Fp3 and Fp4 replace the usual Fp1 and Fp2 electrode locations. A single montage includes anteroposterior, transverse, and midline arrays. Notice the relatively simple convolutional markings of the frontal lobes in comparison with the occipital cortices.įigure 6.1b: Modification of the international 10–20 system commonly used in neonates. At the same time, most EEGers in North America will change the display to 30 mm per second, again resembling adult tracings.įigure 6.1a: Intrauterine MRI of fetus 30 weeks of estimated gestational age.
Beyond 6 weeks of age or a head circumference of 40 cm, many laboratories will use the same complement of electrodes found in adult tracings. Fp3 and Fp4 electrodes are used because electrographic background activity and frontal physiological sharp waves are better visualized there than at the usual frontopolar locations (Fp1 and Fp2) ( 2). If the earlobes are too small, mastoid leads (M1 and M2) may be substituted. The standard neonatal montage includes electrodes Fp3 (halfway between Fp1 and F3), Fp4 (halfway between Fp2 and F4), C3, C4, T3, T4, 01, 02, Fz, Cz, Pz, A1, and A2 ( 1). The international 10–20 system of electrode placement is modified for neonatal EEG recording because of neonates’ small head size and the relative lack of EEG activity in the extreme frontopolar regions ( Fig. The discussion will begin with the most premature babies and will continue through to adolescence.īefore the visual analysis (VA) is discussed, there are a few technical matters that must be addressed. Finally, abnormalities are noted and described. To make the discussion as practical as possible, the pediatric EEG will be described in the same order in which it is typically analyzed, noting first the continuity and then, in turn, the organization of the principal components, the interhemispheric symmetry and synchrony of these components, and the presence of various special features that often serve as signposts of maturation. Accordingly, this chapter will not recapitulate elements from the prior chapter, but instead will focus on the development of pediatric EEG from the premature to adolescence. Children are not small adults, and at first glance their EEGs could not appear more distinct, but the same techniques used to systematically analyze the adult EEG can be applied to children once one appreciates the organizational themes of pediatric EEG. Pediatric EEG interpretation builds on these essential skills but requires one additional element: a thorough knowledge of EEG ontogeny, or the orderly maturational changes in pediatric EEG. The previous chapter covered the normal adult EEG and introduced the major necessary concepts to analyze EEG.
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