Electroencephalography (EEG)
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26-02-2011, 12:16 PM

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1. Electroencephalography (EEG):
Electroencephalography (EEG) is the recording of electrical activity along the scalp produced by the firing of neurons within the brain. 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. A secondary clinical use of EEG is in the diagnosis of coma, encephalopathy, 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 psycho physiological research.
Epilepsy monitoring is typically done:
 to distinguish epileptic seizures from other types of spells, such as psychogenic non-epileptic seizures, syncope (fainting), sub-cortical movement disorders and migraine variants.
 to characterize seizures for the purposes of treatment
 to localize the region of brain from which a seizure originates for work-up of possible seizure surgery
Additionally, EEG may be used to monitor certain procedures:
 to monitor the depth of anesthesia
 as an indirect indicator of cerebral perfusion in carotid endarterectomy
 to monitor amobarbital effect during the Wada test
EEG can also be used in intensive care units for brain function monitoring:
 to monitor for non-convulsive seizures/non-convulsive status epileptics
 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 respective 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 electrodes) under the dura mater, through either a craniotomy or a burr hole. The recording of these signals is referred to aselectrocorticography (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.
Epilepsy is a common chronic neurological disorder characterized by recurrent unprovoked seizures.[1][2] These seizures are transient signs and/or symptoms of abnormal, excessive or synchronous neuronal activity in the brain.[3] About 50 million people worldwide have epilepsy, with almost 90% of these people being in developing countries.[4] Epilepsy is more likely to occur in young children, or people over the age of 65 years; however, it can occur at any time.[5] As a consequence of brain surgery, epileptic seizures may occur in recovering patients.
Epilepsy is usually controlled, but cannot be cured with medication, although surgery may be considered in difficult cases. However, over 30% of people with epilepsy do not have seizure control even with the best available medications.[6][7] Not all epilepsy syndromes are lifelong – some forms are confined to particular stages of childhood. Epilepsy should not be understood as a single disorder, but rather as syndromic with vastly divergent symptoms but all involving episodic abnormal electrical activity in the brain.
Epilepsies are classified in five ways:
1. By their first cause (or etiology).
2. By the observable manifestations of the seizures, known as semiology.
3. By the location in the brain where the seizures originate.
4. As a part of discrete, identifiable medical syndromes.
5. By the event that triggers the seizures, as in primary reading epilepsy or musicogenic epilepsy.
In 1981, the International League Against Epilepsy (ILAE) proposed a classification scheme for individual seizures that remains in common use.[8] This classification is based on observation (clinical and EEG) rather than the underlying path physiology or anatomy and is outlined later on in this article. In 1989, the ILAE proposed a classification scheme for epilepsies and epileptic syndromes.This can be broadly described as a two-axis scheme having the cause on one axis and the extent of localization within the brain on the other. Since 1997, the ILAE have been working on a new scheme that has five axes:
1. ictal phenomenon, (pertaining to an epileptic seizure)
2. seizure type,
3. syndrome,
4. etiology,
5. impairment. [10]
Seizure types
Seizure types are organized firstly according to whether the source of the seizure within the brain is localized (partial or focal onset seizures) or distributed (generalized seizures). Partial seizures are further divided on the extent to which consciousness is affected. If it is unaffected, then it is a simple partial seizure; otherwise it is a complex partial (psychomotor) seizure. A partial seizure may spread within the brain - a process known as secondary generalization. Generalized seizures are divided according to the effect on the body but all involve loss of consciousness. These include absence (petit mal), myoclonic, clonic, tonic, tonic-clonic (grand mal) and atonic seizures.
Children may exhibit behaviors that are easily mistaken for epileptic seizures but are not caused by epilepsy. These include:
 Inattentive staring
 Benign shudders (among children younger than age 2, usually when they are tired or excited)
 Self-gratification behaviors (nodding, rocking, head banging)
 Conversion disorder (flailing and jerking of the head, often in response to severe personal stress such as physical abuse)
Conversion disorder can be distinguished from epilepsy because the episodes never occur during sleep and do not involve incontinence or self-injury.

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