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electroencephalography

 
Medical Encyclopedia: Electroencephalography

Definition

Electroencephalography, or EEG, is a neurological test that uses an electronic monitoring device to measure and record electrical activity in the brain.

Description

Before the EEG begins, a nurse or technician attaches approximately 16–20 electrodes to the patient's scalp with a conductive, washable paste. Depending on the purpose for the EEG, implantable or invasive electrodes are occasionally used. Implantable electrodes include sphenoidal electrodes, which are fine wires inserted under the zygomatic arch, or cheekbone; and depth electrodes, which are surgically-implanted into the brain. The EEG electrodes are painless, and are used to measure the electrical activity in various regions of the brain.

For the test, the patient lies on a bed, padded table, or comfortable chair and is asked to relax and remain still during the EEG testing period. An EEG usually takes no more than one hour. During the test procedure, the patient may be asked to breathe slowly or quickly; visual stimuli such as flashing lights or a patterned board may be used to stimulate certain types of brain activity. Throughout the procedure, the electroencephalograph machine makes a continuous graphic record of the patient's brain activity, or brainwaves, on a long strip of recording paper or on a computer screen. This graphic record is called an electroencephalogram.

The sleep EEG uses the same equipment and procedures as a regular EEG. Patients undergoing a sleep EEG are encouraged to fall asleep completely rather than just relax. They are typically provided a bed and a quiet room conducive to sleep. A sleep EEG lasts up to three hours.

In an ambulatory EEG, patients are hooked up to a portable cassette recorder. They then go about their normal activities, and take their normal rest and sleep for a period of up to 24 hours. During this period, the patient and patient's family record any symptoms or abnormal behaviors, which can later be correlated with the EEG to see if they represent seizures.

Many insurance plans provide reimbursement for EEG testing. Costs for an EEG range from $100 to more than $500, depending on the purpose and type of test (i.e., asleep or awake, and invasive or non-invasive electrodes). Because coverage may be dependent on the disorder

or illness the EEG is evaluating, patients should check with their individual insurance plan.

— Paula Anne Ford-Martin



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Sci-Tech Dictionary: electroencephalography
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(i¦lek·trō·en′sef·ə′läg·rə·fē)

(medicine) The medical specialty concerned with the production and interpretation of electroencephalograms.


Britannica Concise Encyclopedia: electroencephalography
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Technique for recording electrical activity in the brain, whose cells emit distinct patterns of rhythmic electrical impulses. Pairs of electrodes on the scalp transmit signals to an electroencephalograph, which records them as peaks and troughs on a tracing called an electroencephalogram (EEG). Different wave patterns on the EEG are associated with normal and abnormal waking and sleeping states. They help diagnose conditions such as tumours, infections, and epilepsy. The electroencephalograph was invented in the 1920s by Hans Berger (1873 – 1941).

For more information on electroencephalography, visit Britannica.com.

Neurological Disorder:

Electroencephalography

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Definition

Electroencephalography, or EEG, is a neurological test that involves attaching electrodes to the head of a person to measure and record electrical activity in the brain over time.

Purpose

The EEG, also known as a brain wave test, is a key tool in the diagnosis and management of epilepsy and other seizure disorders. It is also used to assist in the diagnosis of brain damage and diseases such as strokes, tumors, encephalitis, mental retardation, and sleep disorders. The results of the test can distinguish psychiatric conditions such as schizophrenia, paranoia, and depression from degenerative mental disorders such as Alzheimer's and Parkinson's diseases. An EEG may also be used to monitor brain activity during surgery to assess the effects of anesthesia. Additionally, it is used to determine brain status and brain death.

Precautions

There are few adverse conditions associated with an EEG test. Persons with seizure disorders may experience seizures during the test in reaction to flashing lights or by deep breathing.

Description

Before an EEG begins, a nurse or technologist attaches approximately 16–21 electrodes to a person's scalp using an electrically conductive, washable paste. The electrodes are placed on the head in a standard pattern based on head circumference measurements. Depending on the purpose for the EEG, implantable, or invasive, electrodes are occasionally used. Implantable electrodes include sphenoidal electrodes, which are fine wires inserted under the zygomatic arch, or cheekbone. Depth electrodes, or subdural strip electrodes, are surgically implanted into the brain and are used to localize a seizure focus in preparation for epilepsy surgery. Once in place, even implantable electrodes do not cause pain. The electrodes are used to measure the electrical activity in various regions of the brain over the course of the test period.

For the test, a person lies on a bed, padded table, or comfortable chair and is asked to relax and remain still while measurements are being taken. An EEG usually takes no more than one hour, although long-term monitoring is often used for diagnosis of seizure disorders. During the test procedure, a person may be asked to breathe slowly or quickly. Visual stimuli such as flashing lights or a patterned board may be used to stimulate certain types of brain activity. Throughout the procedure, the electroencephalography unit makes a continuous graphic record of the person's brain activity, or brain waves, on a long strip of recording paper or computer screen. This graphic record is called an electroencephalogram. If the display is computerized, the test may be called a digital EEG, or dEEG.

The sleep EEG uses the same equipment and procedures as a regular EEG. Persons undergoing a sleep EEG are encouraged to fall asleep completely rather than just relax. They are typically provided a bed and a quiet room conducive to sleep. A sleep EEG lasts up to three hours, or up to eight or nine hours if it is a night's sleep.

In an ambulatory EEG, individuals are hooked up to a portable cassette recorder. They then go about normal activities and take normal rest and sleep for a period of up to 24 hours. During this period, individuals and their family members record any symptoms or abnormal behaviors, which can later be correlated with the EEG to see if they represent seizures.

An extension of the EEG technique, called quantitative EEG (qEEG), involves manipulating the EEG signals with a computer using the fast Fourier transform algorithm. The result is then best displayed using a colored gray scale transposed onto a schematic map of the head to form a topographic image. The brain map produced in this technique is a vivid illustration of electrical activity of the brain. This technique also has the ability to compare the similarity of the signals between different electrodes, a measurement known as spectral coherence. Studies have shown the value of this measurement in diagnosis of Alzheimer's disease and mild closed-head injuries. The technique can also identify areas of the brain having abnormally slow activity when the data are both mapped and compared to known normal values. The result is then known as a statistical or significance probability map (SPM). This allows differentiation between early dementia (increased slowing) or otherwise uncomplicated depression (no slowing).

Preparation

An EEG is generally performed as one test in a series of neurological evaluations. Rarely does the EEG form the sole basis for a particular diagnosis.

Full instructions should be given to individuals receiving an EEG when they schedule their test. Typically, individuals taking medications that affect the central nervous system, such as anticonvulsants, stimulants, or antidepressants, are told to discontinue their prescription for a short time prior to the test (usually one or two days). However, such requests should be cleared with the treating physician. EEG test candidates may be asked to avoid food and beverages that contain caffeine, a central nervous system stimulant. They may also be asked to arrive for the test with clean hair that is free of spray or other styling products to make attachment of the electrodes easier.

Individuals undergoing a sleep EEG may be asked to remain awake the night before their test. They may be given a sedative prior to the test to induce sleep.

Aftercare

If an individual has suspended regular medication for the test, the EEG nurse or technician should advise as to when to begin taking it again.

Risks

Being off certain medications for one to two days may trigger seizures. Certain procedures used during EEG may trigger seizures in persons with epilepsy. Those procedures include flashing lights and deep breathing. If the EEG is being used as a diagnostic tool for epilepsy (i.e., to determine the type of seizures an individual is experiencing), this may be a desired effect, although the person needs to be monitored closely so that the seizure can be aborted if necessary. This type of test is known as an ictal EEG.

Normal results

In reading and interpreting brain wave patterns, a neurologist or other physician will evaluate the type of brain waves and the symmetry, location, and consistency of brain wave patterns. Brain wave response to certain stimuli presented during the EEG test (such as flashing lights or noise) will also be evaluated.

The four basic types of brain waves are alpha, beta, theta, and delta, with the type distinguished by frequency. Alpha waves fall between 8 and 13 Hertz (Hz), beta are above 13 Hz, theta between 4 and 7 Hz, and delta are less than 4 Hz. Alpha waves are usually the dominant rhythm seen in the posterior region of the brain in older children and adults, when they are awake and relaxed. Beta waves are normal in sleep, particularly for infants and young children. Theta waves are normally found during drowsiness and sleep and are normal in wakefulness in children, while delta waves are the most prominent feature of the sleeping EEG. Spikes and sharp waves are generally abnormal; however, they are common in the EEG of normal newborns.

Different types of brain waves are seen as abnormal only in the context of the location of the waves, a person's age, and one's state of consciousness. In general, disease typically increases slow activity such as theta or delta waves, but decreases fast activity such as alpha and beta waves.

Not all decreases in wave activity are abnormal. The normal alpha waves seen in the posterior region of the brain are suppressed merely if a person is tense. Sometimes the addition of a wave is abnormal. For example, alpha rhythms seen in a newborn can signify seizure activity. Finally, the area where the rhythm is seen can be telling. The alpha coma is characterized by alpha rhythms produced diffusely, or, in other words, by all regions of the brain.

Some abnormal beta rhythms include frontal beta waves that are induced by sedative drugs. Marked asymmetry in beta rhythms suggests a structural lesion on the side lacking the beta waves. Beta waves are also commonly measured over skull lesions such as fractures or burr holes, in an activity known as a breach rhythm.

Usually seen only during sleep in adults, the presence of theta waves in the temporal region of awake, older adults has been tentatively correlated with vascular disease. Another rhythm normal in sleep, delta rhythms, may be recorded in a wakeful state over localized regions of cerebral damage. Intermittent delta rhythms are also an indication of damage of the relays between the deep gray matter and the cortex of the brain. In adults, this intermittent activity is found in the frontal region, whereas in children it is in the occipital region.

