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Books on the topic 'ELECTROENCEPHALOGRA'

Author: Grafiati

Published: 11 September 2023

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1

National Institutes of Health (U.S.). Office of Clinical Center Communications, ed. EEG (electroencephalogram). [Bethesda, Md.?]: Clinical Center Communications, National Institutes of Health, 1989.

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2

Vogel, Friedrich. Genetics and the Electroencephalogram. Berlin, Heidelberg: Springer Berlin Heidelberg, 2000. http://dx.doi.org/10.1007/978-3-642-57040-7.

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3

The electroencephalogram: Its patterns and origins. Cambridge, Mass: MIT Press, 1993.

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4

Garner, B. P. Spectral analysis of the electroencephalogram in young children. Manchester: UMIST, 1992.

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5

Empson, Jacob. Human brainwaves: The psychological significance of the electroencephalogram. Houndmills, Basingstoke, Hampshire: Macmillan, 1986.

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6

Parker, James N., and Philip M. Parker. Electroencephalogram: A medical dictionary, bibliography, and annotated research guide to Internet references. San Diego, CA: ICON Health Publications, 2004.

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7

Richards, Mark. Modulation of human electroencephalogram activity by experimentally generated electromagnetic fields: A counterclockwise application of complex magnetic fields known to alter time perception. Sudbury, Ont: Laurentian University, Department of Psychology, 2001.

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8

The Brain's alpha rhythms and the mind: A review of classical and modern studies of the alpha rhythm component of the electroencephalogram with commentaies on associated neuroscience and neuropsychology. Amsterdam: Elsevier, 2003.

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9

Shaw, J. C. The Brain's alpha rhythms and the mind: A review of classical and modern studies of the alpha rhythm component of the electroencephalogram with commentaries on associated neuroscience and neuropsychology. Amsterdam: Elsevier, 2003.

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10

Kam, Julia W. Y., and Todd C. Handy. Electroencephalogram Recording in Humans. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199939800.003.0006.

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This chapter provides an elementary introduction to the theory and practical application of electroencephalogram (EEG) recording for the purpose of studying neurocognitive processes. It is aimed at readers who have had little or no experience in EEG data collection, and would like to gain a better understanding of scientific papers employing this methodology or start their own EEG experiment. We begin with a definition of EEG, and a summary of the strengths and limitations of EEG-based techniques. Following this is a description of the basic theory concerning the cellular mechanisms underlying EEG, as well as two types of data generated by EEG recording. We then present a brief summary of the equipment necessary for EEG data acquisition and important considerations for presentation software. Finally, we provide an overview of the protocol for data acquisition and processing, as well as methods for quantifying both EEG and event-related potentials data.

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11

Vogel, Friedrich. Genetics and the Electroencephalogram. Springer London, Limited, 2012.

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12

Genetics and the Electroencephalogram. Springer, 2000.

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13

Vespa, Paul M. Electroencephalogram monitoring in the critically ill. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0221.

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Electroencephalography monitoring provides a method for monitoring brain function, which can complement other forms of monitoring, such as monitoring of intracranial pressure and derived parameters, such as cerebral perfusion pressure. Continuous electroencephalogram (EEG) monitoring can be helpful in seizure detection after brain injury and coma. Seizures can be detected by visual inspection of the raw EEG and/or processed EEG data. Treatment of status epilepticus can be improved by rapid identification and abolition of seizures using continuous EEG. Quantitative EEG can also be used to detect brain ischaemia and seizures, to monitor sedation and aid prognosis.

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14

Pichlmayr, I. Electroencephalogram in Anesthesia: Fundamentals, Practical Applications, Examples. Springer, 2012.

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15

Pichlmayr, I. Electroencephalogram in Anesthesia: Fundamentals, Practical Applications, Examples. Springer London, Limited, 2012.

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16

Empson, Jacob. Human Brainwaves: The Psychological Significance of the Electroencephalogram. Palgrave Macmillan, 1986.

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17

Pichlmayr, I. The Electroencephalogram in Anesthesia: Fundamentals, Practical Applications, Examples. Springer, 2012.

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18

Hamdi, Salah. Electroencephalogram Signal Analysis: Epileptic Cerebral Activity Localization and Implementation. Cambridge Scholars Publishing, 2022.

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19

The electroencephalogram and the Adaptive Autoregressive Model: Theory and Applications. Shaker Verlag, 2000.

