Email: nunes@pucrs.br
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@International League Against Epilepsy 2012
Table of Contents
Foreword.....................................................................................................................................3
1 Introduction to this unit............................................................................................................3
2 EEG in infancy (2 -12 months)................................................................................................4
3 EEG in early childhood (1-3 years)..........................................................................................5
4 EEG in Preschool age (3-5 years)............................................................................................6
5 EEG in older children (6-12 years)..........................................................................................7
6 EEG in adolescents (13-20 years)............................................................................................8
7 Glossary....................................................................................................................................9
8 Register of Figures & Tables.................................................................................................10
9 References .............................................................................................................................11
Foreword
Foreword
It is a pleasure to start this unit with you. I am a Pediatric Neurologist that
has worked since I was in Medical School with research in different aspects of the developing brain. I am also board certified in Sleep Medicine
and dedicate my research to aspects of ontogenesis and bioeletrogenesis
of preterm newborns. It is very important to recognize normal patterns of
EEG development in order to be an expert Clinical Neurophysiologist. I
hope you enjoy this chapter as much as I enjoyed preparing it.
Learning Goals
At the end of this learning unit you should know how to identify
normal EEG age related patterns and its variants during
childhood, in wake and sleep recordings.
2-12 months
Posterior basal
rhythm (awake)
Other characteristics
(awake)
Drowsiness
NREM
Spindles
POSTS*
none
REM
Mostly slow activity. Decrease percentage during the first years of life
Sleep starts
1 3 years
High voltage slow pattern (1-3Hz) and medium voltage(4-6Hz), maximum amplitude at
occipital region
Posterior basal
rhythm (awake)
Other characteristics
(awake)
Drowsiness
NREM
Spindles
POSTS
REM
Sleep starts
in NREM
Figures 7 9 see separate file
3 5 years
Posterior basal
rhythm (awake)
Other characteristics
(awake)
Drowsiness
NREM
Figures 10 - 14
see separate file
Spindles
POSTS
REM
Little desynchronization
Sleep starts
in NREM
6 - 12 years
Other characteristics
(awake)
Drowsiness
NREM
Spindles
Features of maturity, waves rounded with 1012 Hz, trains usually shorter than1 second.
POSTS
REM
Less slow activity and increasing desynchronization with mixed theta, alpha and beta frequencies.
Sleep starts
in NREM
Figures 15 20
see separate files
13 - 20 years
Posterior basal
rhythm (awake)
Other characteristics
(awake)
Drowsiness
NREM
Spindles
Similar to adults
Similar to adults
POSTS
Similar to adults
REM
Sleep starts
in NREM
7 Glossary
7 Glossary
REM sleep: rapid eyes movement sleep, its percentage decreases dramatically from the neonatal period (around 80% of the sleep cycle). By 8
months active sleep occupies approximately 30% of the sleep cycle and
at age 5 years the adult volume is reached (20 to 25% of the sleep cycle).
NREM sleep: non rapid eyes movement sleep, divided in three stages
(N1, N2 and N3), were n1 is the more light sleep, N2 phase characterized
by the appearance of sleep spindles and K complexes) and N3 (deep slow
wave sleep). Its percentage increases from the neonatal period to adolescence. The complete differentiation of the three NREM sleep stages can
be done around the 6th month of life. In normal healthy young adults
stage 1 accounts for less than 5% of the cycle, stage 2 from 45-55% and
stage 3 13 to 23%.
Drowsiness: the EEG features that represent the transition from awake
state to sleep modify according to age. During the first year of life it is
observed a transition to theta activity, latter from 1 to 6 years the hypnagogic theta hypersynchrony is the prominent pattern, after an increased
theta and delta frequencies with gradually fading of posterior alpha
rhythm, and the more mature pattern is the alpha dropout.
Hypnagogic hypersynchrony: generalized high voltage rhythmic theta
activity(4-6Hz) marker of drowsiness from age 1 to 6 years.
Vertex waves: hallmark of deep drowsiness, , they are secondary evoked
potentials, the morphology varies according to ontogenesis, and the mature pattern is a small spiky discharge of positive polarity the precedes a
large negative wave (more prominent).
Sleep spindles: also called sigma activity or sigma waves, they are
rhythmic waves with a frequency varying from 10-14 Hz, with waxing
and waning amplitude. During childhood they have a more sharp contoured morphology, faster frequency and longer duration of the trains.
K complexes : considered a response to arousing stimuli. The spatial distribution shows a maximum over vertex. The morphology consists of an
initial sharp component, followed by a slow that fuses with a superimposed fast component. In older children and early adolescence the sharp
component is impressive.
Positive occipital sharp transients of sleep: they appear in deep drowsiness and may persist during light and deep sleep, the morphology is a
positive spike-like waves in the occipital areas. They are more common
in adolescents and young adults.
7 Glossary
Lambda waves: sharp transients (biphasic or triphasic, with a positive
most prominent phase) , sawtooth shaped, with amplitude between 2050uV, occurring over the occipital region of subjects in the awake state
during visual exploration.
Mu rhythm: rolandic mu rhythm or wicket rhythm is related in frequency and amplitude to posterior alpha rhythm. This pattern can be observed in children and adult EEGs, but it is more prevalent in adolescents
(11 to 15 years) and adults.
Patterns of marginal and possibly abnormal character occurring
during wakefulness and sleep
Figure 21
see separate file
Rhythmical frontal theta (6-7Hz) activity: this pattern, that occurs during wakefulness, has two main peaks of appearance being the first
between 6-12 years and the second between 13-15 years. It is not considered a clear abnormality, as it appears in the EEGs on health young
subjects; however, some authors have related it to children with predisposition to generalized epilepsies. (Figure 21)
14and 6/seconds positive spikes: are seen during drowsiness and sleep,
form age 6 to 12 years. There is by now evidence that this pattern is not
categorically abnormal, unless if very frequent.
Figure 22
see separate file
Tables
Table 1: Maturation of EEG across childhood: Infancy.............................4
Table 2: Maturation of EEG across childhood: Early Childhood..............5
Table 3: Maturation of EEG across childhood: Preschool age .................6
Table 4: Maturation of EEG across childhood: Older Children ...............7
Table 5 - Maturation of EEG across childhood: Adolescence...................8
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9 References
9 References
(not posted within the Virtual Library due to copyright restrictions)
Niedermeyer E. Maturation of the EEG: development of waking and
sleep patterns. In: Niedermeyer E & Lopes da Silva F (eds),Electroencephalography: Basic Principles,Clinical Applications and Related Fields.Baltimore: Urban & Schwarzenberg 1987, pp 133-161.
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