The EEG readings of persons with epilepsy or other seizure disorders display bursts, or spikes, of electrical activity. In focal epilepsy, spikes are restricted to one hemisphere of the brain. If spikes are generalized to both hemispheres of the brain, multifocal epilepsy may be present. The EEG can be used to localize the region of the brain where the abnormal electrical activity is occurring. This is most easily accomplished using a recording method, or montage, called an average reference montage. With this type of recording, the signal from each electrode is compared to the average signal from all the electrodes. The negative amplitude (an upward movement) of the spike is observed for the different channels, or inputs, from the various electrodes. The negative deflection will be greatest as recorded by the electrode that is closest in location to the origin of the abnormal activity. The spike will be present but of reduced amplitude as the electrodes move farther away from the site producing the spike. Electrodes distant from the site will not record the spike occurrence.

A final variety of abnormal result is the presence of slower-than-normal wave activity, which can either be a slow background rhythm or slow waves superimposed on a normal background. A posterior dominant rhythm of 7 Hz or less in an adult is abnormal and consistent with encephalopathy (brain disease). In contrast, localized theta or delta rhythms found in conjunction with normal background rhythms suggest a structural lesion.

Resources

BOOKS

Chin, W. C., and T. C. Head. Essentials of Clinical Neurophysiology, 3rd edition. London: Butterworth-Heinemann, 2002.

Daube, J. R. Clinical Neurophysiology, 2nd edition. New York: Oxford University Press, 2002.

Ebersole, J. S., and T. A. Pedley. Current Practice of Clinical Electroencephalography, 3rd Edition. Philadelphia: Lippincott Williams & Wilkins, 2002.

Rowan, A. J., and E. Tolunsky. Primer of EEG. London: Butterworth-Heinemann, 2003.

PERIODICALS

De Clercq, W., P. Lemmerling, S. Van Huffel, and W. Van Paesschen. "Anticipation of Epileptic Seizures from Standard EEG Recordings." Lancet 361, no. 9361 (2003): 971–972.

Harden, C. L., F. T. Burgut, and A. M. Kanner. "The Diagnostic Significance of Video-EEG Monitoring Findings on Pseudoseizure Patients Differs between Neurologists and Psychiatrists." Epilepsia 44, no. 3 (2003): 453–456.

Stepien, R. A. "Testing for Non-linearity in EEG Signal of Healthy Subjects." Acta Experimental Neurobiology 62, no. 4 (2002): 277–281.

Vanhatalo, S., M. D. Holmes, P. Tallgren, J. Voipio, K. Kaila, and J. W. Miller. "Very Slow EEG Responses Lateralize Temporal Lobe Seizures: An Evaluation of Non-invasive DC-EEG." Neurology 60, no. 7 (2003): 1098–1104.

ORGANIZATIONS

American Association of Electrodiagnostic Medicine. 421 First Avenue SW, Suite 300 East, Rochester, MN 55902. (507) 288-0100; Fax: (507) 288-1225. aaem@aaem.net. http://www.aaem.net/.

American Board of Registration of EEG and EP Technologists. PO Box 891663, Longwood, FL 32791. (407) 788-6308. http://www.abret.org/index.htm.

American Society of Electroneurodiagnostic Technologists Inc., 204 W. 7th Carroll, IA 51401. (712) 792-2978. http://www.aset.org/.

Epilepsy Foundation. 4351 Garden City Drive, Landover, MD 20785-7223. (800) 332-1000 or (301) 459-3700. http://www.efa.org.

Joint Review Committee on Electroneurodiagnostic Technology. 3350 South 198th Rd., Goodson, MO 65659-9110. (417) 253-5810. http://www.caahep.org.

OTHER

Electroencephalography. Hofstra University. April 27, 2003 (February 18, 2004). http://people.hofstra.edu/faculty/sina_y_rabbany/.

Bergey, Gregory K., and Piotr J. Franaszczuk. "Epileptic Seizures Are Characterized by Changing Signal Complexity." April 17, 2003 (February 18, 2004). http://erl.neuro.jhmi.edu/pfranasz/CN00/cn00.pdf.

Rutherford, Kim, M.D. "EEG (Electroencephalography)." Kid's Health For Parents. June 2001 (February 18, 2004). http://kidshealth.org/parent/system/medical/eeg.html.

Epilepsy Information: Electroencephalography. National Society for Epilepsy. September 2002 (February 18, 2004). http://www.epilepsynse.org.uk/pages/info/leaflets/eeg.cfm.

L. Fleming Fallon, Jr., MD, DrPH


Surgery Encyclopedia: Electroencephalography
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Definition

Electroencephalography, or EEG, is a neurological test that involves attaching electrodes to the head of a person to measure and record electrical activity in the brain over time.

Purpose

The EEG, also known as a brain wave test, is a key tool in the diagnosis and management of epilepsy and other seizure disorders. It is also used to assist in the diagnosis of brain damage and diseases such as strokes, tumors, encephalitis, mental retardation, and sleep disorders. The results of the test can distinguish psychiatric conditions such as schizophrenia, paranoia, and depression from degenerative mental disorders such as Alzheimer's and Parkinson's diseases. An EEG may also be used to monitor brain activity during surgery to assess the effects of anesthesia. It is also used to determine brain status and brain death.

Demographics

The number of EEG tests performed each year can only be estimated. It is not a reportable event and is used in the diagnostic workup for a number of disorders. The number of EEG tests per year is estimated to be in the range of 10–25 million.

Description

Before an EEG begins, a nurse or technologist attaches approximately 16–21 electrodes to a person's scalp using an electrically conductive, washable paste. The electrodes are placed on the head in a standard pattern based on head circumference measurements. Depending on the purpose for the EEG, implantable, or invasive, electrodes are occasionally used. Implantable electrodes include sphenoidal electrodes, which are fine wires inserted under the zygomatic arch, or cheekbone. Depth electrodes, or subdural strip electrodes, are surgically implanted into the brain and are used to localize a seizure focus in preparation for epilepsy surgery. Once in place, even implantable electrodes do not cause pain. The electrodes are used to measure the electrical activity in various regions of the brain over the course of the test period.

For the test, a person lies on a bed, padded table, or comfortable chair and is asked to relax and remain still while measurements are being taken. An EEG usually takes no more than one hour, although long-term monitoring is often used for diagnosis of seizure disorders. During the test procedure, a person may be asked to breathe slowly or quickly. Visual stimuli such as flashing lights or a patterned board may be used to stimulate certain types of brain activity. Throughout the procedure, the electroencephalography unit makes a continuous graphic record of the person's brain activity, or brain waves, on a long strip of recording paper or computer screen. This graphic record is called an electroencephalogram. If the display is computerized, the test may be called a digital EEG, or dEEG.

The sleep EEG uses the same equipment and procedures as a regular EEG. Persons undergoing a sleep EEG are encouraged to fall asleep completely rather than just relax. They are typically provided a bed and a quiet room conducive to sleep. A sleep EEG lasts up to three hours, or up to eight or nine hours if it is a night's sleep.

In an ambulatory EEG, individuals are hooked up to a portable cassette recorder. They then go about normal activities and take normal rest and sleep for a period of up to 24 hours. During this period, individuals and their family members record any symptoms or abnormal behaviors, which can later be correlated with the EEG to see if they represent seizures.

An extension of the EEG technique, called quantitative EEG (qEEG), involves manipulating the EEG signals with a computer using the fast Fourier transform algorithm. The result is then best displayed using a colored gray scale transposed onto a schematic map of the head to form a topographic image. The brain map produced in this technique is a vivid illustration of electrical activity in the brain. This technique also has the ability to compare the similarity of the signals between different electrodes, a measurement known as spectral coherence. Studies have shown the value of this measurement in diagnosis of Alzheimer's disease and mild closed head injuries. The technique can also identify areas of the brain having abnormally slow activity when the data are both mapped and compared to known normal values. The result is then known as a statistical or significance probability map (SPM). This allows differentiation between early dementia (increased slowing) or otherwise uncomplicated depression (no slowing).

Diagnosis/Preparation

An EEG is generally performed as one test in a series of neurological evaluations. Rarely does the EEG form the sole basis for a particular diagnosis.

Full instructions should be given to individuals receiving an EEG when they schedule their test. Typically, individuals taking medications that affect the central nervous system, such as anticonvulsants, stimulants, or antidepressants, are told to discontinue their prescription for a short time prior to the test (usually one to two days). However, such requests should be cleared with the treating physician. EEG test candidates may be asked to avoid food and beverages that contain caffeine, a central nervous system stimulant. They may also be asked to arrive for the test with clean hair that is free of styling products to make attachment of the electrodes easier.

Individuals undergoing a sleep EEG may be asked to remain awake the night before their test. They may be given a sedative prior to the test to induce sleep.

Aftercare

If an individual has suspended regular medication for the test, the EEG nurse or technician should advise as to when to begin taking it again.

Risks

Being off certain medications for one to two days may trigger seizures. Certain procedures used during EEG may trigger seizures in persons with epilepsy. Those procedures include flashing lights and deep breathing. If the EEG is being used as a diagnostic for epilepsy (i.e., to determine the type of seizures an individual is experiencing) this may be a desired effect, although the person needs to be monitored closely so that the seizure can be aborted if necessary. This type of test is known as an ictal EEG.

Normal Results

In reading and interpreting brain wave patterns, a neurologist or other physician will evaluate the type of brain waves and the symmetry, location, and consistency of brain wave patterns. Brain wave response to certain stimuli presented during the EEG test (such as flashing lights or noise) will also be evaluated.