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20

Publications, ICON Health. Electroencephalogram - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References. ICON Health Publications, 2004.

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21

Gandhi, Vaibhav. Brain-Computer Interfacing for Assistive Robotics: Electroencephalograms, Recurrent Quantum Neural Networks, and User-Centric Graphical Interfaces. Elsevier Science & Technology Books, 2014.

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22

Gandhi, Vaibhav. Brain-Computer Interfacing for Assistive Robotics: Electroencephalograms, Recurrent Quantum Neural Networks, and User-Centric Graphical Interfaces. Academic Press, 2014.

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23

Weeber, Edwin J. Angelman Syndrome. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199744312.003.0013.

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Angelman syndrome (AS) is a devastating neurological disorder with a symptom complex that includes but is not limited to severe developmental delay, profound cognitive disruption, motor coordination defects, increased propensity for seizure with a characteristic abnormal electroencephalogram, sleep disruption, behavioral difficulties, a lack of speech, and an overall happy demeanor. Although the disorder was first described in 1965 by British pediatrician Dr. Harry Angelman, because AS is clinically characterized by a wide constellation of symptoms with varying degrees of severity, it is not readily diagnosed by clinical presentation alone and misdiagnosis has commonly occurred.

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24

Butkov, Nic. Polysomnography. Edited by Sudhansu Chokroverty, Luigi Ferini-Strambi, and Christopher Kennard. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199682003.003.0007.

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This chapter provides an overview of the sleep recording process, including the application of electrodes and sensors to the patient, instrumentation, signal processing, digital polysomnography (PSG), and artifact recognition. Topics discussed include indications for PSG, standard recording parameters, patient preparation, electrode placement for recording the electroencephalogram (EEG), electrooculogram (EOG), electromyogram (EMG), and electrocardiogram (ECG), the use of respiratory transducers, oximetry, signal processing, filters, digital data display, electrical safety, and patient monitoring. This chapter also includes record samples of the various types of recording artifacts commonly found in sleep studies, with a detailed description of their causes, preventative measures, and recommended corrective actions.

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25

Pearl, Phillip L., Jules Beal, Monika Eisermann, Sunita Misra, Perrine Plouin, Solomon L. Moshe, James J. Riviello, Douglas R. Nordli, and Eli M. Mizrahi. Normal EEG in Wakefulness and Sleep. Edited by Donald L. Schomer and Fernando H. Lopes da Silva. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190228484.003.0007.

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Electroencephalogram (EEG) interpretation depends on accurate pattern recognition. One of the first lessons the novice electroencephalographer learns is that EEG pattern interpretation must take into account the patient’s age and the level of vigilance, or state. EEG patterns vary according to central nervous system development and maturation. This process evolves over time, starting with the early development and maturation of the nervous system (an evolution) to a peak of maturity, followed by an involution. Basic differences exist between the ascending (developmental) and descending (involutional) portions of this curve. This chapter discusses pediatric EEG, from the dramatic ontogenic transitioning of the neonate, premature and term, to infants, children, and adolescents.

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26

Jef ferys, John G. R. Cortical activity: single cell, cell assemblages, and networks. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199688395.003.0004.

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This chapter describes how the activity of neurons produces electrical potentials that can be recorded at the levels of single cells, small groups of neurons, and larger neuronal networks. It outlines how the movement of ions across neuronal membranes produces action potentials and synaptic potentials. It considers how the spatial arrangement of specific ion channels on the neuronal surface can produce potentials that can be recorded from the extracellular space. Finally, it outlines how the layered cellular structure of the neocortex can result in summation of signals from many neurons to be large enough to record through the scalp as evoked potentials or the electroencephalogram.

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27

Youngblood, Mark W., and Hal Blumenfeld. Biological Basis of Primary Generalized Epilepsies—Pathophysiology. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199937837.003.0037.

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The primary generalized epilepsies include a heterogeneous group of seizures including absence, myoclonic, and generalized tonic-clonic seizures that are not strictly localized on EEG and not secondary to another disorder. The seizures are often associated with a loss of consciousness and may present with motor manifestations, including convulsions and arrest of respiration. Generalized spike-and-wave discharges on electroencephalogram are a uniting feature, and this pattern of activity is a direct manifestation of the underlying mechanism of these disorders. A review of important underlying circuitry will set the stage to discuss the pathological and genetic basis of these disorders, and the chapter will conclude with a review of current and potential therapeutics.

