Electroencephalography

(EEG)
 TABLE OF CONTENT
1. Introduction
- Definition of Electroencephalography (EEG)
- Importance of EEG in medical diagnostics
- Overview of EEG applications in neurology and research
2. History of Electroencephalography (EEG)
- Early discoveries in brain electrical activity
- Contributions of Hans Berger (1924)
- Evolution of EEG technology over time
- Key milestones in EEG advancements
3. Principles of EEG and How It Works
- Basic neurophysiology of brain electrical activity
- Mechanism of EEG signal detection
- EEG waveform characteristics (amplitude, frequency, rhythms)
- Differences between normal and abnormal EEG patterns
4. EEG Machines and Equipment
- Components of an EEG machine
- Electrodes and electrode placement
- Amplifiers and signal processors
- Display and recording systems
- Types of EEG machines
5. EEG Procedure and Steps
-Pre-procedure preparation
- During the procedure
- Post-procedure
6. Types of EEG Tests
- Routine EEG
- Sleep EEG and Polysomnography

ii
 - Ambulatory EEG
- Video EEG monitoring
- Quantitative EEG (qEEG)
- High-density EEG
7. Uses and Applications of EEG
- Clinical Applications
-Research and Non-Medical Uses
8. Benefits of EEG
9. Disadvantages and Limitations of EEG
10. EEG in Pediatric Medicine
- Common Pediatric Conditions Requiring EEG
- Challenges in Pediatric EEG
- Specific EEG Patterns in Children:
- Factor influencing

iii
 INTRODUCTION
The electroencephalogram (EEG) is a widely used non-invasive method for
monitoring the brain. It is based upon placing metal electrodes on the scalp which
measures the small electrical potentials that arise outside of the head due to neuronal
action originating from the brain. EEG is widely used in neurology, sleep studies,
psychiatric evaluations, and brain-computer interface (BCI) research.
The primary function of EEG is to monitor brain function and detect abnormalities
associated with conditions such as epilepsy, sleep disorders, brain injuries, and
cognitive impairments. Since EEG provides real-time information on brain activity, it
plays a crucial role in diagnosing and managing neurological disorders. The sensitivity
of EEG to changes in brain activity on such a millisecond time scale is the major
advantage of EEG over other brain imaging modalities such as functional magnetic
resonance imaging (fMRI) or near-infrared spectroscopy (NIRS) that operate on time
scales in the seconds to minutes range. Its key benefits compared to other brain imaging
techniques are that it has a very high time resolution, it is able to track events within the
brain with millisecond accuracy and that it is in principle portable allowing real-world
neuroimaging to be performed outside of clinical and lab environments. As a result it is
a very widely used sensing modality for a range of health and wellbeing applications
ranging from epilepsy diagnosis to emotional monitoring. Over the past 100 years,
neuroscientists and clinical neurologists have made use of EEG to obtain insight into
cognitive or clinical disease state by applying a variety of signal processing and
statistical analyses to EEG time series. More recently there has been growing interest
in making use of statistical modeling of EEG signals to directly control physical devices
in Brain-Computer Interfaces.

2.0 HISTORY OF ELECTROENCEPHALOGRAPHY (EEG)

 Origin of EEG
The origin of EEG can be traced back to the late 19th and early 20th centuries when
researchers first discovered that the brain produces electrical activity.

1
  Early Discoveries:
 In 1875, British physiologist Richard Caton first recorded electrical signals from the
brains of animals, demonstrating that neurons generate electrical currents.
 Later, in the early 20th century, other scientists built upon this research, buta
German psychiatrist Hans Berger made a groundbreaking discovery.
 In 1924, Berger became the first to record electrical activity from the human brain.
 He introduced the term "electroencephalogram" and identified key brain rhythms,
including alpha waves (8–12 Hz) and beta waves (12–30 Hz).
 Advancements in EEG Technology:
 The 1930s saw the development of the first EEG machines capable of recording
continuous electrical activity.
 By the 1950s, EEG became a standard diagnostic tool for epilepsy and other
neurological disorders.
 Modern EEG systems now use digital technology, wireless connectivity, and
artificial intelligence (AI) to enhance data interpretation.

3.0 Principles of EEG and How It Works

EEG is based on the principle that neurons in the brain communicate using
electrical signals. These signals generate fluctuating voltage changes, which can be
detected on the scalp using electrodes.