The four basic types of brain waves are alpha, beta, theta, and delta, with the type distinguished by frequency. Alpha waves fall between 8 and 13 Hertz (Hz), beta are above 13 Hz, theta between 4 and 7 Hz, and delta are less than 4 Hz. Alpha waves are usually the dominant rhythm seen in the posterior region of the brain in older children and adults, when awake and relaxed. Beta waves are normal in sleep, particularly for infants and young children. Theta waves are normally found during drowsiness and sleep and are normal in wakefulness in children, while delta waves are the most prominent feature of the sleeping EEG. Spikes and sharp waves are generally abnormal; however, they are common in the EEG of normal newborns.

Different types of brain waves are seen as abnormal only in the context of the location of the waves, a person's age, and one's conscious state. In general, disease typically increases slow activity, such as theta or delta waves, but decreases fast activity, such as alpha and beta waves.

Not all decreases in wave activity are abnormal. The normal alpha waves seen in the posterior region of the brain are suppressed merely if a person is tense. Sometimes the addition of a wave is abnormal. For example, alpha rhythms seen in a newborn can signify seizure activity. Finally, the area where the rhythm is seen can be telling. The alpha coma is characterized by alpha rhythms produced diffusely, or, in other words, by all regions of the brain.

Some abnormal beta rhythms include frontal beta waves that are induced by sedative drugs. Marked asymmetry in beta rhythms suggests a structural lesion on the side lacking the beta waves. Beta waves are also commonly measured over skull lesions, such as fractures or burr holes, in activity known as a breach rhythm.

Usually seen only during sleep in adults, the presence of theta waves in the temporal region of awake, older adults has been tentatively correlated with vascular disease. Another rhythm normal in sleep, delta rhythms, may be recorded in the awake state over localized regions of cerebral damage. Intermittent delta rhythms are also an indication of damage of the relays between the deep gray matter and the cortex of the brain. In adults, this intermittent activity is found in the frontal region whereas in children, it is in the occipital region.

The EEG readings of persons with epilepsy or other seizure disorders display bursts, or spikes, of electrical activity. In focal epilepsy, spikes are restricted to one hemisphere of the brain. If spikes are generalized to both hemispheres of the brain, multifocal epilepsy may be present. The EEG can be used to localize the region of the brain where the abnormal electrical activity is occurring. This is most easily accomplished using a recording method, or montage, called an average reference montage. With this type of recording, the signal from each electrode is compared to the average signal from all the electrodes. The negative amplitude (upward movement, by convention) of the spike is observed for the different channels, or inputs, from the various electrodes. The negative deflection will be greatest as recorded by the electrode that is closest in location to the origin of the abnormal activity. The spike will be present but of reduced amplitude as the electrodes move farther away from the site producing the spike. Electrodes distant from the site will not record the spike occurrence.

A final variety of abnormal result is the presence of slower-than-normal wave activity, which can either be a slow background rhythm or slow waves superimposed on a normal background. A posterior dominant rhythm of 7 Hz or less in an adult is abnormal and consistent with encephalopathy (brain disease). In contrast, localized theta or delta rhythms found in conjunction with normal background rhythms suggest a structural lesion.

Morbidity and Mortality Rates

There are few adverse conditions associated with an EEG test. Persons with seizure disorders may induce seizures during the test in reaction to flashing lights or by deep breathing. Mortality from an EEG has not been reported.

Alternatives

There are no equivalent tests that provide the same information as an EEG.

Resources

Books

Chin, W. C., and T. C. Head. Essentials of Clinical Neurophysiology, 3rd ed. London: Butterworth-Heinemann, 2002.

Daube, J. R. Clinical Neurophysiology, 2nd edition. New York: Oxford University Press, 2002.

Ebersole, J. S., and T. A. Pedley. Current Practice of ClinicalElectroencephalography, 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2002.

Rowan, A. J., and E. Tolunsky. Primer of EEG. London: Butterworth-Heinemann, 2003.

Periodicals

De Clercq, W., P. Lemmerling, S. Van Huffel, and W. Van Paesschen. "Anticipation of Epileptic Seizures from Standard EEG Recordings." Lancet 361, no. 9361 (2003): 971–972.

Harden, C. L., F. T. Burgut, and A. M. Kanner. "The Diagnostic Significance of Video-EEG Monitoring Findings on Pseudoseizure Patients Differs Between Neurologists and Psychiatrists." Epilepsia 44, no. 3 (2003): 453–456.

Stepien, R. A. "Testing for Non-linearity in EEG Signal of Healthy Subjects." Acta Experimental Neurobiology 62, no. 4 (2002): 277–281.

Vanhatalo, S., M. D. Holmes, P. Tallgren, J. Voipio, K. Kaila, and J. W. Miller. "Very Slow EEG Responses Lateralize Temporal Lobe Seizures: An Evaluation of Non-invasive DC-EEG." Neurology 60, no. 7 (2003): 1098–1104.

Organizations

American Association of Electrodiagnostic Medicine. 421 First Avenue SW, Suite 300 East, Rochester, MN 55902. (507) 288–0100, Fax: (507) 288–1225. aaem@aaem.net. http://www.aaem.net/.

American Board of Registration for Electroencephalographic Technologists. P.O. Box 916633, Longwood, FL 32791-6633 .

American Board of Registration of EEG and EP Technologists. PO Box 891663, Longwood, FL 32791. (407) 788–6308. http://www.abret.org/index.htm.

American Society of Electroneurodiagnostic Technologists Inc. 204 W. 7th Carroll, IA 51401. (712) 792–2978. http://www.aset.org/.

Epilepsy Foundation. 4351 Garden City Drive, Landover, MD 20785-7223. (800) 332–1000 or (301) 459–3700. http://www.efa.org.

Joint Review Committee on Electroneurodiagnostic Technology. 3350 South 198th Rd., Goodson, MO 65659-9110. (417) 253–5810. http://www.caahep.org/about/coas.htm.

Other

Hofstra University. "Electroencephalography." [cited April 27, 2003]. http://people.hofstra.edu/faculty/sina_y_rabbany/engg181/EEG.html.

Bergey, Gregory K., and Piotr J. Franaszczuk. "Epileptic Seizures are Characterized by Changing Signal Complexity." [cited April 17, 2003]. http://erl.neuro.jhmi.edu/pfranasz/CN00/cn00.pdf.

Rutherford, Kim, M.D. "EEG (Electroencephalography)." Kid's Health For Parents. June 2001 [cited April 27, 2003]. http://kidshealth.org/parent/system/medical/eeg.html.

National Society for Epilepsy. "Epilepsy Information: Electroencephalography." September 2002 [cited April 27, 2003]. http://www.epilepsynse.org.uk/pages/info/leaflets/eeg.cfm.

— L. Fleming Fallon, Jr., MD, DrPH

Sci-Tech Encyclopedia: Electroencephalography
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The biomedical technology and science of recording the minute electric currents produced by the brains of human beings and other animals. Electroencephalography (EEG) has important clinical significance for the diagnosis of brain disease. The interpretation of EEG records has become a clinical specialty for neurological diagnosis.

The recording machine, the electroencephalograph, usually produces a 16-channel ink-written record of brain waves, the electroencephalogram. It is interpreted by an electroencephalographer. The placement of about 20 equally spaced electrodes pasted to the surface of the scalp is in accordance with the standard positions adopted by the International Federation of EEG, and is called the 10/20 system. Electrode positions are carefully measured so that subsequent EEGs from the same person can be compared. About 10 patterns or montages of combinations of electrode pairs are selected for transforming the spatial location from the scalp to the channels which are traced on the EEG pen writer.

The aggregate of synchronized neuronal activity from hundreds of thousands or millions of neurons acting together form the electrical patterns on the surface of the brain (brain waves). The cellular basis of the EEG depends on the spontaneous fluctuations of postsynaptic membrane potentials between the inside and the outside of the dendritic processes of postsynaptic cells. See also Synaptic transmission.

Electrical voltage is transduced from the scalp by differential input amplifiers and amplified about a million times in order to drive the pens for the paper record. The recording usually takes 30–60 min during a relaxed waking state, and also during sleep when possible. Often, activating procedures are used, such as a flickering light stimulator and hyperventilation or overbreathing for about 3 min.

EEG waves are defined by form and frequency. Various frequencies are given Greek letter designations. Alpha rhythm is defined as 8–12-Hz sinusoidal rhythmical waves. Alpha waves are normally present during the waking and relaxed state and enhanced by closing the eyes. They are suppressed or desynchronized when the eyes are open, or when the individual is emotionally aroused or doing mental work. They may be synchronized by bright light flashes and driven over a wide range of frequencies by repetitive visual stimulation (alpha driving). They are of highest amplitude in the posterior regions of the brain. The alpha rhythm develops with age, reaching maturity by about 12 years, stabilizes, and then declines in frequency and amplitude in old age (over 65).

Beta rhythms are faster, low-voltage sinusoidal waves, usually about 14–30 Hz. They are more prominent in the frontal areas. They are often synchronized and prevalent during sedation with phenobarbital or with the use of tranquilizers and some sedative drugs.

Slower rhythms are theta and delta waves. Theta waves of 4–7 Hz usually replace the alpha rhythm during drowsiness and light sleep. Delta waves of 0.5–4 Hz are present during deep sleep in normal people of all ages and they are the primary waves present in the records of normal infants. Delta waves are almost always pathological in the waking records of adults.

The EEG reveals functional abnormalities of the brain, whether caused by localized structural lesions, essential paroxysmal states such as epilepsy, or toxic and abnormal metabolic conditions. The three major classes of abnormalities are asymmetries between the hemispheres, slow rhythms, and very sharp waves or spikes. Slow waves represent a depression of cerebral cortical activity or injury in the projection pathways beneath the recording electrodes. Sharp waves or spikes often indicate a hyperexcitable or irritable state of the cortex. During a full epileptic seizure attack, spikes become repetitive and synchronized over the whole surface of the brain. See also Seizure disorders.

