Patti Baumgartner, R. EEG/EP., CNIM. Danny Glover Sir Isaac Newton Pope Pius IX Socrates Napoleon...
-
Upload
clementine-goodwin -
Category
Documents
-
view
215 -
download
0
Transcript of Patti Baumgartner, R. EEG/EP., CNIM. Danny Glover Sir Isaac Newton Pope Pius IX Socrates Napoleon...
Abnormal EEGs In The Sleep Lab
Patti Baumgartner,R. EEG/EP., CNIM
Danny Glover Sir Isaac Newton Pope Pius IX Socrates Napoleon Charles Dickens maybe someone you know?
What do these people have in common?
They all have epilepsy.
Answer
It is estimated that at least 2/3 of seizures occur in sleep.
Not everyone who has a seizure has epilepsy
Some seizures can hardly be noticed, while others are totally disabling.
What percentage of seizures occur in sleep?
A seizure is a sudden surge of electrical activity in the brain that usually affects how a person feels or acts for a short time.
Seizures are not a disease in themselves. Instead, they are a symptom of many different disorders of the brain.
Not everyone who has a seizure has epilepsy.
What is a seizure?
Epilepsy is a medical condition that produces seizures affecting a variety of mental and physical functions.
When a person has 2 or more unprovoked seizures they are considered to have epilepsy.
Definition of Epilepsy
Any one of us can have a seizure if the conditions are right.
Drugs Hypoglycemia High fever ECT Infectious disease Meningitis/encephalitis
Etiology of Epilepsy
Quick Anatomy Lesson
4 lobes of the brain
Plan for the futureSolve complex problems Express and control emotional behaviorCoordinate complex skilled movementsSome aspects of speech
Frontal Lobe
In most people the temporal lobes have somewhat different functions The left temporal lobe generally helps us to understand language, and speak.The right temporal lobe helps us to remember things.
Temporal Lobe
Includes sensory areas, responsible for feelings of temperature, touch, pressure and pain.
Parietal Lobe
Primary function is vision
Occipital
Seizures are classified into 2 categories or groups:
Partial and Generalized
Classification of Epilepsy
Involve only a portion of the brain at the ONSET.
They are further divided into two parts: Simple partial, in which consciousness is not
impaired Complex partial in which consciousness is
impaired.
Partial Seizures
These seizures are commonly called grand mal. And by definition begin with loss of consciousness.
Typically each seizure has 2 phases, tonic and clonic.
Tonic Phase consists of an increase in muscle tone which causes stiffening.
Clonic Phase consists of alternating tightening and relaxing of muscles--Jerking
Generalized seizures
Another type of generalized seizure is the Atonic Seizure.
The seizure consists of loss of all strength rather than becoming stiff. They last only a few seconds so it is impossible to accurately determine the patient’s level of consciousness.
Generalized seizures
Brief episodes of staring. May have some associated eye blinking/fluttering, or lip smacking.
Spells last only a few seconds Start in Childhood, disappear by late teens
Absence Seizures
Seizures that begin with an abnormal electrical
discharge from a limited area of the brain are called partial seizures.
Two kinds:Simple complexPartial Complex
Partial Seizures
The specific area of he brain where each of these seizures begins determines what the seizure looks like.
Commonality is that the person having the seizure remains alert and can remember what happened.
Sometimes called focal seizures
Simple Partial Seizures
These seizures begin in a small area of the temporal or frontal lobe, but they quickly involve areas that affect alertness and awareness
Consciousness is lost, the patient has no memory of the event
Complex Partial Seizures
Both simple and complex partial seizures can spread , resulting in secondarily generalized tonic clonic seizures.
In the EEG world this is called secondary subcortical synchrony
Secondary generalized seizures
Rebecca Clark-Bash 23
Summary of Clinical & EEG Features of Epileptic SeizuresSeizure Usual
DurationLoss of Consc.
Post-IctalConfusion
ICTALEEG
SimplePartial
5-10 sec NO NO Focal Spikes (NL)
Complex Partial
Variable5-10 sec1-2 min
YES YES Focal orLat. Spike
Absence 5-10 /secClustering
YES NO Gen.3 /sec S & W
Gen.Tonic-Clonic
1-2 min YES YES Gen. HighAmp Spikes
Tegretol Carbatrol ZarontinFelbatrol Gabitril KeppraLamictal Lyrica DilantinTopamax Trileptal DepakeneDepakote
Medications for Epilepsy
Rebecca Clark-Bash25
Term Definition Ictal EEG
Describes the recording during the event
Interictal EEG Describes the recording in between
each event Postictal EEG
Describes the period of time immediately following an event
Any paroxysmal rhythmic frequency (e.g. beta, alpha, or even delta) may also be classified as epileptiform.
Certainly the most common types of Epileptiform activity are: spikes, sharp waves, spike and waves
What is Epileptiform Activity
A wave with a duration of 80 msc or less, usually negative, standing out from the background.
Definition of a Spike
A wave with a duration of 120-80 msc, usually negative, standing out
from the background.
Definition of a Sharp wave
How to measure a spike/sharp wave30 second epoch
Spike followed by a slow wave
Spike and Wave
31
What do you see on the EEG
The signature of epilepsy:
“cat”
Example #1 Sleep parameters
Example #1 EEG Parameters
Eye Blink artifact
Answer
Example #2 Sleep Parameters
Sample #2 EEG Parameters
Asymmetrical Alpha. Alpha activity is higher amplitude on the
Sample #2 Answer
Example # 3 Sleep Parameters
Example #3 EEG Parameters
Generalized spike and wave
Sample #3
Example #4 Sleep Parameters
Example #4 EEG Parameters
Multifocal Spikes
Sample #4
Sample #5 Sleep Parameters
Sample #5 EEG Parameters
C4 spikes
Sample #5
Sample #6 Sleep Parameters
Sample #6 EEG
Generalized Spike and Wave
Sample #6
Sample #7 Sleep Parameters
Sample #7 EEG Parameters
Generalized Polyspike and Wave
Samle #7
Sample #8 Sleep Parameters
Sample #8 EEG Parameters
Focal slow F7 T3
Sample #8
Sample #9 EEG Parameters
Sample #9 Sleep Parameters
Focal Slow, best seen on slow paper speed
Sample #9
Bernard M. Abrams, M. D. Susan Gersh, R. EEG T. Rebecca Clark Bash, R. EEG/EP T., CNIM,
F.ASNM Terry O’Brien
Many Thanks to Those That Helped
1. Eye Blink 2. Asymmetrical Alpha 3. Generalized Spike and Wave 4. Multifocal Spikes 5. C4 focal Spike 6. Generalized spike and wave 7. Generalized Polyspike and wave 8. Focal spikes F7 and T3 9. Focal slowing T3 best seen on Sleep
Parameters (slow speed)
Answers to Sample Wave Forms