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Transcript of EEG of Newborn and Infants - pdfs. · PDF fileMaturation of EEG • Maturation of EEG...

  • EEG of Newborn

    and Infants

    Ki Joong Kim MD PhD

    Pediatric Neurology

    Seoul National University Childrens Hospital

    Seoul, Korea

  • Maturation of EEG

    Maturation of EEG patterns parallels brain development

    Anatomical and physiological development of brain

    Development of age-specific waking and sleep patterns

    Most dramatic EEG changes occur between premature

    age and 1st 3 months of life

    EEG patterns during 1st 6 months closely correlate with

    conceptual age (CA)

  • Neonatal EEG

    Function of actual age of brain

    CA = gestational age + legal (chronological) age

    A number of age-specific normal EEG features for only

    several weeks at a time

    Different clinical implication when seen at later ages

    Persistence or reappearance of patterns with immature

    features (dysmaturity) means cerebral dysfunction

    More mature EEG pattern than expected is usually due

    to underestimated CA

  • T3 C3 Cz C4 T4

    O1 O2

    Pz

    Fz

    Fp3 Fp4

    Fp1 Fp2

    F3 F4 F8F7

    T5 P3 P4 T6

    CH1

    CH2

    CH3

    CH4

    CH5 CH7

    CH6 CH8

    CH9 CH10 CH11 CH12

    Neonatal montage

  • Developmental EEG Characteristics of premature and term baby

    CA

    (wk)

    Continuity of

    Background Activity

    Synchrony of

    Background ActivityEEG

    Difference

    between

    Arousal and

    Sleep

    Appearance and Disappearance of

    Specific Waveforms and Patterns

    Awake Quiet

    sleep

    Active

    sleepAwake

    Quiet

    sleep

    Active

    sleep

    27-28 - D D - ++++ ++++ No

    29-30 D D D 0 0 0 No

    1. Temporal theta bursts

    2. Beta-delta complexes in central region

    3. Occipital very slow activity

    31-33 D D C + + ++ No

    1. Beta-delta complexes in TO region

    2. Rhythmic 1.5Hz activity in frontal leads in

    transitional sleep

    3. Temporal alpha bursts replace 4-5 Hz bursts

    34-35 C D C +++ + +++ No

    1. Frontal sharp transients

    2. Extremely high voltage beta activity during

    beta-delta complexes

    3. Temporal alpha bursts disappear

    36-37 C D C ++++ ++ ++++ Yes

    1. Continuous bioccipital delta activity with

    superimposed 12-15Hz activity during active

    sleep

    2. Central beta-delta complexes disappear

    38-40 C C C ++++ +++ ++++ Yes

    1. Occipital beta-delta complexes decrease and

    disappear by 39wk

    2. Trace alternant pattern (NREM sleep)

    Mizrahi EM et al Atlas of Neonatal EEG 2004

  • Less than 29 wksTrac discontinu (continuously discontinuous and bilaterally synchronous)

    Delta brush emerge at 26 weeks

    29-31 weeksGreater periods of continuous activity, suppression periods les than 30 sec

    Frequent delta brushes, temporal theta burst pattern

    32-34 weeks

    EEG reactivity to stimulation established

    Periods of diffuse attenuation less than 15 sec

    Abundant multifocal sharp transients and delta brushes

    34-37 weeks

    Delta brushes appear less often and multifocal sharp transients less frequent

    Frontal sharp transients appear

    Trac discontinu pattern is replaced by trac alternant

    After 38 weeks

    Low voltage irregular (LVI) in waking and active sleep

    Mixed voltage (MV) pattern in waking, transitional and active sleep

    High voltage slow (HVS) in quiet sleep

    Trac alternant (TA) in quiet sleep

    Fisch BJ EEG Primer 1999

    EEG change in newborn

  • Continuity Discontinuous, long flat stretches

    Interhemispheric synchrony Short bursts in synchrony

    Differentiation of waking and sleeping Undifferentiated

    Posterior basic alpha rhythm None

    Slow activity (awake) Very slow high voltage bursts

    Temporal theta burst Present and increasing

    Occipital theta Prominent

    Fast activity (awake) Very little beta activity

    Low voltage Long flat stretches

    Trac alternant None

    Spindles None

    Vertex waves and K complexes None

    Positive occipital sharp transients None

    Slow and fast activity in sleep Slow activity of high voltage, little slow activity

    REM sleep Undifferentiated

    EEG of Premature ( GA 24-27 Weeks)

    Niedermeyer E Electroencephalography 1999

    (trac discontinu)

  • M / GA 26 wk Trac discontinu

  • M / GA 27 wk Trac discontinu

  • Continuity Discontinuous

    Interhemispheric synchrony Mostly asynchronous

    Differentiation of waking and sleeping Undifferentiated

    Posterior basic alpha rhythm None

    Slow activity (awake) Very slow activity predominant

    Temporal theta burst Prominent (temporal sawtooth waves)

    Occipital theta Decreasing

    Fast activity (awake) Frequent ripples or brushes around 16/sec (delta brushes)