The EEG is frequently used for the evaluation of comatose states. The record is slowed in all areas in coma, with delta waves predominating. If the EEG becomes isoelectric or flat for several hours, brain function is not recoverable and the coma may be considered terminal. “Brain death” is indicated by a flat EEG, recorded at the highest gain with widely spaced electrode positions and the absence of cerebral reflexes and spontaneous respiration. See also Death.

Computer advances in the analysis of EEG signals that are emitted by the brain during sensory stimulation and motor responses have led to the discovery and measurement of electrical waves known as event-related potentials or evoked potentials. These responses are averaged by a computer to enhance the small signals and increase the signal-to-noise ratio, so that they may be graphed and seen.

The complexity of evoked potential and EEG analysis makes interpretation difficult in relation to where various components originate and their pattern of spread through time along the neural transmission pathways. In the 1980s, with the development of minicomputers and color graphics screens, the presentation of topographic information could be analyzed in sophisticated statistical ways for research and clinical purposes by electroencephalographers and neurophysiologists. This method is best known as brain electrical activity mapping (BEAM) and is used in many research investigations of brain activity patterns in learning and language dysfunctions, psychiatric disorders, aging changes and dementia, and studies of normal and impaired child development. Difficult neurological diagnostic problems that do not show anatomical deformities by brain scan methods may often be clarified by these new electrographic procedures. See also Brain; Neurobiology.


Medical Test: Electroencephalography (EEG)
Top

General information

Where It's DoneWho Does ItHow Long It TakesDiscomfort/Pain
Hospital, doctor's office, or commercial laboratory.Doctor, nurse, or EEG technician.2 hours; longer in special circumstances.Possible itchiness from the glue used to affix electrodes to scalp. If test is done for seizures, you may have to go without sleep the previous night.

Results Ready WhenSpecial EquipmentRisks/ComplicationsAverage Cost
Immediately.EEG recorder, and electrodes.Low risk, although seizures may occur as a result of underlying disease.$$

Other names

Electroencephalogram.

Purpose
  • To assess brain electrical activity in order to evaluate the nature or cause of seizures; diagnose coma; evaluate sleep disorders; establish the presence and location of brain tumors, abscesses, or brain injuries; diagnose and evaluate the severity of stroke; and identify certain brain or spinal cord infections.
  • To monitor brain activity during surgery or assess the depth of anesthesia.
  • To distinguish psychiatric conditions from neurological diseases affecting mental status.
  • To predict whether a person is likely to develop seizures after head trauma.
  • To determine brain death.
How it works

Electrical signals produced by the brain neurons are picked up by the electrodes and transmitted to a polygraph, where they produce separate graphs on moving paper using an ink writing pen or on a computer screen.

Preparation
  • Avoid taking sedative drugs, such as benzodiazepines and barbiturates, before the test.
  • Unless you are having a sleep-deprived EEG, come to the test well rested to avoid distorted results.
  • Wash your hair the night before the test. Do not use hair cream, oils, or spray afterward.
Test procedure
  • You lie down on the examining table or bed while eight to 20 electrodes are attached to your scalp.
  • You are asked to relax and lie first with your eyes open, then closed.
  • You may be asked to breathe deeply and rapidly or to stare at a flashing light both of which produce changes in the brain-wave patterns.
  • If you are prone to seizures, you may experience one during the test.
  • If you are being evaluated for a sleep disorder, EEG may be performed continuously during the night while you are asleep. Such a recording, which may involve an evaluation of other body functions during sleep, is referred to as polysomnography.
After the test
  • The electrodes are removed and the glue that held them in place is washed away with acetone. You may have to use additional acetone at home to completely remove the glue.
  • Unless you are actively having seizures or are restricted by your physician, you may drive home.
  • If the EEG was performed overnight, you should arrange to have someone drive you home.
  • If you stopped taking anticonvulsant drugs for the EEG, you can usually start taking them again.
Factors affecting results
  • Lack of sleep before the test can distort some of the brain waves.
  • Movements of the eyes, tongue, head, or body during the recording.
  • Low blood sugar that may be caused by fasting.
  • Medications that affect the brain.
Interpretation

A neurologist examines the EEG recording for abnormalities in the brain-wave pattern, which may reflect diseases of the nervous system. In most psychiatric disorders, multiple sclerosis, and Alzheimer's disease, the EEG is generally normal or shows only minor abnormalities.

Advantages
  • It's noninvasive.
  • It's highly informative.
Disadvantages
  • Results may be slightly abnormal in healthy people and normal in people with disease.
  • It's less helpful than imaging techniques in determining the location of injuries or their precise nature for some diseases such as stroke.
The next step

Other imaging studies of the brain, possibly including CT scans and MRI.

PATIENT TIPS

If you are being evaluated for seizures, you will be told to do the following to increase the likelihood that the EEG will detect a seizure or seizure-related electrical activity:

  • Taper down your dose of anti-seizure medication.
  • Stay up as long as possible the night before the test--a variation called a sleep-deprived EEG.

Sports Science and Medicine: electroencephalography
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Measurement of the electrical activity of the cortex of the brain. Different types of brainwaves are associated with at least three different arousal states; sleep, wakefulness, and excitement. There is a strong correlation between the type of electroencephalograms, and fatigue and overtraining. Electroencephalographs (EEGs) are used to assess brain injuries resulting from blows to the head in contact sports, such as boxing.

 
Columbia Encyclopedia: electroencephalography
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electroencephalography (əlĕk'trōĕnsĕf'əlŏg'rafē), science of recording and analyzing the electrical activity of the brain. Electrodes, placed on or just under the scalp, are linked to an electroencephalograph, which is an amplifier connected to a mechanism that converts electrical impulses into the vertical movement of a pen over a sheet of paper. The recording traced by the pen is called an electroencephalogram (EEG). Readings may be obtained for a particular brain site by coupling a single electrode with an indifferent, or neutral, lead (monopolar technique) or between two areas of the brain through two independent electrodes (bipolar technique). The combination of impulses that are being recorded at any one time is called a montage.

Brainwave Patterns

The electrical activity of the brain was first demonstrated in 1929 by the German psychiatrist Hans Berger. The scientific professions were slow in giving proper attention to Berger's discovery of the brain rhythms he named alpha waves, but since then at least three other standard brainwave patterns have been isolated and identified. Alpha waves are fast, medium-amplitude oscillations, now known to represent the background activity of the brain in the physically and psychologically healthy adult. They are most characteristically visible during dream-sleep or when a subject is relaxing with eyes closed. Delta waves are large, slow-moving, regular waves, typically associated with the deepest levels of sleep. In children up to the age of puberty the appearance of high-amplitude theta waves, having a velocity between those of alpha and delta rhythms, usually signals the onset of emotional stimulation. The presence of theta waves in adults may be a sign of brain damage or of an immature personality. Beta rhythms are small, very fast wave patterns that indicate intense physiological stress, such as that resulting from barbiturate intoxification.

Uses of EEGs

By observing abnormalities in recordings and determining the area of the brain from which they originate, the physician's ability to diagnose and treat such conditions as epilepsy, cerebral tumor, encephalitis, and stroke, is greatly enhanced. Electroencephalograms have also proven valuable in the general study of brain physiology and in the particular study of sleep. Various types of Eastern meditation, e.g., yoga, use techniques that increase alpha and theta wave activity. Because of concomitant physiological changes during meditation, e.g., lessened anxiety, the techniques have recently become popular in the West. Using EEGs to enhance biofeedback, a subject can be taught to monitor and regulate his or her own brain waves; the technique has been used experimentally in control of epilepsy. EEGs are also used to determine brain death (see death).


World of the Mind: electroencephalography
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A common aim of research of the normal brain and of clinical diagnosis of its disorders is to build a complete image of the living tissue and its activity. All practical techniques allow one to view only one aspect of it. The electroencephalogram (EEG) registers potential differences on the scalp which arise as a result of 'feeble currents' of the brain. Electrical activity of the brain was first reported in 1875 by Richard Caton, a British physiologist who studied it in monkeys, cats, and rabbits. Human EEG was first described by Hans Berger, a German psychiatrist, in 1929, but not until E. D. Adrian (later Lord Adrian) and B. H. C. Matthews in England published their work in 1934 did human EEG become a routine diagnostic test in neurology and psychiatry. It also became one of the widely used tools of brain research in humans.

For clinical purposes, most modern EEG machines register as many as sixteen 'channels' of brain activity. Many channels are used in order to be able to detect if there are different types of electrical activity in neighbouring brain areas. However, as will be explained later, spatial resolution of abnormal brain activity is not one of the strong points of clinical electroencephalograms. A 'channel' refers simply to the amplified record of the potential difference between two points on the skull and its changes. Since brain potentials change in time and do not usually measure more than 100 microvolts, the tiny signals need to be amplified and registered, usually with the help of an ink pen recorder. In most clinical EEG studies, small metal discs pasted on the skull, or fine needles inserted into the scalp, will pick up the electrical activity of the brain. They are called electrodes, and each is connected to a powerful amplifier. A number of amplifiers, each with its pen recorder, constitutes the essence of an electroencephalographic machine. When the brain is alive, the potential difference between two recording electrodes changes 'spontaneously' as time goes on. When written out by the pen recorder, this is seen on the EEG record as undulations. By inspecting these one gains the impression that the brain produces waves. In fact, 'brainwave test' is a term used in the United States for the EEG. The wavy appearance provides a simple way of describing and classifying the EEG by sheer visual inspection. The Greek letters alpha, beta, delta, and theta are commonly used for the different periodicities or wave frequencies apparent in the EEG. Alpha stands for brainwaves with a periodicity of about 9–11 per second. Beta is a higher-frequency 'component' of the EEG, while delta and theta are slower-changing brain potentials, or low-frequency waves.