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28

Moeller, Friederike, Ronit M. Pressler, and J. Helen Cross. Genetic generalized epilepsy. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199688395.003.0027.

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This chapter provides an overview of generalized epilepsies (GGE), which comprises a group of epilepsy syndromes of presumed genetic origin. They are classified into several syndromes according to their age, depending on clinical manifestation and associated electroencephalogram (EEG) features. The chapter introduces the concept of GGE before addressing different GGE syndromes, describing their clinical presentation, EEG features, treatment, prognosis, and underlying genetics. The following GGE syndromes are discussed in order of their age of onset—myoclonic astatic epilepsy, childhood absence epilepsy, epilepsy with myoclonic absences, eyelid myoclonia with absences, juvenile absence epilepsy, juvenile myoclonic epilepsy, and epilepsy with generalized tonic seizures on awakening. This is followed by an overview on pathophysiological mechanisms underlying GGE.

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29

Ewen, Joshua B., and Sándor Beniczky. Validating Biomarkers and Diagnostic Tests in Clinical Neurophysiology. Edited by Donald L. Schomer and Fernando H. Lopes da Silva. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190228484.003.0009.

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There has been an explosion in the development of electroencephalogram (EEG)-based biomarkers and clinical tests. This upsurge is likely due to an increase in therapies rooted in biological mechanisms rather than behavioral descriptions, as well as to the democratization of computational power and the lower cost of EEG compared with competing methodologies. This increase in motivation and opportunity demands an increased responsibility for proper validation studies. Fields including laboratory medicine and psychometrics have paved the way for rigorous validation methodology. This chapter reviews a systematic methodology for biomarker/clinical test validation, translating approaches from other fields to the specific characteristics of EEG-based metrics. A checklist is provided to help readers design high-quality diagnostic validation studies of EEG-based biomarkers.

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30

Chadwick, David, Alastair Compston, Michael Donaghy, Nicholas Fletcher, Robert Grant, David Hilton-Jones, Martin Rossor, Peter Rothwell, and Neil Scolding. Investigations. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198569381.003.0100.

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This chapter describes the many methods that can be used to investigate neurological disorders. The application and suitability for specific disorder types are outlined, as are contraindications for use. Methods of imaging the central nervous system include computed tomography (CT) imaging, several magnetic resonance (MR) scanning methods, Single photon emission computed tomography (SPECT) and Positron Emission Tomography (PET). Invasive (angiography) and non-invasive methods of imaging the cerebral circulation are also outlined.The standard method of recording electrical activity of the brain is the electroencephalogram (EEG), which is heavily used in epilepsy to investigate regions of epileptogenesis.Other investigations described include evoked potentials, nerve conduction and electromyography studies, the examination of cerebrospinal fluid and the diagnostic use of neurological autoantibodies. Finally, neurogenetics, neuropsychological assessment and the assessment of treatments by randomized trials are discussed.

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31

Fenton, Lynne, Brian Rothberg, Laura Strom, Allison M. Heru, and Mesha-Gay Brown. Integrative Care Model for Neurology and Psychiatry. Edited by Robert E. Feinstein, Joseph V. Connelly, and Marilyn S. Feinstein. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190276201.003.0019.

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Nonepileptic seizures resemble epileptic seizures but lack epileptiform activity on an electroencephalogram and presumably have psychopathologic origins. Psychiatric comorbidities are common, and effective management requires psychiatric treatment. Unfortunately, many patients fear that seeing a psychiatrist implies their episodes are not being taken seriously and that their neurologist might perceive them as producing their symptoms willfully. Patients might feel abandoned if their neurologist refers them to a psychiatrist and indicates that they no longer need to be seen by the neurologist. Consequently, patients often resist undergoing psychiatric evaluation. To help address this problem our team piloted a program integrating psychiatric and neurologic approaches, placing a therapeutic treatment group within the neurology outpatient department. This chapter reviews the clinical features of non-epileptic seizures, including diagnosis and treatment, and presents our team’s integrated treatment approach.

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32

Elwes, Robert. Presurgical evaluation for epilepsy surgery. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199688395.003.0031.

