 -T O6
6 -T T4
4 -F T8
8 -p F2 F
1 -T O5
5 -T T3
3 -F T7
7 -p F1 F
2 -P O4
4 -C P4
4 -F C4
4 -p F2 F
1 -P O3
3 -C P3
3 -F C3
3 -p F1 F
C3-P3
P3-O1
Fp2-F4
F4-C4
C4-P4
P4-O2 1 sec 50 V
2O-6T
6 T-4T
4 T-8F
8F-2pF
1O-5T
5 T-3T
3 T-7F
7F- 1pF
2O-4P
4P-4C
4C-4F
4F-2pF
1O-3P
3P-3C
3C-3F
3F- 1pF
11 y/o boy with severe cardiomyopathy on ECMO following cardiac electromechanical disassociation
Fp1-F7 F7-T3 T3-T5 T5-O1 Fp2-F8 F8-T4 T4-T6 T6-O2 Fp1-F3 F3-C3 C3-P3 P3-O1 Fp2-F4 F4-C4 C4-P4 P4-O2 1 sec 50 V
11 y/o boy with severe cardiomyopathy on ECMO with right temporal electrographic seizure
Fp1-F7 F7-T3 T3-T5 T5-O1 Fp2-F8 F8-T4 T4-T6 T6-O2 Fp1-F3 F3-C3 C3-P3 P3-O1 Fp2-F4 F4-C4 C4-P4 P4-O2 1 sec 50 V
1 sec
50 V
11 y/o boy with severe cardiomyopathy on ECMO with left hemispheric suppression due to infarction
Fp1-F7 F7-T3 T3-T5 T5-O1 Fp2-F8 F8-T4 T4-T6 T6-O2 Fp1-F3 F3-C3 C3-P3 P3-O1 Fp2-F4 F4-C4 C4-P4 P4-O2 1 sec 50 V
Clinical Case
8.5 year old boy with onset of seizures at age 7 Seizures begin with a tingling sensation in the R hand followed by extension and posturing of the R arm Seizures were never completely controlled with about 1 seizure per week for the first year December, 2001: Seizures began to dramatically increase January-March, 2002: Numerous seizures per day with up to 100 in a single day, and episodes of status epilepticus lasting up to 1 hour
Typical Seizure
*C3-P3
*P3-O1
Fp2-F4
F4-C4
*Fp1-F3
*F3-C3
*C3-P3
*P3-O1
C4-P4
*P4-O2
*Fp1-F3
*F3-C3
*C3-P3
*P3-O1
C4-P4
*P4-O2
MRI Findings
3D-MRI Image
Grid Placement
Craniotomy Closure
41-42 42-43 43-44 44-45 45-46 49-50 50-51 51-52 52-53 53-54 54-55 1 sec 50 V
41-42 42-43 43-44 44-45 45-46 49-50 50-51 51-52 52-53 1 sec 53-54 54-55 50 V
Cortical Resection
100 uV 1 sec
Outcome
2 month old with Enterococcal meningitis with an electrographic seizure discharge, maximal right frontal
FP1-F7 F7-T5 T5-O1 FP1-F3 F3-P3 P3-O1 Fp2-F4 F4-P4 P4-O2 Fp2-F8 F8-T6 T6-O2 1 sec 50 V