Electroneurogram

(ENG)
 ENG

 An electroneurogram is a method used to visualize directly recorded electrical activity

of neurons in the central nervous system (brain, spinal cord) or the peripheral nervous
system (nerves, ganglions).

 An electroneurogram is usually obtained by placing an electrode in the neural tissue.

 The electrical activity generated by neurons is recorded by the electrode and

transmitted to an acquisition system, which usually allows to visualize the activity of
the neuron.

 Depending on the precision of the electrode used to record neural activity, an

electroneurogram can contain the activity of a single neuron to thousands of neurons.
 ENG

 Electroneurography is a non invasive, electro neurological diagnostic

test to measure the conduction velocity and latency of peripheral
nerves.

 It is the most accurate test for detecting and locating peripheral

nerve injury of about 100 kinds of peripheral neuropathies. Such as,
 Diabetic polyneuropathy,
 Gullain- Barre syndrome,
 Carpel tunnel syndrome,
 thoracic outlet syndrome
 NCS

 Nerve conduction studies (NCS) measure how well and how fast the nerves can send
electrical signals.
 Nerves control the muscles in the body with electrical signals called impulses.
 These impulses make the muscles react in certain ways.
 Nerve and muscle problems cause the muscles to react in ways that aren't normal.
 If you have leg pain or numbness, you may have these tests to find out which nerves are
being affected and how much they are affected.
 These tests check how well your spinal nerves are working. They also check the nerves
in your arms and legs.
 NCV

 A nerve conduction velocity (NCV) test — also called a nerve conduction

study (NCS) — measures how fast an electrical impulse moves through
your nerve.
 Conduction velocity is the rate of propagation of nerve impulse (action
potential) along a nerve fiber.
 Conduction velocity and latency in a peripheral nerve are the most
generally useful parameters associated with peripheral nerve function.
 Conduction velocity has potential clinical value.
 In a regenerating nerve fiber, conduction velocity is slowed following
nerve injury.
 NCV can identify nerve damage.
 NCV

 It is measured by stimulating a motor nerve at two

points a known distance apart along its course.
 During the test, your nerve is stimulated, usually with
electrode patches attached to your skin.
 Two electrodes are placed on the skin over your nerve.
 One electrode stimulates your nerve with a very mild
electrical impulse. The other electrode records it.
 The resulting electrical activity is recorded by another
electrode. This is repeated for each nerve being tested.
 The speed is then calculated by measuring the distance
between electrodes and the time it takes for electrical
impulses to travel between electrodes.
NCV
 Why NCV is done?

 Find damage to the peripheral nervous system.

 This includes all the nerves that lead away from the brain and spinal
cord.
 It also includes the smaller nerves that branch out from those nerves.
 This test is often used to help find nerve problems such as carpal
tunnel syndrome or Guillain-Barré syndrome.
ELECTROENCEPHALOGRAM
(EEG)
 EEG

 An electroencephalogram (EEG) is the study, observation and

recording of brain, which are measureable expression of electrical
activity of brain.

 Brain cells communicate with each other through electrical impulses.

 An EEG can be used to help detect potential problems associated

with this activity.
 EEG

 The test tracks and records brain wave patterns. Small, flat metal discs
called electrodes are attached to the scalp with wires.

 The electrodes analyze the electrical impulses in the brain and send
signals to a computer, where the results are recorded.

 The electrical impulses in an EEG recording look like wavy lines with peaks
and valleys.

 These lines allow doctors to quickly assess whether there are abnormal
patterns.

 Any irregularities may be a sign of seizures or other brain disorders.

 EEG

 Standard EEG:
 has 10 – 20 standardized placement system.
 Electrodes placed on anatomic location.
 8 – 20 wave lines are graphed.
EEG SIGNALS

 There are 3 basic parameters that are recorded in EEG waves:

1. Amplitude : measurement of electrical height. Ranges from 0 -200

μV.

2. Frequency : it is no of times per second the wave touches the zero

voltage line. It is the degree of activity of cerebral cortex.

3. Time : plotted on x axis

 EEG APPLICATION

 seizure disorders (such as epilepsy)

 a head injury
 encephalitis (an inflammation of the brain)
 a brain tumor
 encephalopathy (a disease that causes brain dysfunction)
 memory problems
 sleep disorders
 stroke
 dementia
 The test can also be used to monitor activity during brain surgery.
When someone is in a coma, an EEG may be performed to determine the
level of brain activity.
 RISK ASSOCIATED WITH EEG

 There are no risks associated with an EEG.

