Type of Surgery
Last updated: 02/17/2009
In reading and interpreting brain wave patterns, a neurologist or other physician will evaluate the type of brain waves and the symmetry, location, and consistency of brain wave patterns. Brain wave response to certain stimuli presented during the...
EEG test (such as flashing lights or noise) will also be evaluated.
The four basic types of brain waves are alpha, beta, theta, and delta, with the type distinguished by frequency. Alpha waves fall between 8 and 13 Hertz (Hz), beta are above 13 Hz, theta between 4 and 7 Hz, and delta are less than 4 Hz. Alpha waves are usually the dominant rhythm seen in the posterior region of the brain in older children and adults, when awake and relaxed. Beta waves are normal in sleep, particularly for infants and young children. Theta waves are normally found during drowsiness and sleep and are normal in wakefulness in children, while delta waves are the most prominent feature of the sleeping EEG. Spikes and sharp waves are generally abnormal; however, they are common in the EEG of normal newborns.
Different types of brain waves are seen as abnormal only in the context of the location of the waves, a person's age, and one's conscious state. In general, disease typically increases slow activity, such as theta or delta waves, but decreases fast activity, such as alpha and beta waves.
Not all decreases in wave activity are abnormal. The normal alpha waves seen in the posterior region of the brain are suppressed merely if a person is tense. Sometimes the addition of a wave is abnormal. For example, alpha rhythms seen in a newborn can signify seizure activity. Finally, the area where the rhythm is seen can be telling. The alpha coma is characterized by alpha rhythms produced diffusely, or, in other words, by all regions of the brain.
Some abnormal beta rhythms include frontal beta waves that are induced by sedative drugs. Marked asymmetry in beta rhythms suggests a structural lesion on the side lacking the beta waves. Beta waves are also commonly measured over skull lesions, such as fractures or burr holes, in activity known as a breach rhythm.
Usually seen only during sleep in adults, the presence of theta waves in the temporal region of awake, older adults has been tentatively correlated with vascular disease. Another rhythm normal in sleep, delta rhythms, may be recorded in the awake state over localized regions of cerebral damage. Intermittent delta rhythms are also an indication of damage of the relays between the deep gray matter and the cortex of the brain. In adults, this intermittent activity is found in the frontal region whereas in children, it is in the occipital region.
The EEG readings of persons with epilepsy or other seizure disorders display bursts, or spikes, of electrical activity. In focal epilepsy, spikes are restricted to one hemisphere of the brain. If spikes are generalized to both hemispheres of the brain, multifocal epilepsy may be present. The EEG can be used to localize the region of the brain where the abnormal electrical activity is occurring. This is most easily accomplished using a recording method, or montage, called an average reference montage. With this type of recording, the signal from each electrode is compared to the average signal from all the electrodes. The negative amplitude (upward movement, by convention) of the spike is observed for the different channels, or inputs, from the various electrodes. The negative deflection will be greatest as recorded by the electrode that is closest in location to the origin of the abnormal activity. The spike will be present but of reduced amplitude as the electrodes move farther away from the site producing the spike. Electrodes distant from the site will not record the spike occurrence.
A final variety of abnormal result is the presence of slower-than-normal wave activity, which can either be a slow background rhythm or slow waves superimposed on a normal background. A posterior dominant rhythm of 7 Hz or less in an adult is abnormal and consistent with encephalopathy (brain disease). In contrast, localized theta or delta rhythms found in conjunction with normal background rhythms suggest a structural lesion.
Electroencephalography (EEG) is the measurement of electrical activity produced by the brain as recorded from electrodes placed on the scalp.
Just as the activity in a computer can be understood on multiple levels, from the activity of individual transistors to the function of applications, so can the electrical activity of the brain be described on relatively small to relatively large scales. At one end are action potentials in a single axon or currents within a single dendrite of a single neuron, and at the other end is the activity measured by the EEG which aggregates the electric voltage fields from millions of neurons. So-called scalp EEG is collected from tens to hundreds of electrodes positioned on different locations at the surface of the head. EEG signals (in the range of milli-volts) are amplified and digitalized for later processing. The data measured by the scalp EEG are used for clinical and research purposes. In neurology, the main diagnostic application of EEG is for epilepsy but this technique is also used to investigate many other pathologies such as sleep-related disorders, sensory deficits, brain tumors, etc. In cognitive neuroscience, EEG is used to investigate the neural correlates of mental activity from low-level perceptual and motor processes to higher-order cognition (attention, memory, reading, etc).
For a neurosurgery, as for any other surgery, it's important to always bring x-rays and any other medical records the patients has.
-Dr Catherine McAuley
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