Electroencephalography
Electroencephalography
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Electroencephalography

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Electroencephalography

Electroencephalography (EEG) 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 (commonly called "scalp EEG") 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 (8–13 Hz), beta (13–30 Hz), delta (0.5–4 Hz), and theta (4–7 Hz). 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 (location and time) 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 (MRI) and computed tomography (CT). 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 (EP), which involves averaging the EEG activity time-locked to the presentation of a stimulus of some sort (visual, somatosensory, or auditory). Event-related potentials (ERPs) 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.

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 (typically with a duration of 20–30 minutes) can be normal in people that have epilepsy. When an EEG shows interictal epileptiform discharges (e.g. sharp waves, spikes, spike-and-wave, etc.) it is confirmatory of epilepsy in nearly all cases (high specificity), however up to 3.5% of the general population may have epileptiform abnormalities in an EEG without ever having had a seizure (low false positive rate) 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 (EMU) 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.

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 (at home) or during a hospital admission, preferably to an Epilepsy Monitoring Unit (EMU) 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.

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