Interpretation and description

off EEG
정기영
고려대학교 의과대학 신경과학교실
고려대학교의료원 안암병원 신경과
KU Computational Neuroscience Research Lab
(http //eeg re kr)
(http://eeg.re.kr)

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Department of Neurology
Korea University
 Outline
• Electrical fields and recording techniques
– Electrode placement
p
– Derivation and Montage
– Polarity
P l it convention
ti
• Description of EEG
• Reporting EEG

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Department of Neurology
Korea University
 Digital EEG System
Analog Memory
Display
Amplifier

G1 Filter ADC Mi
Microprocessor Monitor

G2

archives

Software: record & interpretation

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International 10
10-20
20 system

Fp: frontopolar
F: frontal
T: temporal
C: central
P: parietal
O: occipital
A: auricular

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Department of Neurology
Korea University
Modified combinatorial system:
y 10-10 system
y

Fp: frontopolar
F: frontal
T: temporal
C: central
P: parietal
O: occipital
A: auricular

T3 Æ T7
T5 Æ P7
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Department of Neurology
Korea University
 Cerebral Location of International 10-20
System Electrode Placement

C3
P3
F3
Fp1
01
F7

P7
T7

Homan et al
al., Electroencephalogr Clin Neurophysiol 1987 Okamoto et al.,
al Neuroimage 2004
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Department of Neurology
Korea University
 Derivation and Montage
g

• Electrode (=
( Lead) vs. Channel
• Derivation: G1-G2 voltage difference
– Bipolar derivation
– Referential derivation
• Montage:
g derivation 방법에 따라 채널을 체
계적으로 조합한 유형

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Department of Neurology
Korea University
 Montage
g
• Systematic
y and symmetric:
y 전후,, 좌우,, 정중
• Types of montage
– Bipolar
• longitudinal
• transverse
t
– Referential
• Temporal: A1/A2, linked-ear
• Midline:Cz or Pz
• Extracerebral: RSH
– Virtual
• common average
• Laplacian
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Department of Neurology
Korea University
 Bipolar
p vs. Referential

• Most useful in defining • Clear characterization of

localized potential widespread or complex
gradients potential fields
• Eliminating effect of • Unambiguous
contaminated references determination of voltage
• Avoid problems that can polarity
arise from unbalanced • Less distortion of EEG
amplifier input with a patterns exhibiting time
common reference lags across the scalp

Department of Neurology
Korea University
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Department of Neurology
Korea University
 Description
p of EEG
• Waveform
• Frequency or wavelength
• Amplitude
• Distribution (location)
• Rhythmicity (Regularity)
• Reactivity
• Interhemispheric coherence
– Symmetry
– synchrony
h

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Korea University
 Waveform (1)
( )
• Wave: any change in the difference of the
electrical potential between two recording
electrodes
• EEG activity:
y anyy wave or sequence
q of waves
• Regular:
– monomorphic,
monomorphic
– sinusoidal, spindle-shaped
• Irregular: polymorphic
• Phase: mono, di, triphasic, polyphasic

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Department of Neurology
Korea University
 Waveform (2)
( )
• Transient: an event that clearly stands out
g
against the background
g
– Sharp transient
– Spike:
S ik 2020-70
70 ms
– Sharp
p wave: 70-200 ms
• Complex: a sequence of two or more
waves that
th t h
have a characteristic
h t i ti fform or
recur with a fairlyy consistent shape
p

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Korea University
 Frequency
q y

• Delta: < 4 Hz
• Theta: < 8 Hz
• Alpha: < 13 Hz
• B t < 30 H
Beta: Hz
• Gamma: > 30 Hz

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Department of Neurology
Korea University
 Amplitude
p
• Medium: 20-70
20 70 uV
• Low: < 20 uV
• High: > 70 uV

• Background suppression: < 10 uV

• Electrocerebral inactivity: < 2 uV

• Amplitude asymmetry

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Korea University
Amplitude
= voltage (uV)

