8/17/2019 Moore - EEG Academic Half-day 2009 Part 1 and 2

1/42

EEG

For Neurology Residents2009

8/17/2019 Moore - EEG Academic Half-day 2009 Part 1 and 2

2/42

Not exactly EEG, but…

…things you need to know.

1. Epilepsy and driving.

2. Epilepsy and pregnancy

8/17/2019 Moore - EEG Academic Half-day 2009 Part 1 and 2

3/42

O!"#NE

#. $hat is an EEG and how is it recorded %

##. &ow do you read an EEG %

###. !he use o' EEG

#(. )lideshow*+ui

8/17/2019 Moore - EEG Academic Half-day 2009 Part 1 and 2

4/42

-/! #

$&! #) N EEG N0 &O$ #)

#! /EO/0E0%

8/17/2019 Moore - EEG Academic Half-day 2009 Part 1 and 2

5/42

/ecording procedure

20-30 minutes, relaxed patientEyes opened/closedPhotic stimulation,Hyperventilation

+/- sleep +/- pain, noise

8/17/2019 Moore - EEG Academic Half-day 2009 Part 1 and 2

6/42

8/17/2019 Moore - EEG Academic Half-day 2009 Part 1 and 2

7/42

-/! ##

&O$ 0O O /E0 N EEG %

8/17/2019 Moore - EEG Academic Half-day 2009 Part 1 and 2

8/42

$hy do you need to know this%

• Exa3s

•

E3ergencies

• !o understand the reports

8/17/2019 Moore - EEG Academic Half-day 2009 Part 1 and 2

9/42

 n organied approach

1. Orient yoursel'.

2. #s there nor3al brain activity present or

is it altered %

4. #s there abnor3al activity present %

5. $hat is the state %

6. #s it age 7 appropriate %8. re there any arti'acts present %

8/17/2019 Moore - EEG Academic Half-day 2009 Part 1 and 2

10/42

1. O/#EN! O/)E"9

Montage !ipolar or re"erential# $%, $&!i3e scale

'ensitivity amplitude, positive*negative:Other channels ;E

8/17/2019 Moore - EEG Academic Half-day 2009 Part 1 and 2

11/42

2. #s there nor3al brain activity or is

it altered%

• Is the stuff that is supposed to be there

actually there ?

• #s there evidence o' a structural lesion or a

toxic*3etabolic process that has altered

the nor3al EEG background activity%

8/17/2019 Moore - EEG Academic Half-day 2009 Part 1 and 2

12/42

Nor3al brain activity

• $aves= 0elta 1>4 &!heta 5>? &

 lpha @>12 &

Aeta B 12 &

• -osterior do3inant alpha rhyth3 with eyeclosure.

•  lpha rhyth3 C alpha 'reDuency

• "ow a3plitude, 'rontal Aeta activity.

8/17/2019 Moore - EEG Academic Half-day 2009 Part 1 and 2

13/42

!he typical EEG

8/17/2019 Moore - EEG Academic Half-day 2009 Part 1 and 2

14/42

Nor3al deviations 'ro3 nor3al

;:1. 0rowsiness

2. )leep

4. ge ;young and old:5. ctivation procedures

;a: &yperventilation

;b: -hotic sti3ulation

8/17/2019 Moore - EEG Academic Half-day 2009 Part 1 and 2

15/42

Aackground abnor3alities

• )lowing ;theta or delta:• 9ocal or di''use

• Ailaterally synchronous or not

• /hyth3ic vs. irregular*poly3orphic

• &igh vs. low a3plitude

• #nter3ittent vs. continuous

• an be 3ore subtle•  ttenuation o' a3plitude

•  sy33etry o' alpha

Etc…

8/17/2019 Moore - EEG Academic Half-day 2009 Part 1 and 2

16/42

$ocal slo(ing

8/17/2019 Moore - EEG Academic Half-day 2009 Part 1 and 2

17/42

)enerali*ed slo(ing E!ersole Pedley

8/17/2019 Moore - EEG Academic Half-day 2009 Part 1 and 2

18/42

)u33ary

• 9ocal slowingF rule out structural lesion

•

Generalied rhyth3ic slowing F consider deep structural lesion ordestructive process

• -oly3orphic generalied slowing F very nonspeci'ic

0isturbance o' the background activityH

8/17/2019 Moore - EEG Academic Half-day 2009 Part 1 and 2

19/42

4. bnor3al activity

Is there any stuff there that should not bethere at all ?