Much interest has accompanied the nature of the alpha rhythm since it was shown by Berger that it appears when a human is resting quietly, but disappears when he opens his eyes. This disappearance is called 'alpha blocking'. Some people produce alpha waves even with eyes open, and in these people a flash of light is needed to block them. The presence of alpha is thought to be associated with a meditative, quiescent state, while its disappearance in the normal human is thought to be due to attention and arousal. Because of the relation of the alpha rhythm to vision, several investigators studied its presence or absence when patients suffer from abnormalities of their visual system. It has been reported that if a person has reduced vision due to some ocular abnormality but can see flashes of light, these are not enough to block his alpha rhythm. Apparently, not all visual activities block alpha rhythm. However, mental imagery, such as occurs when playing blindfold chess, can block alpha rhythm. Another pertinent observation has been that most patients who lose the ability to see as a result of a stroke of the visual cortex on both sides of the brain do not have alpha rhythm. Stroke results from depriving a part of the brain of its blood supply, such as occurs when one of its supplying arteries is completely or partially occluded. Bilateral stroke of the visual cortex occurs when the so-called basilar artery or its branches receives diminished blood supply.

The slow waves of the EEG occur for short periods only in normal sleep, but commonly when there is pathology of the brain — such as a stroke or a tumour. The electroencephalographer can sometimes diagnose the size and nature of brain pathology by comparing the simultaneous activity of many channels of the EEG. In some patients brainwaves paroxysmally change their characteristics: they no longer appear as gentle waves of the sea, but become very sharp and spiky. (The appearance of such a 'brainstorm' unfortunately does not represent the occurrence of some sharp thought.) These abnormalities are seen in seizure disorders, called epilepsies. The EEG provides a major contribution to the diagnosis of epilepsy. Clinically different types of epilepsies have their individual EEG fingerprints, and these different types respond to different medications. Sometimes a medication which is good for one type of seizure disorder may be harmful in another. Thus for these patients EEG recording is indispensable.

The understanding of potential changes of the human brain has been helped by experimental recordings done in other animals. While their surface skull potential EEG is recorded, simultaneously an electrode is being advanced into the depth of the cortex and a third electrode may be held at a constant depth near to or within a single cortical cell. Thus surface EEG, intracellular potential changes, and extracellular spike activity can be recorded in the same animal at the same time. Studies by D. A. Pollen showed that slow surface potential changes (one of the main components of the EEG) are not influenced by spike generation of individual neurons; rather waves represent changes of potential differences between the bodies and processes of single neurons.

Using the electroencephalogram to reveal abnormal or even normal cognitive processes of the brain has been very disappointing. The attempt has been likened to trying to diagnose the problems of a computer by holding a voltmeter up to it. The EEG reveals the pathology of the human brain, but little about abnormal thinking. One reason may be that the EEG scalp electrode samples potential changes which arise in a large volume of the brain, and deficiencies of specific nerve cells which may not all be in the same volume of tissue cannot be detected. The situation is different when, under surgery, the electrical activity of the brain can be directly recorded. With some patients there are medical reasons for putting electrodes on the surface or in the depth of the cortex, and exploring connections between distant areas of the brain. Surprisingly, under this condition, even a relatively large surface electrode samples only the activity of a small volume of tissue. Two intracranial surface electrodes, when spaced only 1 millimetre apart, can show different EEGs.

Resolution of brain pathology by EEG methods is limited by the organization of the human cerebral cortex itself. Sensory stimuli such as light through the eyes, tones through the ears, temperature and pressures, and other sensations, are first transduced and then transmitted to the cortex as changes in electrical activity along nerve fibres as a series of pulses. Often, as the nerves enter the cortex they branch like a tree and connect to many different cells (neurons) of the brain. In addition there are connections between various neurons in the immediate vicinity of each other, as well as long fibres connecting different parts of the brain. Consequently distant cells may register identical changes.

Modern diagnosis in clinical neurology relies less and less on registering spontaneous activity of the brain. Rather, one attempts to induce changes in specific brain areas devoted to one or another sensory modality, such as vision and hearing. Induced activity is of much smaller amplitude than the 'spontaneously' arising potential change and, to detect it, the averaging and summation of a large number of tiny signals is required. The technique is called 'evoked' (as opposed to spontaneous) potentials.

The conventional EEG is obtained through an alternating current (AC) coupled recording. Usually only changes in potentials that occur in less than 1 second are registered. Recordings that show the slower changes of so-called 'standing' potentials of the brain were made as long ago as the 19th century. 'Slow' in this context means a DC shift noticeable only over many seconds. Beck, a Polish investigator, was remarkably successful using the then available technique to record DC potentials. DC recording became clinically useful only with the development of transistorized amplifiers and better electrodes. DC potential changes of the brain may reveal more about cognitive processing than classical EEG does. For example, W. Grey Walter, one of the pioneers of modern electroencephalography, has been able to show that DC potential shifts occur and may relate to anticipation and decision making by the human. A potential shift measured at the top of the head and called the contingent negative variation or CNV is the best-known example of a 'slow' potential change.



Fig. 1. a. Eight simultaneously recorded channels of normal EEG. Letters to the left of each trace represent electrode locations referring to a schematized drawing of a head. Notice on the right side of the figure the spindling of normal alpha range activity in several channels. b. Abnormal EEG of a patient with right cerebral lesion. Notice large-amplitude, slow-wave activity in the even-numbered right-sided channels, especially in the frontotemporal (F8–T6) derivation. There was clinical evidence of focal seizure manifested by jerking of the left leg of the patient.


(Published 1987)

— Ivan Bodis-Wollner

    Bibliography
  • Cooper, R., Osselton, J. W., and Shaw, J. C. (1974). EEG Technology.
  • Pollen, D. A. (1969). Basic Mechanisms of the Epilepsies.
  • Walter, W. G. (1953). The Living Brain (repr. 1968).


Veterinary Dictionary: electroencephalography
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The recording of changes in electric potentials in various areas of the brain by means of electrodes placed on the head or on or in the brain itself, and connected to an amplifier, which augments the impulses more than a million times. The impulses are of sufficient magnitude to move an electromagnetic pen that records the brain waves.

Wikipedia: Electroencephalography
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An EEG recording cap being used on a participant in a brain wave study.

Electroencephalography (EEG) is the recording of electrical activity along the scalp produced by the firing of neurons within the brain.[1] In clinical contexts, EEG refers to the recording of the brain's spontaneous electrical activity over a short period of time, usually 20–40 minutes, as recorded from multiple electrodes placed on the scalp. In neurology, the main diagnostic application of EEG is in the case of epilepsy, as epileptic activity can create clear abnormalities on a standard EEG study.[2] A secondary clinical use of EEG is in the diagnosis of coma, encephalopathies, and brain death. EEG used to be a first-line method for the diagnosis of tumors, stroke and other focal brain disorders, but this use has decreased with the advent of anatomical imaging techniques such as MRI and CT.

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 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.

Epileptic spike and wave discharges monitored with EEG.

Contents

Source of EEG activity

The electrical activity of the brain can be described in spatial scales from the currents within a single dendritic spine to the relatively gross potentials that the EEG records from the scalp, much the same way that the economics can be studied from the level of a single individual's personal finances to the macro-economics of nations. Neurons, or nerve cells, are electrically active cells which are primarily responsible for carrying out the brain's functions. Neurons create action potentials, which are discrete electrical signals that travel down axons and cause the release of chemical neurotransmitters at the synapse, which is an area of near contact between two neurons. This neurotransmitter then activates a receptor in the dendrite or body of the neuron that is on the other side of the synapse, the post-synaptic neuron. The neurotransmitter, when combined with the receptor, typically causes an electrical current within the dendrite or body of the post-synaptic neuron. Thousands of post-synaptic currents from a single neuron's dendrites and body then sum up to cause the neuron to generate an action potential (or not). This neuron then synapses on other neurons, and so on.

EEG reflects correlated synaptic activity caused by post-synaptic potentials of cortical neurons. The ionic currents involved in the generation of fast action potentials may not contribute greatly to the averaged field potentials representing the EEG .[3][4] More specifically, the scalp electrical potentials that produce EEG are generally thought to be caused by the extracellular ionic currents caused by dendritic electrical activity, whereas the fields producing magnetoencephalographic signals.[5] are associated with intracellular ionic currents [6]

The electric potentials generated by single neurons are far too small to be picked by EEG or MEG.[4] EEG activity therefore always reflects the summation of the synchronous activity of thousands or millions of neurons that have similar spatial orientation, radial to the scalp. Currents that are tangential to the scalp are not picked up by the EEG. The EEG therefore benefits from the parallel, radial arrangement of apical dendrites in the cortex. Because voltage fields fall off with the fourth power of the radius, activity from deep sources is more difficult to detect than currents near the skull.[7]

Scalp EEG activity shows oscillations at a variety of frequencies. Several of these oscillations have characteristic frequency ranges, spatial distributions and are associated with different states of brain functioning (e.g., waking and the various sleep stages). These oscillations represent synchronized activity over a network of neurons. The neuronal networks underlying some of these oscillations are understood (e.g., the thalamocortical resonance underlying sleep spindles), while many others are not (e.g., the system that generates the posterior basic rhythm). Research that measures both EEG and neuron spiking finds the relationship between the two is complex with the power of surface EEG only in two bands that of gamma and delta relating to neuron spike activity.[8]

Clinical use

A routine clinical EEG recording typically lasts 20–30 minutes (plus preparation time) and usually involves recording from 25 scalp electrodes. Routine EEG is typically used in the following clinical circumstances:

At times, a routine EEG is not sufficient, particularly when it is necessary to record a patient while he/she is having a seizure. In this case, the patient may be admitted to the hospital for days or even weeks, while EEG is constantly being recorded (along with time-synchronized video and audio recording). A recording of an actual seizure (i.e., an ictal recording, rather than an inter-ictal recording of a possibly epileptic patient at some period between seizures) can give significantly better information about whether or not a spell is an epileptic seizure and the focus in the brain from which the seizure activity emanates.