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This chapter describes the preoperative electroclinical assessment of the various epilepsy syndromes and pathologies that are open to surgical treatment. Particular emphasis is placed on medial temporal epilepsy and frontal epilepsy. The assessment of cases considered for hemispherotomy, multiple subpial transection for Landau–Kleffner syndrome, anterior two-thirds callosotomy in symptomatic generalized epilepsy, neural stimulation, and cases with nodular hetertopia are summarized. Throughout the chapter, particular emphasis is placed on the need for multidisciplinary assessment, and the interpretation of the electroencephalogram (EEG) in the context of the clinical features, imaging, and neuropsychology. Evaluation pathways are suggested and the indications for intracranial EEG, the types of electrodes used and the operative complications are discussed in detail. Summaries of the key points in the electroclinical evaluation of temporal and frontal lobe epilepsy are given.

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33

Koutroumanidis, Michalis, and Robin Howard. Encephalopathy, central nervous system infections, and coma. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199688395.003.0032.

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This chapter provides an overview of the indications for and the diagnostic and prognostic value of acute video-electroencephalogram (EEG) and continuous video-EEG monitoring in patients with encephalopathies, encephalitides, and coma. Particular emphasis is placed on the detection of non-convulsive seizures and non-convulsive status epilepticus secondary to acute and sub-acute cerebral insults, including post-cardiac arrest hypoxic-ischaemic brain injury, and on the related pitfalls and uncertainties. It also discusses key technical aspects of the EEG recording, including artefact identification and limitation, timing and type of external stimulation and assessment of EEG reactivity, and highlights the main relevant pitfalls. Finally, it explores the role of evoked potentials (EPs) in outcome prediction and the value of Cognitive EPs and quantitative EEG in the assessment of chronic disorders of consciousness.

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34

Koutroumanidis, Michalis, Dimitrios Sakellariou, and Vasiliki Tsirka. Electroencephalography. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199688395.003.0011.

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This chapter concentrates on essential technical aspects of the electroencephalogram (EEG) and its role in the clinical and aetiological diagnosis of people with epilepsy. The technical subsection explores important stages of the largely ‘mystifying’ process from the generation of the abnormal signals in the brain to their final visualization on the screen, including digitalization of the signal and sampling rate, montages, and derivations, focusing on their clinical relevance. The second part reviews the behavioural attributes of the interictal and ictal discharges in the different epilepsy types and syndromes, discusses the optimal use of activation methods, including sleep deprivation and sleep, hyperventilation, photic, and other specific stimulation, and describes specific diagnostic tools like polygraphy and cognitive assessment during apparently subclinical discharges. It also discusses aspects of the clinical EEG interpretation and reporting and delineates indications and limitations of the EEG.

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35

Amzica, Florin, and Fernando H. Lopes da Silva. Cellular Substrates of Brain Rhythms. Edited by Donald L. Schomer and Fernando H. Lopes da Silva. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190228484.003.0002.

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The purpose of this chapter is to familiarize the reader with the basic electrical patterns of the electroencephalogram (EEG). Brain cells (mainly neurons and glia) are organized in multiple levels of intricate networks. The cellular membranes are semipermeable media between extracellular and intracellular solutions, populated by ions and other electrically charged molecules. This represents the basis of electrical currents flowing across cellular membranes, further generating electromagnetic fields that radiate to the scalp electrodes, which record changes in the activity of brain cells. This chapter presents these concepts together with the mechanisms of building up the EEG signal. The chapter discusses the various behavioral conditions and neurophysiological mechanisms that modulate the activity of cells leading to the most common EEG patterns, such as the cellular interactions for alpha, beta, gamma, slow, delta, and theta oscillations, DC shifts, and some particular waveforms such as sleep spindles and K-complexes and nu-complexes.

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36

Herring, Christina. Neuromodulation in Psychiatric Disorders. Edited by Anthony J. Bazzan and Daniel A. Monti. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190690557.003.0013.

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Quantitative electroencephalogram (qEEG) is the transformation of the EEG by spectral analysis in which the amount of electrical activity at a particular frequency is determined and compared against a normative data base. EEG findings are specific for different psychiatric problems and help reveal brain abnormalities associated with psychological symptoms. Repetitive transcranial magnetic stimulation (rTMS) is a system of delivering multiple pulses within a short time period that induce changes that outlast the stimulation period. Operant conditioning involves providing a reward to increase the probability of a certain behavior. Neurofeedback involves recording, analyzing, and presenting results of qEEG analyses in near real-time to patients in order to promote changes in brain electrical activity. This chapter reviews how neuromodulation works both clinically and from a neurophysiological perspective. This chapter also reviews current clinical data on the use of neuromodulation approaches for improving mental health and well-being.

