Electroencephalogram
Dr Mazlyn Mustapha
MB BCh BAO (Dublin), MRCP (Ireland)
23rd June 2010
EEG
• Surface recording of electric potentials
produced by neurons
• Recorded from the scalp
10-20 System of Electrode Placement
Uses
• Diagnosis of epilepsy
• Part of polysomnography
EEG Recording
• Several electrodes
placed all over scalp
• Pairs of electrodes
connected to
electroencephalograph
or EEG machine
EEG Signal
• Continuous wave with mixed & variable
frequency
• EEG waves categorized into four types:
–α
–β
–δ
–θ
EEG Synchronization
• Appearance of tall, rhythmic α waves or other high
amplitude, low frequency waves
Alpha Waves
• Most prominent component of EEG
• Most marked in parieto-occipital area of scalp
with eyes closed
• Disappears on opening eyes & being attentive
– EEG desynchronization
• Disappears during deep sleep
Beta Waves
• Greater than 13 Hz
• Recorded from frontal & parietal areas
• Drugs eg barbiturates induce them
Theta Waves
• 4-8 Hz
• Seen in
– Children: parietal & temporal region
– Emotional distress in adults
– Many brain disorders
Delta Wave
• Frequency less than 3 Hz
• Seen in deep sleep & infancy
• In awake adult – indicates serious organic
brain disease
Sample EEG Tracing
Abnormal EEG Waves
• Several types
• Epileptiform waves – most important
– diagnosis of epilepsy
• Epileptiform wave may be:
– A spike
– A sharp wave
– A spike and complex
• In grand mal epilepsy: polyspikes
Activation procedures
• In suspected case of epilepsy – epileptiform
waves confirms diagnosis
• Epileptiform waves – only occur during attack
• EEG normally recorded – interictal period
• Attempt to trigger epileptiform waves
– Hyperventilation
– Intermittent photic stimulation (flashes of bright
light)
Origin of EEG Waves
• Produced by currents set up by dipoles formed
on cerebral cortex
• Cerebral cortex – pyramidal cells
• Give off long dendrites
• Polarity depends on whether EPSP or IPSP
EEG – Visual Analysis
• Diagnostic importance
– Epilepsy-seizure potentials
– Irregular slowing associated with cerebral trauma
or metabolic coma
– Local changes associated with tumours
– Changes associated with psychotropic drugs
– Brain death: isoelectric or flat EEG
– Artifacts: sweat, blink, etc
EEG – Quantitative Analysis
• Bulky record (5mins – 9x16 meters EEG)
• Computer summarizes key features: in terms of
voltage and frequency
• Evoked potentials – stimulus delivered to subject
while EEG is being recorded
– Result: several waves in EEG after brief latency
• Event related potentials-evoked potentials with
latencies > 250ms
– Reflects cognitive process
Epilepsies
• Generalized
• Focal
Sleep
Sleep
• Reversible state of unresponsiveness &
perceptual dissociation from the environment
• Within sleep: two separate states
– Rapid eye movement (REM) sleep
– Nonrapid eye movement (NREM) sleep
REM Sleep
• EEG shows desynchronized or wakefulness
pattern
– Desynchronized sleep
• More difficult to awake than NREM sleep
– Paradoxical sleep
• Longer episodes of dreaming
• Inhibition of spinal motor neurons via
brainstem – atonia of antigravity muscles
REM Sleep
• Bursts of rapid eye movement, twitches in
muscles & changes in breathing pattern
• Sweating & shivering due to impaired
thermoregulation in NREM sleep stops
NREM Sleep
• Divided into four stages based on EEG
• Stage 1 – lightest sleep
• Stage 4 – deepest sleep
• Body movements – signals drift to lighter NREM
sleep stages
• Lack of mental activity
• EEG pattern – synchronous
– Sleep spindles, K complexes, high-voltage slow waves
Stage 1 NREM Sleep
• EEG changes from alpha activity to low
voltage, mixed frequency pattern
• Bursts of theta activity (young adults &
children)
• Moderate sensitivity to sensory stimuli
– Unable to produce full arousal
– Produce vertex sharp wave or V wave
Stage 2 NREM Sleep
• Sleep spindles appear in EEG
• Auditory stimuli evoke K complexes
• Gradual appearance of high-voltage slow wave
activity
Stage 3 NREM Sleep
• Characterized by delta waves 20-50% of EEG
Stage 4 NREM Sleep
• Delta activity > 50% of EEG
• Together with stage 3: slow wave deep sleep,
delta sleep or deep sleep
Sleep Onset
• Polysomnography:
• Record of EEG, EMG (electromyogram) & EOG
(electrooculogram), other physiologic
parameters
• Indicate the depth & onset of sleep
Electrophysiological Response
• EOG – slow eye movements
• EMG – gradual reduction in motor unit
potential amplitude
• Not coincide with perceived onset of sleep
Behavioural Response
• Stages 1 & 2 – response to visual stimuli is
infrequent
• Auditory response is absent at sleep onset
• Some response to meaningful stimuli during
sleep
– Sensory processing occurs after sleep onset
– Meaningful stimuli eg own name – evoked K
complexes
Intellectual Functions
• Toward onset of sleep thoughts become
illogical & incoherent
• Transition from wakefulness to sleep produces
retrograde amnesia
– Sleep inactivates consolidation of short-term into
long-term memory
Sleep Cycles
• In normal adults: begins with NREM sleep
• NREM & REM sleep alternate cyclically
through the night
• In infants: start with REM sleep
• In adults, REM sleep at onset occurs with:
– Jet lag, chronic sleep deprivation, narcolepsy,
acute withdrawal of REM-suppressing drugs,
depression
THE END