 Basic Neurophysiology:
- The brain consists of billions of neurons that transmit information through electrical
impulses.
- Synaptic activity generates tiny voltage changes, which sum up to produce larger
signals detectable by EEG.

 EEG Signal Detection:-

Electrodes attached to the head detect the cumulative electric fields associated
with these impulses, and the potential differences produced can be amplified, processed,

2
displayed as waveforms on a computer and stored giving characteristic representations
of brain activity. Research into the precise cerebral origin of EEG signals that manifest
outside of the head is still ongoing. It is clear that the brain has a large number of
electrical sources present in it, each neuron has intrinsic electrical properties as action
potentials are generated by voltage-gated ion-channels in the cellular membranes, and
synapses operate based upon the flow of sodium and potassium ions.
The scalp EEG is a very large-scale sum of this electrical activity from large
populations of neurons and glial cells operating in synchrony and with volume
conduction effects affecting the size of the brain area to be considered. For practical
use, the EEG can be viewed as an emergent property of these populations and networks:
a voltage waveform with its own characteristic shapes and properties appears on the
scalp due to the neuronal action within the brain,

 EEG Waveforms and Frequencies:

1. Delta waves (0.5–4 Hz):- They are the slowest waves present in adults when in deep
sleep and unconscious states.
2. Theta waves (4–8 Hz):- They are slow waves that are a typical part of light sleep and
relaxation.
3. Alpha waves (8–12 Hz):- They are slower waves present in Relaxed wakefulness. 4.
Beta waves (12–30 Hz):- Are fast waves in active thinking and problem-solving.
5. Gamma waves (30–100 Hz):- These are the fastest waves in high-level cognition and
consciousness.

Fig 1. Different types of normal EEG wave pattern

3
 Differences between normal and abnormal EEG pattern
A). Normal EEG
Normal EEG shows a regular, uniform pattern of brain activity, with consistent
frequencies and amplitudes

Features of a Normal EEG

1) Regular and Uniform Background Activity: A normal EEG typically shows a
consistent, regular background rhythm, often characterized by alpha waves (8-12 Hz)
in the posterior regions during wakefulness.
2) Symmetry: Brainwave activity should be relatively symmetrical between the two
hemispheres.
3) Age and State-Appropriate Rhythms: The brainwave patterns should be appropriate
for the individual's age and state of alertness (e.g., alpha waves are common during
relaxed wakefulness, while beta waves are more prominent during active thinking).
4) Absence of Abnormal Waveforms: A normal EEG should not show the presence of
abnormal waveforms, such as spikes, sharp waves, or other epileptiform discharges.
5) Reactivity to Stimuli: The brainwave activity should react appropriately to external
stimuli, such as opening or closing the eyes.

B). ABNORMAL EEG

Features of an Abnormal EEG

1) Irregular or Slow Background Activity: Abnormal EEGs may show irregular or slow
background activity, including the presence of delta or theta waves in an awake adult,
or a general slowing of the background rhythm.
2) Asymmetry: Significant asymmetries in brainwave activity between the two
hemispheres can indicate an abnormality.
3) Abnormal Waveforms: The presence of abnormal waveforms, such as spikes, sharp
waves, or spike-and-wave complexes, can indicate seizure activity or other neurological
problems.

4
4) Focal Abnormalities: Abnormalities may be localized to a specific area of the brain,
indicating a focal lesion or dysfunction.
5) Lack of Reactivity: A lack of normal reactivity to stimuli can also be an indication
of an abnormality.

Examples of Abnormal Patterns:

1) Epileptiform discharges: Spikes, sharp waves, and spike-and-wave complexes.
2) Hypsarrhythmia: A pattern of disorganized, high-amplitude, and irregular
brainwaves seen in some forms of epilepsy.
3) Burst suppression: A pattern of alternating periods of high-amplitude activity and
periods of suppression.
4) Slow waves: Excessive slow wave activity (delta or theta waves) in an awake adult.

Fig 2. Diagram showing normal, slightly abnormal and abnormal EEG patterns

4.0 EEG MACHINES AND EQUIPMENT

Modern EEG systems consist of several key components:

1) Electrodes and electrode placements:- EEG electrodes are small, flat metal discs
(usually made of silver or gold) that are attached to the scalp. They pick up the tiny
electrical signals (brainwaves) generated by the brain's neurons and transmit them to

5
the EEG machine. The choice of EEG electrode is critical for obtaining good-quality
EEG signals. The EEG has very low amplitude, easily corrupted by noise, and without
good-quality electrodes and set up to connect them well to the head, it is very difficult
to obtain high-quality data. Today, there are three main types of electrode available:
passive wet, active and dry.