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37

Furlong, Paul L., Elaine Foley, Caroline Witton, and Stefano Seri. Magnetoencephalography. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199688395.003.0013.

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For presurgical assessments for resection of an epileptogenic lesion or zone, evaluations over the last 20 years have established magnetoencephalography (MEG) as a valuable tool in routine clinical practice in both adult and paediatric age groups. MEG can accurately localize both ictal and inter-ictal spike sources. MEG yields important additional information in around 30% of patients with epilepsy of suspected neocortical origin, aiding in the modification or extension of invasive measurements. Seizure freedom is most likely to occur when there is concordance between electroencephalogram (EEG) and MEG localization, and least likely to occur when these results are divergent. In some patients, invasive recordings may not be viable or repeatable. In these cases, MEG localization frequently provides additional information for planning surgery. Recent developments in technology for movement compensation and enhanced noise reduction provide optimism for continually improving outcomes of MEG-enhanced presurgical evaluations.

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38

Goyal, Sushma. Electroclinical features of paediatric conditions. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199688395.003.0034.

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Paediatric epilepsy is one of the most challenging aspects of clinical neurophysiology, as it is a dynamic entity in continuous evolution. A sound clinical understanding based on clinical history and examination combined with the ability to interpret paediatric electroencephalogram (EEG) is imperative prior to considering a diagnosis of epilepsy in children. A multidisciplinary approach involving regular communication between the referring physician, paediatric neurophysiologist, neuroradiologist, and geneticist is helpful as the child grows and the epilepsy becomes apparent. In a clinical setting, the primary aim is to diagnose seizure type(s) and distinguish it from the multitude of conditions that mimic epilepsy. The secondary aim is to define the electroclinical syndrome and aetiology, where possible, to guide treatment and prognosis. . In this chapter, the major paediatric epilepsies will be described according to the age of presentation from neonatal period, infancy, childhood, and adolescence as this approach mirrors clinical practice.

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39

Krishnan, Vaishnav, Bernard S. Chang, and Donald L. Schomer. Normal EEG in Wakefulness and Sleep. Edited by Donald L. Schomer and Fernando H. Lopes da Silva. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190228484.003.0008.

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The normal adult electroencephalogram (EEG) is not a singular entity, and recognizing and appreciating the various expressions of a normal EEG is vital for any electroencephalographer. During wakefulness, the posterior dominant rhythm (PDR) must display a frequency within the alpha band, although an absent PDR is not abnormal. A symmetrically slowed PDR, excessive theta activity, or any delta activity during wakefulness is abnormal and a biomarker of encephalopathy. Low-voltage EEGs have been associated with a variety of neuropathological states but are themselves not abnormal. During non-rapid eye movement sleep, a normal EEG will display progressively greater degrees of background slowing and amplitude enhancement, which may or may not be associated with specific sleep-related transients. In contrast, the EEG during rapid eye movement sleep more closely resembles a waking EEG (“desynchronized”) in amplitude and background frequencies. Across both wakefulness and sleep, significant asymmetries in background frequencies and amplitude are abnormal.

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40

Gaitanis, John, Phillip L. Pearl, and Howard Goodkin. The EEG in Degenerative Disorders of the Central Nervous System. Edited by Donald L. Schomer and Fernando H. Lopes da Silva. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190228484.003.0013.

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Nervous system alterations can occur at any stage of prenatal or postnatal development. Any of these derangements, whether environmental or genetic, will affect electrical transmission, causing electroencephalogram (EEG) alteration and possibly epilepsy. Genetic insults may be multisystemic (for example, neurocutaneous syndromes) or affect only the brain. Gene mutations account for inborn errors of metabolism, channelopathies, brain malformations, and impaired synaptogenesis. Inborn errors of metabolism cause seizures and EEG abnormalities through a variety of mechanisms, including disrupted energy metabolism (mitochondrial disorders, glucose transporter defect), neuronal toxicity (amino and organic acidopathies), impaired neuronal function (lysosomal and peroxisomal disorders), alteration of neurotransmitter systems (nonketotic hyperglycinemia), and vitamin and co-factor dependency (pyridoxine-dependent seizures). Environmental causes of perinatal brain injury often result in motor or intellectual impairment (cerebral palsy). Multiple proposed etiologies exist for autism, many focusing on synaptic development. This chapter reviews the EEG findings associated with this myriad of pathologies occurring in childhood.