Epilepsy monitoring is typically done

Additionally, EEG may be used to monitor certain procedures:

EEG can also be used in intensive care units for brain function monitoring:

  • to monitor for non-convulsive seizures/non-convulsive status epilepticus
  • to monitor the effect of sedative/anesthesia in patients in medically induced coma (for treatment of refractory seizures or increased intracranial pressure)
  • to monitor for secondary brain damage in conditions such as subarachnoid hemorrhage (currently a research method)

If a patient with epilepsy is being considered for resective surgery, it is often necessary to localize the focus (source) of the epileptic brain activity with a resolution greater than what is provided by scalp EEG. This is because the cerebrospinal fluid, skull and scalp smear the electrical potentials recorded by scalp EEG. In these cases, neurosurgeons typically implant strips and grids of electrodes (or penetrating depth electodes) under the dura mater, through either a craniotomy or a burr hole. The recording of these signals is referred to as electrocorticography (ECoG), subdural EEG (sdEEG) or intracranial EEG (icEEG)--all terms for the same thing. 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 (or at all) in scalp EEG can be seen clearly in ECoG. Further, smaller electrodes (which cover a smaller parcel of brain surface) allow even lower voltage, faster components of brain activity to be seen. Some clinical sites record from penetrating microelectrodes.

Research use

An early EEG recording, obtained by Hans Berger in 1924. The upper tracing is EEG, and the lower is a 10 Hz timing signal.

EEG, and its derivative, ERPs, are used extensively in neuroscience, cognitive science, cognitive psychology, and psychophysiological research. Many techniques used in research contexts are not standardized sufficiently to be used in the clinical context.

A different method to study brain function is functional magnetic resonance imaging (fMRI). Some benefits of EEG compared to fMRI include:

  • Hardware costs are significantly lower for EEG sensors versus an fMRI machine
  • EEG sensors can be deployed into a wider variety of environments than a bulky, immobile fMRI machine
  • EEG enables higher temporal resolution, on the order of milliseconds, rather than seconds
  • EEG is relatively tolerant of subject movement versus an fMRI (where the subject must remain completely still)
  • EEG is silent, which allows for better study of the responses to auditory stimuli
  • EEG does not cause claustrophobia

Limitations of EEG as compared with fMRI include:

  • Significantly less spatial resolution
  • Need to apply electrodes to the scalp (which may bother people with severe tactile sensitivities, e.g., some individuals with autism)
  • ERP studies require relatively simple paradigms, compared with block-design fMRI studies

EEG recordings have been successfully obtained simultaneously with fMRI scans, though successful simultaneous recording requires that several technical issues be overcome, such as the presence of ballistocardiographic artifact, MRI pulse artifact and the induction of electrical currents in EEG wires that move within the strong magnetic fields of the MRI.

EEG also has some characteristics that compare favorably with behavioral testing:

  • EEG can detect covert processing (i.e., that which does not require a response)
  • EEG can be used in subjects who are incapable of making a motor response
  • Some ERP components can be detected even when the subject is not attending to the stimuli
  • As compared with other reaction time paradigms, ERPs can elucidate stages of processing (rather than just the final end result)

Method

Computer Electroencephalograph Neurovisor-BMM 40

In conventional scalp EEG, the recording is obtained by placing electrodes on the scalp with a conductive gel or paste, usually after preparing the scalp area by light abrasion to reduce impedance due to dead skin cells. Many systems typically use electrodes, each of which is attached to an individual wire. Some systems use caps or nets into which electrodes are embedded; this is particularly common when high-density arrays of electrodes are needed.

Electrode locations and names are specified by the International 10–20 system[9] for most clinical and research applications (except when high-density arrays are used). This system ensures that the naming of electrodes is consistent across laboratories. In most clinical applications, 19 recording electrodes (plus ground and system reference) are used. A smaller number of electrodes are typically used when recording EEG from neonates. Additional electrodes can be added to the standard set-up when a clinical or research application demands increased spatial resolution for a particular area of the brain. High-density arrays (typically via cap or net) can contain up to 256 electrodes more-or-less evenly spaced around the scalp.

Each electrode is connected to one input of a differential amplifier (one amplifier per pair of electrodes); a common system reference electrode is connected to the other input of each differential amplifier. These amplifiers amplify the voltage between the active electrode and the reference (typically 1,000–100,000 times, or 60–100 dB of voltage gain). In analog EEG, the signal is then filtered (next paragraph), and the EEG signal is output as the deflection of pens as paper passes underneath. Most EEG systems these days, however, are digital, and the amplified signal is digitized via an analog-to-digital converter, after being passed through an anti-aliasing filter. Analog-to-digital sampling typically occurs at 256-512 Hz in clinical scalp EEG; sampling rates of up to 20 kHz are used in some research applications.

During the recording, a series of activation procedures may be used. These procedures may induce normal or abnormal EEG activity that might not otherwise be seen. These procedures include hyperventilation, photic stimulation (with a strobe light), eye closure, mental activity, sleep and sleep deprivation. During (inpatient) epilepsy monitoring, a patient's typical seizure medications may be withdrawn.

The digital EEG signal is stored electronically and can be filtered for display. Typical settings for the high-pass filter and a low-pass filter are 0.5-1 Hz and 35–70 Hz, respectively. The high-pass filter typically filters out slow artifact, such as electrogalvanic signals and movement artifact, whereas the low-pass filter filters out high-frequency artifacts, such as electromyographic signals. An additional notch filter is typically used to remove artifact caused by electrical power lines (60 Hz in the United States and 50 Hz in many other countries).[10]

As part of an evaluation for epilepsy surgery, it may be necessary to insert electrodes near the surface of the brain, under the surface of the dura mater. This is accomplished via burr hole or craniotomy. This is referred to variously as "electrocorticography (ECoG)", "intracranial EEG (I-EEG)" or "subdural EEG (SD-EEG)". Depth electrodes may also be placed into brain structures, such as the amygdala or hippocampus, structures which are common epileptic foci and may not be "seen" clearly by scalp EEG. The electrocorticographic signal is processed in the same manner as digital scalp EEG (above), with a couple of caveats. ECoG is typically recorded at higher sampling rates than scalp EEG because of the requirements of Nyquist theorem—the subdural signal is composed of a higher predominance of higher frequency components. Also, many of the artifacts which affect scalp EEG do not impact ECoG, and therefore display filtering is often not needed.

A typical adult human EEG signal is about 10µV to 100 µV in amplitude when measured from the scalp [11] and is about 10–20 mV when measured from subdural electrodes.

Since an EEG voltage signal represents a difference between the voltages at two electrodes, the display of the EEG for the reading encephalographer may be set up in one of several ways. The representation of the EEG channels is referred to as a montage.

Bipolar montage 
Each channel (i.e., waveform) represents the difference between two adjacent electrodes. The entire montage consists of a series of these channels. For example, the channel "Fp1-F3" represents the difference in voltage between the Fp1 electrode and the F3 electrode. The next channel in the montage, "F3-C3," represents the voltage difference between F3 and C3, and so on through the entire array of electrodes.
Referential montage
Each channel represents the difference between a certain electrode and a designated reference electrode. There is no standard position at which this reference is always placed; it is, however, at a different position than the "recording" electrodes. Midline positions are often used because they do not amplify the signal in one hemisphere vs. the other. Another popular reference is "linked ears," which is a physical or mathematical average of electrodes attached to both earlobes or mastoids.
Average reference montage 
The outputs of all of the amplifiers are summed and averaged, and this averaged signal is used as the common reference for each channel.
Laplacian montage 
Each channel represents the difference between an electrode and a weighted average of the surrounding electrodes.[12]

When analog (paper) EEGs are used, the technologist switches between montages during the recording in order to highlight or better characterize certain features of the EEG. With digital EEG, all signals are typically digitized and stored in a particular (usually referential) montage; since any montage can be constructed mathematically from any other, the EEG can be viewed by the electroencephalographer in any display montage that is desired.

The EEG is read by a neurologist, optimally one who has specific training in the interpretation of EEGs. This is done by visual inspection of the waveforms. The use of computer signal processing of the EEG—so-called quantitative EEG—is somewhat controversial when used for clinical purposes (although there are many research uses).

Limitations

EEG has several limitations. Most important is its poor spatial resolution. EEG is most sensitive to a particular set of post-synaptic potentials: those which are generated in superficial layers of the cortex, on the crests of gyri directly abutting the skull and radial to the skull. Dendrites which are deeper in the cortex, inside sulci, in midline or deep structures (such as the cingulate gyrus or hippocampus), or producing currents which are tangential to the skull, have far less contribution to the EEG signal.

The meninges, cerebrospinal fluid and skull "smear" the EEG signal, obscuring its intracranial source.

It is mathematically impossible to reconstruct a unique intracranial current source for a given EEG signal[citation needed], as some currents produce potentials that cancel each other out. This is referred to as the inverse problem. However, much work has been done to produce remarkably good estimates of, at least, a localized electric dipole that represents the recorded currents.

EEG vs fMRI and PET

EEG has several strong points as a tool for exploring brain activity. For example, its temporal resolution is very high (on the level of a single millisecond). Other methods of looking at brain activity, such as PET and fMRI have time resolution between seconds and minutes. EEG measures the brain's electrical activity directly, while other methods record changes in blood flow (e.g., SPECT, fMRI) or metabolic activity (e.g., PET), which are indirect markers of brain electrical activity. EEG can be used simultaneously with fMRI so that high-temporal-resolution data can be recorded at the same time as high-spatial-resolution data, however, since the data derived from each occurs over a different time course, the data sets do not necessarily represent the exact same brain activity. There are technical difficulties associated with combining these two modalities, including the need to remove the MRI gradient artifact present during MRI acquisition and the ballistocardiographic artifact (resulting from the pulsatile motion of blood and tissue) from the EEG. Furthermore, currents can be induced in moving EEG electrode wires due to the magnetic field of the MRI.