    Low voltage Flat stretches, mainly asynchronous

    Trac alternant None

    Spindles None (but ripples present)

    Vertex waves and K complexes None

    Positive occipital sharp transients None

    Slow and fast activity in sleep Much slow activity, more irregular, little fast activity

    REM sleep Undifferentiated

    EEG of Premature (28-31 Weeks)

    Niedermeyer E Electroencephalography 1999

    (trac discontinu)

  • M / GA 28 wk Trac discontinu

  • F / GA 29 wk Temporal theta

  • F / GA 29 wk Delta brush

  • M / GA 30 wk Ripples including delta brush

  • M / GA 31 wk Ripples

  • Continuity Continuous in waking and REM, discontinuous in NREM

    Interhemispheric synchrony Partly synchronous, especially in occipital leads

    Differentiation of waking and sleeping Waking distinguished from sleep early in the period

    Posterior basic alpha rhythm None

    Slow activity (awake) Slow (delta) with occipital maximum

    Temporal theta burst Decreasing and disappearing

    Occipital theta Decreasing

    Fast activity (awake) Frequent ripples or brushes (16-20/sec)

    Low voltage Low voltage records suspect of serious cerebral pathology

    Trac alternant Present in NREM (quite) sleep

    Spindles None (but ripples present)

    Vertex waves and K complexes None

    Positive occipital sharp transients None

    Slow and fast activity in sleep Irregular slow activity of occipital predominance

    REM sleep Continuous slow activity

    EEG of Premature (32-35 Weeks)

    Niedermeyer E Electroencephalography 1999

  • M / GA 32 wk Discontinuity

  • M / GA 32 wk Asymmetry and asynchrony

  • M / GA 32 wk Continuity

  • F / GA 33 wk Continuity

  • F / GA 33 wk Asynchrony

  • M / GA 34 wk Status change

  • F / GA 34 wk Ripples and frontal sharp transient

  • F / GA 35 wk Continuity

  • F / GA 35 wk Trace alternant

  • Continuity Continuous except for trac alternant in NREM (quiet) sleep

    Interhemispheric synchrony Minor asynchronies still present

    Differentiation of waking and sleeping Good

    Posterior basic alpha rhythm None

    Slow activity (awake) Slow (delta) mostly of moderate voltage

    Temporal theta burst Disappearing or absent

    Occipital theta Absent

    Fast activity (awake) Decreasing ripples, sparse fast activity

    Low voltage Very low voltage records due to serious cerebral pathology

    Trac alternant Present in NREM (quite) sleep

    Spindles None (but scanty ripples)

    Vertex waves and K complexes None

    Positive occipital sharp transients None

    Slow and fast activity in sleep Much delta and theta activity, continuous in REM sleep

    REM sleep Continuous slow activity

    EEG of Full-term Newborn (36-41 Weeks)

    Niedermeyer E Electroencephalography 1999

  • M / GA 36 wk

  • F / GA 37 wk

  • M / GA 38 wk Trac alternant

  • F / GA 39 wk Frontal sharp transient

  • F / GA 40 wk

  • M / GA 40 wk Anterior dysrhythmia

  • M / GA 42 wk

  • Appearance and disappearance of developmental EEG landmarks

    26 28 30 32 34 36 38 40 42 44 46 48 50 52 54

    Beta Delta Complex

    Temporal Theta Bursts

    Frontal Sharp Transients

    Trace Alternant

    Temporal

    Alpha Bursts

    Occipital

    Dominant

    Alpha Rhythm

    Conceptual Age (weeks)

    Mizrahi EM et al Atlas of Neonatal EEG 2004

    Sleep Spindles

    Vertex Transients

  • F / GA 38 wk Excessive suppression in HIE

  • F / GA 38 wk Rhythmic epileptiform activity in HIE

  • F / GA 38 wk Rhythmic epileptiform activity in HIE

  • F / GA 41 wk Focal spike discharges

  • F / GA 40 wk FST vs. epileptiform spike

  • F / GA 40 wk Repetitive spike discharges

  • F / GA 40 wk Neonatal seizures

  • F / GA 40 wk Neonatal seizures

  • F / GA 40 wk Neonatal seizures

  • M / GA 33 wk Neonatal seizures

  • M / GA 33 wk Neonatal seizures

  • M / GA 33 wk Neonatal seizures

  • Early Infantile Epileptic Encephalopathy

    with Suppression-bursts (EIEE)

    Pseudoperiodical suppression-bursts pattern

    High amplitude bursts alternating with and nearly flat

    suppression phases

    Bursts of irregular 150-350 V high voltage slow waves

    mixed with spikes for 1-3 seconds

    Suppression phase for 3-4 seconds

    Burst-burst interval 5-10 seconds

    Appearance regardless of waking and sleep states

  • F / 1 mo Burst suppression in EIEE

  • F / 1 mo Burst suppression in EIEE

  • Normal EEG in Infancy

    Delta and theta equally p