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41

Shibasaki, Hiroshi, and Masatoshi Nakamura. Automatic Integrated EEG Interpretation and Reporting. Edited by Donald L. Schomer and Fernando H. Lopes da Silva. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190228484.003.0027.

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Automatic interpretation of electroencephalograms (EEG) is complicated due to fluctuation of background activity, paroxysmal activities, artifacts, and use of different electrode montages. Previous attempts at automatic EEG interpretation focused on a certain feature such as background activity and paroxysmal abnormalities. The authors’ group has developed a computer-assisted, offline system for automatic comprehensive interpretation of EEG that takes into account all features of the adult waking EEG and provides the results in a written report. The system is not aimed at standardization of EEG interpretation, but its results can match the results of visual inspection by a limited number of qualified EEG-ers. Thus, this system can be adjusted in accordance with the strategy of visual inspection adopted by any EEG-er. Artifacts, spikes, and the vigilance level and attention level of subjects are automatically detected. This system can be used to supplement visual inspection and for training purposes.

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42

Gotman, Jean, and Nathan E. Crone. High-Frequency EEG Activity. Edited by Donald L. Schomer and Fernando H. Lopes da Silva. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190228484.003.0033.

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Activities with frequencies between 60 and 80 Hz and approximately 500 Hz are labeled here as high-frequency activities. They were largely ignored until the beginning of the millennium, but their importance is now well recognized. They can be divided into activities occurring in the healthy brain in relation to sensory, motor, and cognitive or memory activity and activities occurring in the epileptic brain in the form of brief events (high-frequency oscillations), which appear to be an important marker of the brain regions that are able to generate seizures of focal origin. In humans, most of the work related to these activities has been done in intracerebral electrodes, where they are relatively frequent and easy to identify. They have been recorded in scalp electroencephalograms in some circumstances, however. This chapter reviews the recording methods, the circumstances in which they occur, their mechanism of generation, and their clinical significance.

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43

Schomer, Donald L., Charles M. Epstein, Susan T. Herman, Douglas Maus, and Bruce J. Fisch. Recording Principles. Edited by Donald L. Schomer and Fernando H. Lopes da Silva. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190228484.003.0005.

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This chapter reviews the technical aspects of recording and reviewing clinical electroencephalograms (EEGs) and related biopotentials. While advances in engineering technology have revolutionized EEG machines, the basic principles underlying accurate representation of brain activity are largely unchanged. The first section reviews the analog EEG components, and the second section discusses analog-to-digital conversion, digital filters, and display and storage parameters. Digital EEG machines are now less expensive and their capabilities far surpass those of analog machines. The third section reviews how electrode positions and systems of signal display (montages) can be used to determine the polarity and field of EEG signals. The final section describes how other biopotentials are acquired and displayed. Polygraphy can provide crucial information on other physiological processes that can impact EEG activity and can help identify potential artifactual signals. We highlight recent advances that allow the recording of a broader range of EEG frequencies and spatial distribution.

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44

Edwards, Jonathan Charles, and Ekrem Kutluay. Patterns of Unclear Significance. Edited by Donald L. Schomer and Fernando H. Lopes da Silva. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190228484.003.0012.

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Accurate interpretation of electroencephalograms requires knowledge and experience with a wide range of findings. Misinterpretation is common and may result from insufficient inexperience, incomplete training, or simply human error. However, misinterpretation may also arise from the relative rarity of some findings, and also from the evolution and necessary change in our understanding of the significance of these findings. One of the most common sources of reader error is in dealing with patterns that have some hallmarks of abnormalities but are actually normal findings. We refer to these findings as variants, or “patterns of unclear significance.” This chapter reviews several of the common and uncommon patterns (fast or slow alpha variant, alpha squeak, rhythmic midtemporal theta bursts of drowsiness, midline theta rhythm, subclinical rhythmic electrographic discharge in adults, 14- and 6-Hz positive bursts, 6-Hz spike-and-wave bursts, benign sporadic sleep spikes, wickets, frontal arousal rhythm), emphasizing characteristics that can optimize interpretation.

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45

Bleck, Thomas P. Assessment and management of seizures in the critically ill. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0232.