Types of EEG Electrodes

1) Passive Electrodes:
The passive electrode is a transducer which converts ionic currents coming from
the human body into electron currents that can be measured by conventional electronics.
There is a hole in the centre of the electrode (or a cup) to allow a conductive gel to be
added which ensures that a conductive path is made between the electrode metal and
the scalp. Key to good operation of passive electrodes is to ensure that the contact
impedance between the electrode and the scalp is low, always below 10 kΩ and ideally
below 5 kΩ.

Fig 3. Diagram of passive wet electrodes (a) Disposable (b) Reusable

2) Active Electrodes:
These electrodes have built-in amplifiers, which can improve the signal quality
and reduce noise, part of the instrumentation electronics, principally a buffer amplifier,
is placed on top of the electrode itself. The obvious drawback is that it increases the
electrode size and weight. However, it has the advantage of reducing mains interference

6
and artefacts due to the movement of the recording wires. These electrodes generally
still require a gel to be added but much less than in the classical passive case as high-
quality recordings can be obtained with such a set up even with impedances up to 40
kΩ present.

Fig 4. Diagram of an active electrode

3) Dry Electrodes:
These electrodes do not use a conductive gel or abrasive paste, and are often used
for portability and ease of use. Most dry electrodes focus on having fingers in order to
better penetrate the hair and are attached to springs to help keep them in place.

Fig 5. Diagram of a dry electrode

 Electrode Placement
The placement of electrodes in Electroencephalography (EEG) is a standardized
procedure that ensures consistent and comparable recordings of brain electrical activity

7
across individuals. The most widely used system is the International 10-20 System. The
"10" and "20" in the name refer to the fact that the actual distances between adjacent
electrodes are either 10% or 20% of the total front-back or right-left distance of the
skull.
This proportional system is crucial because it identifies the same relative position
on the scalp regardless of differences in head size and shape

 Key Anatomical Landmarks

The 10-20 system relies on four primary bony landmarks on the skull:
1) Nasion: The indentation between the forehead and the nose.
2) Inion: The lowest point of the skull at the back of the head.
3) Preauricular Points: The small indentations just in front of each ear.

 Measurements:
-The distance between the nasion and the inion is measured along the midline of the
scalp.
- The distance between the left and right preauricular points is measured across the
top of the head, passing through the vertex (the highest point of the skull).

 Electrode Positions: These measured distances are then used to determine the
locations of the electrodes at 10% and 20% intervals.
-Labeling System: Each electrode site is identified by a letter and a number:
-Letters: Indicate the lobe or area of the brain beneath the electrode:
Fp: Frontopolar (most frontal)
- F: Frontal , c- central , T - Temporal , p - Parietal , O- Occipital
-Numbers: Indicate the hemisphere:
- Odd numbers (1, 3, 5, 7, etc.): Left hemisphere
- Even numbers (2, 4, 6, 8, etc.): Right hemisphere
- "z": Midline positions (e.g., Fz, Cz, Pz)

8
Fig 6. Letters and numbers used to represent electrodes

Fig 7. Full names for electrode

2) Amplifiers and Filters:-

- EEG signals are weak, so amplifiers increase their strength.
- Filters remove noise and unwanted signals.
3) Computer Interface:-
- Converts analog signals into digital format for analysis.
- Uses AI algorithms to help interpret EEG patterns.

9
 Types of EEG Machines
1) Routine EEG Machine: Used for standard brain monitoring, often in a clinical
settings, it is typically short, lasting 20-30 minutes. May involve tasks like looking at
flashing lights or taking deep breaths.
2) Ambulatory EEG: This uses a portable EEG machine to record brain activity
throughout the day and night for 1 day or longer.
3) Sleep EEG: This is done while you sleep to check for sleep disorders.
4) Video EEG: This involves filming you while the EEG is recording brainwaves to
gather more information.
5) Invasive EEG: This involves surgery to place electrodes on or into the brain to
identify the location causing seizures. It is rarely used.