EEG can be recorded at the same time as MEG so that data from these complementary high-time-resolution techniques can be combined.

Normal activity

One second of EEG signal

The EEG is typically described in terms of (1) rhythmic activity and (2) transients. The rhythmic activity is divided into bands by frequency. To some degree, these frequency bands are a matter of nomenclature (i.e., any rhythmic activity between 8–12 Hz can be described as "alpha"), but these designations arose because rhythmic activity within a certain frequency range was noted to have a certain distribution over the scalp or a certain biological significance. Frequency bands are usually extracted using spectral methods (for instance Welch) as implemented for instance in freely available EEG software such as EEGLAB.

Most of the cerebral signal observed in the scalp EEG falls in the range of 1–20 Hz (activity below or above this range is likely to be artifactual, under standard clinical recording techniques).

Comparison table

Comparison of EEG bands
Type Frequency (Hz) Location Normally Pathologically
Delta up to 4 frontally in adults, posteriorly in children; high amplitude waves
  • subcortical lesions
  • diffuse lesions
  • metabolic encephalopathy hydrocephalus
  • deep midline lesions
Theta 4 – 7 Hz
  • young children
  • drowsiness or arousal in older children and adults
  • idling
  • focal subcortical lesions
  • metabolic encephalopathy
  • deep midline disorders
  • some instances of hydrocephalus
Alpha 8 – 12 Hz posterior regions of head, both sides, higher in amplitude on dominant side. Central sites (c3-c4) at rest .
  • relaxed/reflecting
  • closing the eyes
  • coma
Beta 12 – 30 Hz both sides, symmetrical distribution, most evident frontally; low amplitude waves
  • alert/working
  • active, busy or anxious thinking, active concentration
Gamma 30 – 100 +
  • certain cognitive or motor functions

Wave patterns

  • Delta is the frequency range up to 4 Hz. It tends to be the highest in amplitude and the slowest waves. It is seen normally in adults in slow wave sleep. It is also seen normally in babies. It may occur focally with subcortical lesions and in general distribution with diffuse lesions, metabolic encephalopathy hydrocephalus or deep midline lesions. It is usually most prominent frontally in adults (e.g. FIRDA - Frontal Intermittent Rhythmic Delta) and posteriorly in children (e.g. OIRDA - Occipital Intermittent Rhythmic Delta).
  • Theta is the frequency range from 4 Hz to 7 Hz. Theta is seen normally in young children. It may be seen in drowsiness or arousal in older children and adults; it can also be seen in meditation.[13] Excess theta for age represents abnormal activity. It can be seen as a focal disturbance in focal subcortical lesions; it can be seen in generalized distribution in diffuse disorder or metabolic encephalopathy or deep midline disorders or some instances of hydrocephalus. On the contrary this range has been associated with reports of relaxed, meditative, and creative states.
  • Alpha is the frequency range from 8 Hz to 12 Hz. Hans Berger named the first rhythmic EEG activity he saw, the "alpha wave." This is activity in the 8–12 Hz range seen in the posterior regions of the head on both sides, being higher in amplitude on the dominant side. It is brought out by closing the eyes and by relaxation. It was noted to attenuate with eye opening or mental exertion. This activity is now referred to as "posterior basic rhythm," the "posterior dominant rhythm" or the "posterior alpha rhythm." The posterior basic rhythm is actually slower than 8 Hz in young children (therefore technically in the theta range). In addition to the posterior basic rhythm, there are two other normal alpha rhythms that are typically discussed: the mu rhythm and a temporal "third rhythm". Alpha can be abnormal; for example, an EEG that has diffuse alpha occurring in coma and is not responsive to external stimuli is referred to as "alpha coma".
  • Mu rhythm is alpha-range activity that is seen over the sensorimotor cortex. It characteristically attenuates with movement of the contralateral arm (or mental imagery of movement of the contralateral arm).
  • Beta is the frequency range from 12 Hz to about 30 Hz. It is seen usually on both sides in symmetrical distribution and is most evident frontally. Beta activity is closely linked to motor behavior and is generally attenuated during active movements.[14] Low amplitude beta with multiple and varying frequencies is often associated with active, busy or anxious thinking and active concentration. Rhythmic beta with a dominant set of frequencies is associated with various pathologies and drug effects, especially benzodiazepines. It may be absent or reduced in areas of cortical damage. It is the dominant rhythm in patients who are alert or anxious or who have their eyes open.
  • Gamma is the frequency range approximately 30–100 Hz. Gamma rhythms are thought to represent binding of different populations of neurons together into a network for the purpose of carrying out a certain cognitive or motor function.

"Ultra-slow" or "near-DC" activity is recorded using DC amplifiers in some research contexts. It is not typically recorded in a clinical context because the signal at these frequencies is susceptible to a number of artifacts.

Some features of the EEG are transient rather than rhythmic. Spikes and sharp waves may represent seizure activity or interictal activity in individuals with epilepsy or a predisposition toward epilepsy. Other transient features are normal: vertex waves and sleep spindles are transient events which are seen in normal sleep.

It should also be noted that there are types of activity which are statistically uncommon but are not associated with dysfunction or disease. These are often referred to as "normal variants." The mu rhythm is an example of a normal variant.

The normal EEG varies by age. The neonatal EEG is quite different from the adult EEG. The EEG in childhood generally has slower frequency oscillations than the adult EEG.

The normal EEG also varies depending on state. The EEG is used along with other measurements (EOG, EMG) to define sleep stages in polysomnography. Stage I sleep (equivalent to drowsiness in some systems) appears on the EEG as drop-out of the posterior basic rhythm. There can be an increase in theta frequencies. Santamaria and Chiappa cataloged a number of the variety of patterns associated with drowsiness. Stage II sleep is characterized by sleep spindles—transient runs of rhythmic activity in the 12–14 Hz range (sometimes referred to as the "sigma" band) that have a frontal-central maximum. Most of the activity in Stage II is in the 3–6 Hz range. Stage III and IV sleep are defined by the presence of delta frequencies and are often referred to collectively as "slow-wave sleep." Stages I-IV comprise non-REM (or "NREM") sleep. The EEG in REM (rapid eye movement) sleep appears somewhat similar to the awake EEG.

EEG under general anesthesia depends on the type of anesthetic employed. With halogenated anesthetics, such as halothane or intravenous agents, such as propofol, a rapid (alpha or low beta), nonreactive EEG pattern is seen over most of the scalp, especially anteriorly; in some older terminology this was known as a WAR (widespread anterior rapid) pattern, contrasted with a WAIS (widespread slow) pattern associated with high doses of opiates. Anesthetic effects on EEG signals are beginning to be understood at the level of drug actions on different kinds of synapses and the circuits that allow synchronized neuronal activity (see: http://www.stanford.edu/group/maciverlab/).

Artifacts

Biological artifacts

Electrical signals detected along the scalp by an EEG, but that originate from non-cerebral origin are called artifacts. EEG data is almost always contaminated by such artifacts. The amplitude of artifacts can be quite large relative to the size of amplitude of the cortical signals of interest. This is one of the reasons why it takes considerable experience to correctly interpret EEGs clinically. Some of the most common types of biological artifacts include:

  • Eye-induced artifacts (includes eye blinks and eye movements)
  • EKG (cardiac) artifacts
  • EMG (muscle activation)-induced artifacts
  • Glossokinetic artifacts

Eye-induced artifacts are caused by the potential difference between the cornea and retina, which is quite large compared to cerebral potentials. When the eye is completely still, this does not affect EEG. But there are nearly always small or large reflexive eye movements, which generates a potential which is picked up in the frontopolar and frontal leads. Involuntary eye movements, known as saccades, are caused by ocular muscles, which also generate electromyographic potentials. Purposeful or reflexive eye blinking also generates electromyographic potentials, but more importantly there is reflexive movement of the eyeball during blinking which gives a characteristic artifactual appearance of the EEG (see Bell's phenomenon).

Eyelid fluttering artifacts of a characteristic type were previously called Kappa rhythm (or Kappa waves). It is usually seen in the prefrontal leads, that is, just over the eyes. Sometimes they are seen with mental activity. They are usually in the Theta (4–7 Hz) or Alpha (8–13 Hz) range. They were named because they were believed to originate from the brain. Later study revealed they were generated by rapid fluttering of the eyelids, sometimes so minute that it was difficult to see. They are in fact noise in the EEG reading, and should not technically be called a rhythm or wave. Therefore, current usage in electroencephalography refers to the phenomenon as an eyelid fluttering artifact, rather than a Kappa rhythm (or wave).[15]

Some of these artifacts are useful. Eye movements are very important in polysomnography, and is also useful in conventional EEG for assessing possible changes in alertness, drowsiness or sleep.

EKG artifacts are quite common and can be mistaken for spike activity. Because of this, modern EEG acquisition commonly includes a one-channel EKG from the extremities. This also allows the EEG to identify cardiac arrhythmias that are an important differential diagnosis to syncope or other episodic/attack disorders.

Glossokinetic artifacts are caused by the potential difference between the base and the tip of the tongue. Minor tongue movements can contaminate the EEG, especially in parkinsonian and tremor disorders.

Environmental artifacts

In addition to artifacts generated by the body, many artifacts originate from outside the body. Movement by the patient, or even just settling of the electrodes, may cause electrode pops, spikes originating from a momentary change in the impedance of a given electrode. Poor grounding of the EEG electrodes can cause significant 50 or 60 Hz artifact, depending on the local power system's frequency. A third source of possible interference can be the presence of an IV drip; such devices can cause rhythmic, fast, low-voltage bursts, which may be confused for spikes.