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In previously conscious patients seizures are usually easily detected. Critically-ill patients are frequently sedated and a proportion are paralysed with neuromuscular blocking agents, in such patients it may be hard or impossible to detect seizures clinically. An urgent electroencephalogram (EEG) should be obtained whenever seizures are witness or suspected, especially if the patient does not rapidly return to baseline, when non-convulsive status epilepticus must be excluded. Unless the cause of the seizure activity is already known, an urgent CT, or MRI is indicated. If central nervous system infection is suspected a lumbar puncture may be needed. Status epilepticus is diagnosed when there is recurrent or continued seizure activity without intervening recovery. Most seizures are self-limiting and stop after 1–2 minutes, seizures that continue for more than 5 minutes should be treated. Treatment priorities for any seizure are to stop the patient hurting either themselves or anyone else. General supportive measures include attention to the airway, breathing, circulation, exclusion of hypoglycaemia and an EEG to exclude non-convulsive status epilepticus. A variety of drugs can be used to terminate seizures; parenteral benzodiazepines are the most commonly used agents although propofol and barbiturates are alternatives. Emergent endotracheal intubation may well be necessary, hypotension can be expected and may need treatment with intravenous fluids and vasopressors.

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46

Luginbühl, Martin, and Arvi Yli-Hankala. Assessment of the components of anaesthesia. Edited by Antony R. Wilkes and Jonathan G. Hardman. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0026.

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Abstract:

In modern anaesthesia practice, hypnotic drugs, opioids, and neuromuscular blocking agents (NMBAs) are combined. The introduction of NMBAs in particular substantially increased the risk of awareness and recall during general anaesthesia. Hypnotic drugs such as propofol and volatile anaesthetics act through GABAA receptors and have typical effects on the electroencephalogram (EEG). During increasing concentrations of these pharmaceuticals, the EEG desynchronization is followed by gradual synchronization, slowing frequency, and increasing amplitude of EEG, thereafter EEG suppressions (burst suppression), and, finally, isoelectric EEG. Hypnotic depth monitors such as the Bispectral Index™, Entropy™, and Narcotrend® are based on quantitative EEG analysis and translate these changes into numbers between 100 and 0. Although they are good predictors of wakefulness and deep anaesthesia, their usefulness in prevention of awareness and recall has been challenged, especially when inhalation anaesthetics are used. External and patient-related artifacts such as epileptiform discharges and frontal electromyography (EMG) affect the signal so their readings need careful interpretation. Their use is recommended in patients at increased risk of awareness and recall and in patients under total intravenous anaesthesia. Monitors of analgesia and nociception are not established in clinical practice but mostly remain experimental although some are commercially available. Some use EEG changes induced by noxious stimulation (EEG arousal) or quantify the frontal EMG in relation to EEG, while others are based on the sympathoadrenergic stress response. Various other devices are also discussed in this chapter.

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Magee, Patrick, and Mark Tooley. Intraoperative monitoring. Edited by Jonathan G. Hardman. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0043.

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Chapter 25 introduced some basic generic principles applicable to many measurement and monitoring techniques. Chapter 43 introduces those principles not covered in Chapter 25 and discusses in detail the clinical applications and limitations of the many monitoring techniques available to the modern clinical anaesthetist. It starts with non-invasive blood pressure measurement, including clinical and automated techniques. This is followed by techniques of direct blood pressure measurement, noting that transducers and calibration have been discussed in Chapter 25. This is followed by electrocardiography. There then follows a section on the different methods of measuring cardiac output, including the pulmonary artery catheter, the application of ultrasound in echocardiography, pulse contour analysis (LiDCO™ and PiCCO™), and transthoracic electrical impedance. Pulse oximetry is then discussed in some detail. Depth of anaesthesia monitoring is then described, starting with the electroencephalogram and its application in BIS™ monitors, the use of evoked potentials, and entropy. There then follow sections on gas pressure measurement in cylinders and in breathing systems, followed by gas volume and flow measurement, including the rotameter, spirometry, and the pneumotachograph, and the measurement of lung dead space and functional residual capacity using body plethysmography and dilution techniques. The final section is on respiratory gas analysis, starting with light refractometry as the standard against which other techniques are compared, infrared spectroscopy, mass spectrometry, and Raman spectroscopy (the principles of these techniques having been introduced in Chapter 25), piezoelectric and paramagnetic analysers, polarography and fuel cells, and blood gas analysis.

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