Frequency = 1/λ
Duration (ms)
= wave length (λ)
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Korea University
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Korea University
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Korea University
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Korea University
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Korea University
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Korea University
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Korea University
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Korea University
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Department of Neurology
Korea University
 Rhythmicity
y y ((repetition)
p )
• Rhythmic
• Semirhythmic
• Irregular

• Monomorphic
M hi
• Polymorphic

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Korea University
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Korea University
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Department of Neurology
Korea University
63/M dementia, myoclonus

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Korea University
 Distribution
• Generalized: bilateral and relatively diffuse
distribution.
• Lateralized: restricted to one hemisphere, but
not to one lobe or a region of the hemisphere.
hemisphere
• Regional: limited to one lobe or a part of one
lobe.
• Focal: Used only for interictal and ictal
epileptiform discharges, which are confined
to one or two invasive electrodes

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Department of Neurology
Korea University
 Phase
• 두 채널 사이에서 뇌파의 발생시간(timing)과
발생시간(ti i )과 극성
(polarity)의 관계

F3-C3
• In phase
C3-P3

• Out of phase F3-C3

C3-P3

• Phase reversal F3-C3

C3-P3
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Korea University
 Phase reversal

A-B
A-E

B-C

B-E
B E

C-D C-E

D-E D-E

Negative Positive A>B>D>E>C

Bipolar montage Referential montage

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Department of Neurology
Korea University
 Timing
g
• Synchronous vs
vs. asynchronous

• Bilaterally synchronous (bisynchronous)

• Independent
I d d t vs. dependent
d d t

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Korea University
 Persistence
• Quantity or amount
• The proportion of time during which certain
waves appear
• Ex) the amount of slow activity
– Small,
Small moderate,
moderate large amount
– Intermittent vs. Continuous

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Korea University
Amount of slow

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Korea University
 Reactivityy
• Change that can be produced in some
normal and abnormal p patterns by
y various
maneuvers
• Eye
E open, closing
l i
• Hyperventilation
• Photic or sensory stimulation
• Mental arithmetic

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Department of Neurology
Korea University
 Reporting the EEG
1994 American Electroencephalographic Society

• The printed forms for reporting EEG should

be p
provide for a minimum of information
about the patient

• Three principal parts

– Description of the record
• Condition of the recording
• Description of normal and abnormal findings
– EEG summary or impression
– Interpretation or conclusion
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Department of Neurology
Korea University
 Description
p of the record
- condition of the recording -
• a statement of the kind of preparation the patient
h d if any, ffor th
had, the recording
di session
i
– patient’s state of consciousness at the onset of record,
– medication, sedation, sleep deprivation
– behavioral abnormalities such as lack of cooperation,
or persistent movement causing excessive artifact
• The recording environment
• special method of recording

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Department of Neurology
Korea University
 Description
p of the record
- description of EEG findings -
• Use internationally accepted terminology
• Simple
Si l b brief
i fd
description
i ti off th
the essential
ti l ffeatures
t off
normal and abnormal activity
• Artifacts should be mentioned
waking sleep
Normal Post. Background act POSTs
Beta act Vertex
Sleep spindle
Abnormal EDs EDs
Sl
Slow Sl
Slow
Asymmetry
Periodic pattern
Voltage suppression
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HV, PS
 Summary
y of EEG ((Impression)
p )
• 간결하게 중요 뇌파 소견을 요약한다. 요약한다
• 가급적 정량화 또는 계층화한다 (grading
system)
• Ex) normal, abnormal 1 ~ 3
• Ex) normal
normal, mild
mild, moderate
moderate, marked
abnormal

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Department of Neurology
Korea University
고려대병원의 기준

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Department of Neurology
Korea University
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Department of Neurology
Korea University
 Interpretation
p ((conclusion))
• 요약된 뇌파 소견의 임상적인 의미를 제시
하고,
• 환자의 임상 증상이나 상태를 설명할 수 있
는지 여부와 연관성이 있는 가장 가능성있
는 진단을 제시
• 추가적인 검사나 추적 검사을 추천

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Department of Neurology
Korea University
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