 The test is painless and safe.
 When someone has epilepsy or another seizure disorder, the stimuli
presented during the test (such as a flashing light) may cause a
seizure.
 However, the technician performing the EEG is trained to safely
manage the situation.
 What Can I Expect During an EEG?

 An EEG measures the electrical impulses in your brain by using

several electrodes that are attached to your scalp.
 An electrode is a conductor through which an electric current enters
or leaves.
 The electrodes transfer information from your brain to a machine
that measures and records the data.
 What Do the EEG Test Results Mean?

 A neurologist (someone who specializes in nervous system disorders)

interprets the recordings taken from the EEG and then sends the
results to your doctor.
 Your doctor may schedule an appointment to go over the test results
with you.
 NORMAL RESULTS

 Electrical activity in the brain is seen in an EEG as a pattern of waves.

 Different levels of consciousness, such as sleeping and waking, have a
specific range of frequencies of waves per second that are considered
normal.
 In normal, The wave patterns move faster when you’re awake than
when you’re asleep.
 The EEG will show if the frequency of waves or patterns are normal.
 Normal activity typically means you don’t have a brain disorder.
 ABNORMAL RESULTS

Abnormal EEG results may be due to:

 epilepsy or another seizure disorder
 abnormal bleeding or hemorrhage
 sleep disorder
 encephalitis (swelling of the brain)
 a tumor
 dead tissue due to a blockage of blood flow
 migraines
 alcohol or drug abuse
 head injury
 TYPES OF EEG WAVES
Activity Frequency (Hz) Behavior

Gamma () 30-100 Motor function, higher mental activity

Beta () 13-30 Low range: Relaxed yet focused,

integrated
Mid range: Thinking, aware of self and
surroundings, High range: Alertness,
agitation
Alpha () 8-13 Relaxed, but not drowsy, tranquil,
conscious
Theta () 4-8 Intuitive, creative, recall, fantasy,
imaginary dream
Delta () 0.5-4 Deep, dreamless Sleep, unconscious
How does it looks like?
What we can understand?
 Beta Activity

Frequency of over 13 Hz; if  30-35 Hz  gamma activity or exceedingly

fast activity by Gibbs.
Average voltage is 10-20 microvolts
Two main types in adults:
Often enhanced during drowsiness or when present over a skull defect
Should not be misinterpreted as a focus of abnormal fast activity.
 Alpha WAVE

The starting point of analyzing awake EEG

8-13 Hz activity occurring during wakefulness
20-60 mV, max over posterior head regions
Present when eyes closed; blocked by eye opening or alerting the patient
8 Hz is reached by 3 years of age and progressively increases in a stepwise
fashion until 9-12 Hz is reached by adolescence
Very stable in an individual, rarely varying by more than 0.5 Hz.
With drowsiness, alpha activity may decrease by 1-2 Hz
A difference of greater than 1 Hz between the two hemispheres is
significant.
10% of adult have little or no alpha
 Theta Activity

The term theta was coined by Gray Walter in 1944 when it was believed that
this rhythm was related to the function of the thalamus.
Occurs as a normal rhythm during drowsiness
In young children between age 4 months-8 years: predominance over the
fronto-central regions during drowsiness
In adolescents: sinusoidal theta activity can occur over the anterior head
regions during drowsiness.
In adults, theta components can occur diffusely or over the posterior head
regions during drowsiness.
Single transient theta waveforms or mixed alpha-theta waves can be
present over the temporal regions in older adults.
 EVOKED POTENTIAL

 The EEG machine records tiny electrical voltages from the brain,
representing the averaged electrical activity of millions of neurons.
- non specific.

 But evoked potentials are triggered. They are very specific.

 EVOKED POTENTIAL

 What are evoked potentials:

• The electrical potentials produced after stimulation of specific
neural tracts.
• The recorded plot of voltage versus time
Initial artifact representing the stimulation of the tract followed
by the neuronal response, which is recorded as a series of peaks and
valleys
 EVOKED POTENTIAL

 Many times signals are small so an amplifier can be used.

 reduces the electrical noise by subtracting the signal at a reference

electrode from the recording electrode.

 Filtering of this signal we focus on the evoked response of interest.

 EVOKED POTENTIAL

 The evoked response always occurs at a set time after stimulation.

 Summing all those responses increases the time-locked response,

whereas the background activity acts as a random signal and
averages out to zero.

 So we get only the evoked potential response.

CLASSIFICATION OF EVOKED POTENTIAL
Evoked potential

Sensory Motor Event Related

Evoked potential Evoked potential Potential

Visual Evoked Auditory Evoked Somatosensory

Potential Potential Evoked Potential
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