Not simply alteration of the background 

sually, we are asking i' there is epileptic

activity ;interictal or ictal:.

 

8/17/2019 Moore - EEG Academic Half-day 2009 Part 1 and 2

20/42

9ocal #nter>ictal activity

• )pikes and sharp waves

• -hase reversal

•

/ecurrent and consistent• $ith a 'ield

• 9ollowed by slow wave

•

 sy33etrical• Not explained by arti'act

8/17/2019 Moore - EEG Academic Half-day 2009 Part 1 and 2

21/42

9ocal epileptic activity

8/17/2019 Moore - EEG Academic Half-day 2009 Part 1 and 2

22/42

$ocal epileptic activity

8/17/2019 Moore - EEG Academic Half-day 2009 Part 1 and 2

23/42

!er3inology

-otentially epileptic abnor3alityH

Epilepti'or3 abnor3alityH

8/17/2019 Moore - EEG Academic Half-day 2009 Part 1 and 2

24/42

-hase /eversal

8/17/2019 Moore - EEG Academic Half-day 2009 Part 1 and 2

25/42

Non>epileptic phase reversal ;nor3al background activity:

8/17/2019 Moore - EEG Academic Half-day 2009 Part 1 and 2

26/42

Generalied #nter>ictal ctivity

Generalied spike and wave

8/17/2019 Moore - EEG Academic Half-day 2009 Part 1 and 2

27/42

#ctal ctivity ;)eiures:

• Electrographic lasts B 1I sec

•

)eiures not de'ined by single patternJspikes, spike and wave, slowing,

attenuation etc…

• Rhythmic activity that changes with time

8/17/2019 Moore - EEG Academic Half-day 2009 Part 1 and 2

28/42

-artial co3plex seiure with secondary generaliation

8/17/2019 Moore - EEG Academic Half-day 2009 Part 1 and 2

29/42

Neonatal seiure

8/17/2019 Moore - EEG Academic Half-day 2009 Part 1 and 2

30/42

Neonatal seiure cont…

8/17/2019 Moore - EEG Academic Half-day 2009 Part 1 and 2

31/42

4 & spike and wave ;'ro3 Ebersole and -edley:

8/17/2019 Moore - EEG Academic Half-day 2009 Part 1 and 2

32/42

)u33ary

• #nterictal epileptic activity

F spikes and sharp waves

• #ctal epileptic activity

F evolving rhyth3ic activity

8/17/2019 Moore - EEG Academic Half-day 2009 Part 1 and 2

33/42

5. )tate

• 5 )leep stages, plus /EK

1. "ose L, slow EOK, v>waves

2. )pindles, co3plex, v>waves

  4. 0elta M 6I5. 0elta B 6I

/EK= >looks nor3al ;i.e. awake:, need EOG, EKG etc…

•

)leep onset• Kost consider stage 1 sleep F drowsiness• Aut…so3e de'ine sleep onset as appearance o' v>

waves, others as sleep spindles.

8/17/2019 Moore - EEG Academic Half-day 2009 Part 1 and 2

34/42

0ont 9orget…

6. ge• -rior to birth, continuous evolution o' EEG• -osterior>do3inant rhyth3 by 8>12 3onthsJ

alpha 'reDuency by 5>@ years

8. rti'acts• E

8/17/2019 Moore - EEG Academic Half-day 2009 Part 1 and 2

35/42

Electrode arti"act

8/17/2019 Moore - EEG Academic Half-day 2009 Part 1 and 2

36/42

Eye Movements

8/17/2019 Moore - EEG Academic Half-day 2009 Part 1 and 2

37/42

E) rti"act

8/17/2019 Moore - EEG Academic Half-day 2009 Part 1 and 2

38/42

Head movement arti"act during a pseudosei*ure

8/17/2019 Moore - EEG Academic Half-day 2009 Part 1 and 2

39/42

)o how do you read an EEG%

“Plan and scan”

Organized Approach

OrientNor3al

 bnor3al

 ge and )tate

 rti'acts

Scanning(ertical

 &oriontal

8/17/2019 Moore - EEG Academic Half-day 2009 Part 1 and 2

40/42

)canning

8/17/2019 Moore - EEG Academic Half-day 2009 Part 1 and 2

41/42

$ocal slo(ing

8/17/2019 Moore - EEG Academic Half-day 2009 Part 1 and 2

42/42

#' all else 'ails…

Describe what you see

$rom $isch and 'pehlmann