Electroencephalography
Electroencephalography
is a method to record an electrogram of the spontaneous electrical activity of the brain. The bio signals detected by EEG have been shown to represent the postsynaptic potentials of pyramidal neurons in the neocortex and allocortex. It is typically non-invasive, with the EEG electrodes placed along the scalp using the International 10–20 system, or variations of it. Electrocorticography, involving surgical placement of electrodes, is sometimes called "intracranial EEG". Clinical interpretation of EEG recordings is most often performed by visual inspection of the tracing or quantitative EEG analysis.
Voltage fluctuations measured by the EEG bio amplifier and electrodes allow the evaluation of normal brain activity. As the electrical activity monitored by EEG originates in neurons in the underlying brain tissue, the recordings made by the electrodes on the surface of the scalp vary in accordance with their orientation and distance to the source of the activity. Furthermore, the value recorded is distorted by intermediary tissues and bones, which act in a manner akin to resistors and capacitors in an electrical circuit. This means that not all neurons will contribute equally to an EEG signal, with an EEG predominately reflecting the activity of cortical neurons near the electrodes on the scalp. Deep structures within the brain further away from the electrodes will not contribute directly to an EEG; these include the base of the cortical gyrus, medial walls of the major lobes, hippocampus, thalamus, and brain stem.
A healthy human EEG will show certain patterns of activity that correlate with how awake a person is. The range of frequencies one observes are between 1 and 30 Hz, and amplitudes will vary between 20 and 100 μV. The observed frequencies are subdivided into various groups: alpha, beta, delta, and theta. Alpha waves are observed when a person is in a state of relaxed wakefulness and are mostly prominent over the parietal and occipital sites. During intense mental activity, beta waves are more prominent in frontal areas as well as other regions. If a relaxed person is told to open their eyes, one observes alpha activity decreasing and an increase in beta activity. Theta and delta waves are not generally seen in wakefulness – if they are, it is a sign of brain dysfunction.
EEG can detect abnormal electrical discharges such as sharp waves, spikes, or spike-and-wave complexes, as observable in people with epilepsy; thus, it is often used to inform medical diagnosis. EEG can detect the onset and spatio-temporal evolution of seizures and the presence of status epilepticus. It is also used to help diagnose sleep disorders, depth of anesthesia, coma, encephalopathies, cerebral hypoxia after cardiac arrest, and brain death. EEG used to be a first-line method of diagnosis for tumors, stroke, and other focal brain disorders, but this use has decreased with the advent of high-resolution anatomical imaging techniques such as magnetic resonance imaging and computed tomography. Despite its limited spatial resolution, EEG continues to be a valuable tool for research and diagnosis. It is one of the few mobile techniques available and offers millisecond-range temporal resolution, which is not possible with CT, PET, or MRI.
Derivatives of the EEG technique include evoked potentials, which involves averaging the EEG activity time-locked to the presentation of a stimulus of some sort. Event-related potentials refer to averaged EEG responses that are time-locked to more complex processing of stimuli; this technique is used in cognitive science, cognitive psychology, and psychophysiological research.
Uses
Epilepsy
EEG is the gold standard diagnostic procedure to confirm epilepsy. The sensitivity of a routine EEG to detect interictal epileptiform discharges at epilepsy centers has been reported to be in the range of 29–55%. Given the low to moderate sensitivity, a routine EEG can be normal in people that have epilepsy. When an EEG shows interictal epileptiform discharges it is confirmatory of epilepsy in nearly all cases, however up to 3.5% of the general population may have epileptiform abnormalities in an EEG without ever having had a seizure or with a very low risk of developing epilepsy in the future.When a routine EEG is normal and there is a high suspicion or need to confirm epilepsy, it may be repeated or performed with a longer duration in the epilepsy monitoring unit or at home with an ambulatory EEG. In addition, there are activating maneuvers such as photic stimulation, hyperventilation and sleep deprivation that can increase the diagnostic yield of the EEG.
Epilepsy Monitoring Unit (EMU)
At times, a routine EEG is not sufficient to establish the diagnosis or determine the best course of action in terms of treatment. In this case, attempts may be made to record an EEG while a seizure is occurring. This is known as an ictal recording, as opposed to an interictal recording, which refers to the EEG recording between seizures. To obtain an ictal recording, a prolonged EEG is typically performed accompanied by a time-synchronized video and audio recording. This can be done either as an outpatient or during a hospital admission, preferably to an Epilepsy Monitoring Unit with nurses and other personnel trained in the care of patients with seizures. Outpatient ambulatory video EEGs typically last one to three days. An admission to an Epilepsy Monitoring Unit typically lasts several days but may last for a week or longer. While in the hospital, seizure medications are usually withdrawn to increase the odds that a seizure will occur during admission. For reasons of safety, medications are not withdrawn during an EEG outside of the hospital. Ambulatory video EEGs, therefore, have the advantage of convenience and are less expensive than a hospital admission, but they also have the disadvantage of a decreased probability of recording a clinical event.Epilepsy monitoring is often considered when patients continue having events despite being on anti-seizure medications or if there is concern that the patient's events have an alternate diagnosis, e.g., psychogenic non-epileptic seizures, syncope, sub-cortical movement disorders, migraine variants, stroke, etc. In cases of epileptic seizures, continuous EEG monitoring helps to characterize seizures and localize/lateralize the region of the brain from which a seizure originates. This can help identify appropriate non-medication treatment options. In clinical use, EEG traces are visually analyzed by neurologists to look at various features. Increasingly, quantitative analysis of EEG is being used in conjunction with visual analysis. Quantitative analysis displays like power spectrum analysis, alpha-delta ratio, amplitude integrated EEG, and spike detection can help quickly identify segments of EEG that need close visual analysis or, in some cases, be used as surrogates for quick identification of seizures in long-term recordings.
Other brain disorders
An EEG might also be helpful for diagnosing or treating the following disorders:- Brain tumor
- Brain damage from head injury
- Brain dysfunction that can have a variety of causes
- Inflammation of the brain
- Stroke
- Sleep disorders
- distinguish epileptic seizures from other types of spells, such as psychogenic non-epileptic seizures, syncope, sub-cortical movement disorders and migraine variants
- differentiate "organic" encephalopathy or delirium from primary psychiatric syndromes such as catatonia
- serve as an adjunct test of brain death in comatose patients
- prognosticate in comatose patients or in newborns with brain injury from various causes around the time of birth
- determine whether to wean anti-epileptic medications.
Intensive Care Unit (ICU)
In cases where significant brain injury is suspected, e.g., after cardiac arrest, EEG can provide some prognostic information.
If a patient with epilepsy is being considered for resective surgery to treat epilepsy, it is often necessary to localize the focus of the epileptic brain activity with a resolution greater than what is provided by scalp EEG. In these cases, neurosurgeons typically implant strips and grids of electrodes or penetrating depth electrodes under the dura mater, through either a craniotomy or a burr hole. The recording of these signals is referred to as electrocorticography, subdural EEG, intracranial EEG, or stereotactic EEG. The signal recorded from ECoG is on a different scale of activity than the brain activity recorded from scalp EEG. Low-voltage, high-frequency components that cannot be seen easily in scalp EEG can be seen clearly in ECoG. Further, smaller electrodes allow for better spatial resolution to narrow down the areas critical for seizure onset and propagation. Some clinical sites record data from penetrating microelectrodes.