5.0 EEG PROCEDURES AND STEPS

Standard EEG follows these steps:
1) Pre-Procedure Preparation:
- The patient is advised to:
- Wash their hair to remove oils that may interfere with electrode contact.
- Avoid caffeine, which can affect brain activity.
- Sleep less, if a sleep EEG is required.
2) During the Procedure:
- The technician places electrodes on the scalp following the 10-20 system.
- The patient remains relaxed while EEG data is recorded.
- Additional tests may be conducted, such as:
- Hyperventilation: The patient breathes rapidly to provoke abnormalities.
- Photic Stimulation: A flashing light helps detect epilepsy.
- Sleep Deprivation EEG: Performed after a lack of sleep to trigger abnormal activity.
3) Post-Procedure:
- EEG recordings are analyzed by a neurologist.
- The report is generated for diagnosis and treatment planning.

10
6.0 Types of EEG Tests
Different types of EEG tests serve specific diagnostic purposes:
1. Routine EEG: Standard EEG lasting 20–30 minutes.
2. Sleep EEG: Performed during sleep to assess sleep disorders.
3. Ambulatory EEG: The patient wears a portable EEG device for 24–72 hours.
4. Video EEG Monitoring: Used in epilepsy diagnosis, combining EEG with video
recording.
5. Quantitative EEG (qEEG): Uses computer analysis for advanced diagnostics.
6. High-Density EEG: Uses more than 64 electrodes for detailed brain mapping.

7.0 Uses and Applications of EEG

EEG has multiple medical and non-medical applications:
Clinical Uses:
- Epilepsy:vIdentifies abnormal brain activity and seizure patterns.
- Sleep Disorders:vDiagnoses conditions like insomnia, narcolepsy, and sleep apnea.
- Brain Injuries: Assesses brain function in coma patients.
- Psychiatric Disorders: Helps in diagnosing schizophrenia, depression, and ADHD.
Research and Technology Uses:
- Neurofeedback: Used in cognitive training and mental health therapies.
- Brain-Computer Interfaces (BCI): Helps disabled individuals control devices using
brain signals.
- AI and EEG: Machine learning aids in automated EEG interpretation.

8.0 Benefits of EEG

1. Non-invasive and painless.
2. Provides real-time data.
3. More affordable than MRI or CT scans.
4. Portable and can be used for long-term monitoring.
5. Effective for early detection of neurological disorders.

11
9.0 Disadvantages and Limitations of EEG
1. Low spatial resolution: Cannot detect deep brain structures.
2. Susceptible to artifacts: Movement, blinking, and muscle activity can distort results.
3. Requires expertise: Interpretation is complex and needs trained professionals.
4. Short recording time: Some abnormalities may not appear during routine EEG.

10.0 EEG IN PEDIATRIC MEDICINE

 Common Pediatric Conditions Requiring EEG

1. Neonatal Seizures: EEG helps in detecting and managing infant seizures.
2. Childhood Epilepsy: Essential for classifying seizure types and guiding treatment.
3. Autism Spectrum Disorder (ASD): EEG research explores abnormal brain
connectivity.
4. Developmental Delays: Helps in assessing brain function in children with cognitive
impairments.

 Challenges in Pediatric EEG

1. Young children may be uncooperative, requiring sedation.
2. Pediatric EEG requires specialized interpretation

 Specific EEG Patterns in Children:

1. Neonates (Birth to 1 month): EEG patterns are characterized by high-amplitude,
slow activity (delta waves) during sleep and irregular, low-amplitude activity during
wakefulness.
2. Infants (1 month to 1 year): As infants mature, theta waves (4-7 Hz) become more
prominent during wakefulness, and the background activity becomes more
rhythmic.
3. Toddlers (1 to 3 years): The posterior dominant rhythm (PDR), a precursor to the
alpha rhythm, emerges, typically at 5-7 Hz.
4. School-Age Children (6 to 12 years): The PDR matures into the alpha rhythm (8-12
Hz), which is the dominant background rhythm in awake, relaxed adults.

12
5. Adolescents (13 to 20 years): The EEG patterns become more similar to those of
adults, with a prominent alpha rhythm and increased beta activity (13 Hz and higher)
during wakefulness.
6. Drowsiness: During drowsiness, the EEG shows a mix of theta and delta waves, and
the background activity becomes more irregular.
7. Sleep: During sleep, the EEG shows slow, high-amplitude delta waves, and there
are also periods of faster, more rhythmic activity (theta waves) during REM sleep.

 Factor influencing EEG

1) Age (i) Infant– theta, delta wave
(ii) Child – alpha formation
(iii) Adult – all four waves.
2) Level of consciousness (sleep)
3) Hypocapnia(hyperventilation) slow & high amplitude waves.
4) Hypoglycemia
5) Hypothermia
6) Low glucocorticoids slow waves

13