Artifact correction

Recently, source decomposition techniques have been used to correct or remove EEG contaminates. These techniques attempt to "unmix" the EEG signals into some number of underlying components. There are many source separation algorithms, often assuming various behaviors or natures of EEG. Regardless, the principle behind any particular method usually allow "remixing" only those components that would result in "clean" EEG by nullifying (zeroing) the weight of unwanted components.

Abnormal activity

Abnormal activity can broadly be separated into epileptiform and non-epileptiform activity. It can also be separated into focal or diffuse.

Focal epileptiform discharges represent fast, synchronous potentials in a large number of neurons in a somewhat discrete area of the brain. These can occur as interictal activity, between seizures, and represent an area of cortical irritability that may be predisposed to producing epileptic seizures. Interictal discharges are not wholly reliable for determining whether a patient has epilepsy nor where his/her seizure might originate. (See focal epilepsy.)

Generalized epileptiform discharges often have an anterior maximum, but these are seen synchronously throughout the entire brain. They are strongly suggestive of a generalized epilepsy.

Focal non-epileptiform abnormal activity may occur over areas of the brain where there is focal damage of the cortex or white matter. It often consists of an increase in slow frequency rhythms and/or a loss of normal higher frequency rhythms. It may also appear as focal or unilateral decrease in amplitude of the EEG signal.

Diffuse non-epileptiform abnormal activity may manifest as diffuse abnormally slow rhythms or bilateral slowing of normal rhythms, such as the PBR.

More advanced measures of abnormal EEG signals have also recently received attention as possible biomarkers for different disorders such as Alzheimer's disease.[16]

History

A timeline of the history of EEG is given by Swartz.[17] Richard Caton (1842–1926), a physician practicing in Liverpool, presented his findings about electrical phenomena of the exposed cerebral hemispheres of rabbits and monkeys in the British Medical Journal in 1875. In 1890, Polish physiologist Adolf Beck published an investigation of spontaneous electrical activity of the brain of rabbits and dogs which included rhythmic oscillations altered by light.

In 1912, Russian physiologist, Vladimir Vladimirovich Pravdich-Neminsky published the first EEG and the evoked potential of the mammalian (dog).[18] In 1914, Napoleon Cybulski and Jelenska-Macieszyna photographed EEG-recordings of experimentally induced seizures.

German physiologist and psychiatrist Hans Berger (1873–1941) began his studies of the human EEG in 1920. He gave the device its name and is sometimes credited with inventing the EEG, though others had performed similar experiments. His work was later expanded by Edgar Douglas Adrian. In 1934, Fisher and Lowenback first demonstrated epileptiform spikes. In 1935 Gibbs, Davis and Lennox described interictal spike waves and the 3 cycles/s pattern of clinical absence seizures, which began the field of clinical electroencephalography. Subsequently, in 1936 Gibbs and Jasper reported the interictal spike as the focal signature of epilepsy. The same year, the first EEG laboratory opened at Massachusetts General Hospital.

Franklin Offner (1911–1999), professor of biophysics at Northwestern University developed a prototype of the EEG which incorporated a piezoelectric inkwriter called a Crystograph (the whole device was typically known as the Offner Dynograph).

In 1947, The American EEG Society was founded and the first International EEG congress was held. In 1953 Aserinsky and Kleitman describe REM sleep.

In the 1950s, William Grey Walter developed an adjunct to EEG called EEG topography which allowed for the mapping of electrical activity across the surface of the brain. This enjoyed a brief period of popularity in the 1980s and seemed especially promising for psychiatry. It was never accepted by neurologists and remains primarily a research tool.

Various uses

The EEG has been used for many purposes besides the conventional uses of clinical diagnosis and conventional cognitive neuroscience. Neurofeedback remains an important extension, and in its most advanced form is also attempted as the basis of brain computer interfaces. The EEG is also used quite extensively in the field of neuromarketing. There are many commercial products substantially based on the EEG.

Honda is attempting to develop a system to move its Asimo robot using EEG, a technology which it eventually hopes to incorporate into its automobiles. [19]

EEGs have been used as evidence in trials in the Indian state of Maharastra. [20]

EEG and Telepathy

DARPA has budgeted $4 million in 2009 to investigate technology to enable soldiers on the battlefield to communicate via computer-mediated telepathy. The aim is to analyse neural signals that exist in the brain before words are spoken. [21]

Games

  • In March 24 2007 a US company called Emotiv launched a pointing device for video games based on electroencephalography.[22]
  • Announced at the turn of 2008/2009 were two one-player tabletop gadgets, based on the EEG technology of the company Neurosky. MindFlex by Mattel consists of a ball on a small obstacle course,[23] Force Trainer by Uncle Milton Industries of a ball in a transparent tube.[24] Both feature a headset and a motor to levitate the ball.

Images

See also

References

  1. ^ E. Niedermeyer, Lopes da Silva, F., Electroencephalography, 4th Ed., 1999, Williams & Wilkins, Baltimore, MD, 1258 pp.
  2. ^ Atlas of EEG & Seizure Semiology. B. Abou-Khalil; Musilus, K.E.; Elsevier, 2006.
  3. ^ Creutzfeldt OD, Watanabe S, Lux HD (1966). "Relations between EEG phenomena and potentials of single cortical cells. I. Evoked responses after thalamic and epicortical stimulation". Electroencephalogr Clin Neurophysiol 20: 1-18. 
  4. ^ a b Nunez PL, Srinivasan R (1981). Electric fields of the brain: The neurophysics of EEG. Oxford University Press. 
  5. ^ Hamalainen M, Hari R, Ilmoniemi RJ, Knuutila J, Lounasmaa OV (1993). "Magnetoencphalography - Theory, instrumentation, and applications to noninvasive studies of the working human brain". Reviews of Modern Physics 65: 413-497. 
  6. ^ Buzsaki G (2006). Rhythms of the brain. Oxford University Press. 
  7. ^ Klein, S., & Thorne, B. M. (2007). Biological psychology. New York, N.Y.: Worth.
  8. ^ Whittingstall K, Logothetis NK. (2009). Frequency-band coupling in surface EEG reflects spiking activity in monkey visual cortex. Neuron. 64(2):281-9. PMID 19874794
  9. ^ Towle VL, Bolaños J, Suarez D, Tan K, Grzeszczuk R, Levin DN, Cakmur R, Frank SA, Spire JP. (1993). "The spatial location of EEG electrodes: locating the best-fitting sphere relative to cortical anatomy". Electroencephalogr Clin Neurophysiol 86: 1-6. 
  10. ^ Niedermeyer E, Lopes da Silva F (2004). Electroencephalography: Basic Principles, Clinical Applications, and Related Fields. Lippincot Williams & Wilkins. 
  11. ^ H. Aurlien, I.O. Gjerde, J. H. Aarseth, B. Karlsen, H. Skeidsvoll, N. E. Gilhus (March 2004). "EEG background activity described by a large computerized database.". Clinical Neurophysiology 115 (3): 665–673. doi:10.1016/j.clinph.2003.10.019. 
  12. ^ Nunez PL, Pilgreen KL (1991). "The spline-Laplacian in clinical neurophysiology: a method to improve EEG spatial resolution". J Clin Neurophysiol 8: 397-413. 
  13. ^ Cahn BR, & Polich J. (2006). Meditation states and traits: EEG, ERP, and neuroimaging studies. Psychological Bulletin. 132 (2), 180-211.
  14. ^ Pfurtscheller G, Lopes da Silva FH (1999). "Event-related EEG/MEG synchronization and desynchronization: basic principles". Clin Neurophysiol 110: 1842-1857. 
  15. ^ Epstein, Charles M. (1983). Introduction to EEG and evoked potentials. J. B. Lippincot Co.. ISBN 0-397-50598-1. 
  16. ^ Montez T, Poil S-S, Jones BF, Manshanden I, Verbunt JPA, van Dijk BW, Brussaard AB, van Ooyen A, Stam CJ, Scheltens P, Linkenkaer-Hansen K (2009). "Altered temporal correlations in parietal alpha and prefrontal theta oscillations in early-stage Alzheimer disease". PNAS 106 (5): 1614-1619. doi:10.1073/pnas.0811699106. http://www.pnas.org/content/106/5/1614.abstract. 
  17. ^ Swartz, B.E (1998). "Timeline of the history of EEG and associated fields" (PDF). Electroencephalography and clinical Neurophysiology 106: 173–176. doi:10.1016/S0013-4694(97)00113-2. http://www.sciencedirect.com/science?_ob=MImg&_imagekey=B6SYX-4FV4S6H-1-1&_cdi=4846&_user=10&_orig=browse&_coverDate=02%2F28%2F1998&_sk=998939997&view=c&wchp=dGLbVzz-zSkWb&md5=47fbbe7e51a806779716fba415b96ab7&ie=/sdarticle.pdf. 
  18. ^ Pravdich-Neminsky VV. Ein Versuch der Registrierung der elektrischen Gehirnerscheinungen (In German). Zbl Physiol 27: 951–960, 1913.
  19. ^ [1] 1 Apr 20009, Japan Times
  20. ^ This brain test maps the truth 21 Jul 2008, 0348 hrs IST, Nitasha Natu,TNN
  21. ^ Katie, Drummond; Noah Schachtman (2009-05-14). "Pentagon Preps Soldier Telepathy Push". Wired. http://www.wired.com/dangerroom/2009/05/pentagon-preps-soldier-telepathy-push/. Retrieved 2009-06-14. 
  22. ^ Reporter: Don Clark "Video Mind Control Device". 2007. http://video.msn.com/v/us/fv/msnbc/fv.htm??f=00&g=09e9f856-63f3-40cd-83e6-eb6f2910a31c&p=&t=m5&rf=http://www.msnbc.msn.com/id/17740749/&fg=. Retrieved 2007-03-25. 
  23. ^ http://www.physorg.com/news150781868.html
  24. ^ http://www.usatoday.com/life/lifestyle/2009-01-06-force-trainer-toy_N.htm

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