EEG in Neonates - Normal Variants and Pathological Traces
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This pattern discusses the various EEG patterns seen in term as well as pre term neonates. Normal Variations as well as pathological traces are discussed
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EEG in Neonates - Normal Variants and Pathological Traces
- 1. Neonatal EEG Dr. Rahul Kumar
- 3. Road Map for the Session • • • • • • • Continuity Inter-hemispheric Synchrony Beta-Delta Complexes Temporal Theta Bursts Frontal Sharp Waves Reactivity to Stimulus Differentiation between sleep and awake eeg
- 4. Road Map for the Session • • • • • • • Continuity Inter-hemispheric Synchrony Beta-Delta Complexes Temporal Theta Bursts Frontal Sharp Waves Reactivity to Stimulus Differentiation between sleep and awake eeg
- 5. • • • • Activity discontinuous in early life Long periods of electrical silence Presen in both sleep and awake records Seen till 30th week CA • This pattern is referred to as ‘Trace Discontinua’
- 7. • EEG activity becomes continuous during waking by 34 weeks CA • EEG activity becomes continuous during NREM by 37 weeks CA • However, semi-periodic, voltage attenuation still seen during NREM sleep, lasting for 1015 seconds • Present upto 5-6 weeks of age
- 11. Road Map for the Session • • • • • • • Continuity Inter-hemispheric Synchrony Beta-Delta Complexes Temporal Theta Bursts Frontal Sharp Waves Reactivity to Stimulus Differentiation between sleep and awake eeg
- 12. • EEG activity asynchronous till 28 weeks CA • Degree of asynchrony decreases with age, mature brain has minimal asynchrony
- 13. Road Map for the Session • • • • • • • Continuity Inter-hemispheric Synchrony Beta-Delta Complexes Temporal Theta Bursts Frontal Sharp Waves Reactivity to Stimulus Differentiation between sleep and awake eeg
- 14. • Beta-delta waveforms are composed of random wave forms • 0.3-1.5 Hz frequency, superimposed on fast frequency • Fast frequency in two frequency bands • 8-12 Hz and 18-22 Hz • Voltage <75 • Also known as spindle delta bursts, ripples of prematurity, etc
- 16. Road Map for the Session • • • • • • • Continuity Inter-hemispheric Synchrony Beta-Delta Complexes Temporal Theta Bursts Frontal Sharp Waves Reactivity to Stimulus Differentiation between sleep and awake eeg
- 17. • Appear by 26 weeks CA • 4.5-6 Hz, 20-200 µv • Occur independently for short bursts, <2 sec • Expressed maximally at 30-32 weeks CA, then decline in frequency • Used to determine CA, replaced by alpha rhythm
- 19. Road Map for the Session • • • • • • • Continuity Inter-hemispheric Synchrony Beta-Delta Complexes Temporal Theta Bursts Frontal Sharp Waves Reactivity to Stimulus Differentiation between sleep and awake eeg
- 20. • Bilaterally synchronous • Present from 35 week CA, up to 44 weeks, till 6weeks post term • 50-150 µv • Resemble vertex sharp waves
- 21. Parameter Normal Abnormal Amplitude 50-150 µv > 150 µv Duration <100 msec >150 msec Initial Polarity Surface negative Surface positive or negative Phase Mono or diphasic Polyphasic Occurrence Random, bilateral, Sleep Runs, 1Hz, unilateral, awake Following slow wave Absent Present
- 22. Road Map for the Session • • • • • • • Continuity Inter-hemispheric Synchrony Beta-Delta Complexes Temporal Theta Bursts Frontal Sharp Waves Reactivity to Stimulus Differentiation between sleep and awake eeg
- 23. • Response easily identifiable by 37 weeks CA • Generalised attenuation or rarely augmentation of voltage to loud sounds seen by 34 th week • If background is high voltage delta, response is attenuation • If background is low voltage theta, response is augmentation
- 24. Road Map for the Session • • • • • • • Continuity Inter-hemispheric Synchrony Beta-Delta Complexes Temporal Theta Bursts Frontal Sharp Waves Reactivity to Stimulus Differentiation between sleep and awake eeg
- 25. • Distinction clear by 36th week CA • Till that age, Beta Delta complexes dominate • These change to random, semi arrhythmic activity at 4-8 Hz • Trace alternans seen during 36-38 weeks
- 26. Summary …
- 27. Road Map for the Session • • • • • • • Continuity Inter-hemispheric Synchrony Beta-Delta Complexes Temporal Theta Bursts Frontal Sharp Waves Reactivity to Stimulus Differentiation between sleep and awake eeg
- 34. Roffwarg, Muzio, and Dement. Science, 1966 34