neurologic disorders
Electroencephalography (EEG)
Introduction
Twenty electrodes are distributed symmetrically over the scalp to detect electrical changes in the brain that are associated with Seizure Disorders None Approach to the Patient With a Sleep or Wakefulness Disorder None Metabolic or structural encephalopathies The normal awake EEG shows 8- to 12-Hz, 50-muV sinusoidal alpha waves that wax and wane over the occipital and parietal lobes and>12-Hz, 10- to 20-muV beta waves frontally, interspersed with 4- to 7-Hz, 20- to 100-muV theta waves. The EEG is examined for asymmetries between the 2 hemispheres (suggesting a structural disorder), for excessive slowing (appearance of 1- to 4-Hz, 50- to 350-muV delta waves, as occurs in depressed consciousness, encephalopathy, and dementia), and for abnormal wave patterns. Abnormal wave patterns may be nonspecific (eg, epileptiform sharp waves) or diagnostic (eg, 3-Hz spike and wave discharges for absence seizures and 1-Hz periodic sharp waves in Creutzfeldt-Jakob Disease (CJD) ). If a seizure disorder is suspected and the routine EEG is normal, maneuvers that electrically activate the cortex (eg, hyperventilation, photic stimulation, sleep, sleep deprivation) can sometimes elicit evidence of a seizure disorder. Nasopharyngeal leads can sometimes detect a temporal lobe seizure focus when the EEG is otherwise uninformative. Continuous ambulatory monitoring of the EEG (with or without video monitoring) over 24 hours or longer can often determine whether fleeting memory lapses, subjective auras, or unusual episodic motor behavior is due to seizure activity. If clinicians need to determine whether an episode is a true seizure or a manifestation of a psychiatric disorder, a video camera may be used to monitor the patient while EEG is done in the hospital. This technique (called video EEG) is also used before surgery to see what type of seizure results from an abnormality in a particular epileptogenic focus. The EEG is particularly useful for evaluating episodes of altered consciousness with uncertain etiology. 