Amplitude integrated electroencephalography

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Amplitude integrated electroencephalography
Normal CFM trace.jpg
A normal CFM trace in a term infant who is several days old. The amplitude-integrated trace is in the top half of the screen displaying left- and right-sided traces. There is a normal baseline and upper limit, sleep-wake cycling, and no seizures.
Purposemonitoring brain function in intensive care

Amplitude integrated electroencephalography (aEEG), cerebral function monitoring (CFM) or continuous electroencephalogram (CEEG) is a technique for monitoring brain function in intensive care settings over longer periods of time than the traditional electroencephalogram (EEG), typically hours to days. By placing electrodes on the scalp of the patient, a trace of electrical activity is produced which is then displayed on a semilogarithmic graph of peak-to-peak amplitude over time; amplitude is logarithmic and time is linear. In this way, trends in electrical activity in the cerebral cortex can be interpreted to inform on events such as seizures or suppressed brain activity. [1] aEEG is useful especially in neonatology where it can be used to aid in diagnosis of hypoxic ischemic encephalopathy (HIE), and to monitor and diagnose seizure activity.

Contents

Interpretation of the aEEG

The CFM readout offers an integrated trace in one pane and a non-integrated trace in another pane (see image). Modern machines give a readout for each hemisphere corresponding to the positions of electrodes placed on the patient's head. The characteristics of the CFM include the 'baseline' which should be more than 5 µV, the upper limit of the trace which should be more than 10 µV, and the presence of 'sleep wake cycling' whereby the trace is expected to narrow and broaden over time. Seizures appear on the trace as regions of high activity with a raised and compacted trace in the aEEG pane; this would correspond to high-amplitude, repetitive waveforms in the non-integrated pane. A low-amplitude or 'suppressed' trace is prognostically concerning as it indicates abnormally low brain activity. A further possible pattern is a 'burst suppression' trace which consists of a low-amplitude signal interspersed with periods of high activity on the aEEG readout. This also carries a poor prognosis. [2]

See also

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<span class="mw-page-title-main">K-complex</span>

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<span class="mw-page-title-main">Burst suppression</span>

Burst suppression is an electroencephalography (EEG) pattern that is characterized by periods of high-voltage electrical activity alternating with periods of no activity in the brain. The pattern is found in patients with inactivated brain states, such as from general anesthesia, coma, or hypothermia. This pattern can be physiological, as during early development, or pathological, as in diseases such as Ohtahara syndrome.

Electroencephalography (EEG) is the science of recording the spontaneous rhythmic electrical activity of a living brain through electrodes on the scalp. Brain rhythms have origins similar to the electrical activity of the heart. The rhythmic activity varies in frequency and amplitude with age, attention, sleep, and chemical concentrations of oxygen, carbon dioxide, glucose, ammonia, and hormones. Chemicals that affect brain functions change brain rhythms in systematic and identifiable ways. As new psychoactive drugs were discovered that changed behavior, the basis for the science of psychopharmacology, the accompanying changes in the rhythms were found to be drug class specific. The measurement of the changes in rhythms became the basis for the science of pharmaco-EEG.

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<span class="mw-page-title-main">Fetal EEG</span>

Fetal electroencephalography, also known as prenatal EEG includes any recording of electrical fluctuations arising from the brain of a fetus. Doctors and scientists use EEGs to detect and characterize brain activity, such as sleep states, potential seizures, or levels of a coma. EEG captures the electrical activity in the vicinity of the recording electrodes. The majority of the neural electrical activity arises from the flow of current from the cell bodies of pyramidal neurons to their apical dendrites, which become depolarized by excitatory inputs from other neurons. To record the most accurate signals, scientists try to minimize the distance between the recording electrode and the neural activity that they want to detect. Given the difficulty of attaching electrodes to a fetus inside a uterus, doctors and scientists use a variety of techniques to record fetal brain activity.

Malignant migrating partial seizures of infancy (MMPSI) is a rare epileptic syndrome that onsets before 6 months of age, commonly in the first few weeks of life. Once seizures start, the site of seizure activity repeatedly migrates from one area of the brain to another, with few periods of remission in between. These seizures are 'focal' (updated term for 'partial'), meaning they do not affect both sides of the brain at the same time. These continuous seizures cause damage to the brain, hence the descriptor 'malignant.'

References

  1. Maynard D, Prior P, Scott D. Device for continuous monitoring of cerebral activity in resuscitated patients. Br Med J. 1969 Nov 29;4(5682):545-6. PMID   5354856
  2. Azzopardi D. TOBY Cerebral Function Monitoring: Addition to CFM handbook for users of the Olympic CFM 6000. Imperial College London, 2004.