Upload
afrianto-akhmad
View
281
Download
0
Embed Size (px)
Citation preview
7/27/2019 Eeg Migraine
1/20
EEG-BM &
Headache
Sub-bag Neurofisiologi/Poli Elektromedik
FK- UGM/RS Sardjito
7/27/2019 Eeg Migraine
2/20
THE ELECTROENCEPHALOGRAM IN THE EVALUATION OF HEADACHE
The American Academy of Neurology 1994
Headache disorders are clinicalsyndromes defined by historical criteria.
The EEG is not included in the diagnostic
criteria of the International HeadacheSociety for migraine or other majorheadache categories.
The majority of headache sufferers do nothave an identifiable structural lesion thatexplains their pain.
7/27/2019 Eeg Migraine
3/20
therefore
An EEG could be considered useful in theevaluation of headache if abnormalitieswere observed that :
(1) separate persons with and withoutheadache, potentially shedding light on theunderlying pathophysiology of headaches;
(2) define subgroups associated with differentnatural histories or responses to therapy; or
(3) effectively identify patients with a definablestructural etiology.
7/27/2019 Eeg Migraine
4/20
THE EVIDENCES
7/27/2019 Eeg Migraine
5/20
Electroencephalographic mapping in migraine during the critical and
intercritical periods
Rev Electroencephalogr Neurophysiol Clin. 1987 Sep;17(3):289-99.
Twenty-nine migraineurs underwent spectralanalysis and topographic EEG mapping.
Migraine with a complex aura, posterior-anteriorspreading of slow activities and depression of alphaactivity contralateralto the neurological signs were the
prominent findings. Migraine with a visual aurahad unilateral reduction of
alpha and theta activity.
Common migrainethe only abnormality was markedly
reduced alpha activity over one occipital region andreduction of theta activityin the same location.
Note: In all patients, except one, restudied at least 7 days after an attack, EEGasymmetries had disappeared
7/27/2019 Eeg Migraine
6/20
Cont.
Unilateral EEG changes can thus be detectedduring attacks of both classic and commonmigraine. The posterior-anterior spreading ofslow activities during an induced attack ofclassic migraine has temporal and spatialsimilarities with the "spreading oligemia.
This suggests that common, as classic, migraineis associated with unilateral disturbances ofcortical electrogenesis, which might reflect anunderlying metabolic abnormality.
7/27/2019 Eeg Migraine
7/20
Brain mapping in migraine.
Hughes JR, Robbins LD.
Clin Electroencephalogr. 1990 Jan;21(1):14-24.
The topographic maps of 100 various types of
headache >< 38 normal :
Patients with classic migraine showed 11 markers,
but especially three of high amplitude theta on
0(1) and alpha on 0(1) and T6,
Patients with other types of headaches in general
did not show useful markers.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term=%22Hughes+JR%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term=%22Robbins+LD%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term=%22Robbins+LD%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term=%22Hughes+JR%22%5BAuthor%5D7/27/2019 Eeg Migraine
8/20
Results demonstrate that there are nosignificantdifferences between the controlgroup and the tension-type headache group.
Neither were differences found in migrainewithout aura group but in migraine with aurathere was an increase of the theta/alpharatioin the temporal posterior and occipital zones.
This ratio could be used as a neurophysiologicalindicator in the evolution of the migraine withaura pathology.
EEG in migraine: a review of the literature.
Sand T.Funct Neurol. 1991 Jan-Mar;6(1):7-22.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term=%22Sand+T%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term=%22Sand+T%22%5BAuthor%5D7/27/2019 Eeg Migraine
9/20
Alpha rhythm power and the effect of photic stimulation in
migraine with brain mapping.
Tsounis S, Varfis G. Clin Electroencephalogr. 1992 Jan;23(1):1-6.
The topographic maps of 50 patients sufferingfrom migraine with or without aura werecompared to the brain maps of 20 normalcontrols and 20 patients with tension-type
headaches. Only the migraine group showed a significant
decrement of alpha rhythm power, during restwith eyes closed, at the posterior areas of thebrain, and a significant increment of alphapowerat the same regions during IPS at 20c/sec.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term=%22Tsounis+S%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term=%22Varfis+G%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term=%22Varfis+G%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term=%22Tsounis+S%22%5BAuthor%5D7/27/2019 Eeg Migraine
10/20
In migraine between attacks EMG studiesare normal.
Temporalis exteroceptive silent period
is useful in the differential diagnosis ofheadaches and sheds some light on thepathophysiology of tension-typeheadache.
Clinical neurophysiology studies in headache: a review of data
and pathophysiological hints.
Schoenen J.
Funct Neurol. 1992 May-Jun;7(3):191-204.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term=%22Schoenen+J%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term=%22Schoenen+J%22%5BAuthor%5D7/27/2019 Eeg Migraine
11/20
Prominent photic driving at high flash
frequencies (H-response) in migraine
patients is the most consistently reported
difference between headache patients andcontrols.
THE ELECTROENCEPHALOGRAM IN THE EVALUATION OF
HEADACHE
The American Academy of Neurology 1994
7/27/2019 Eeg Migraine
12/20
Quantitative EEG in children with headache.
Valdizan JR, Andreu C, Almarcegui C, Olivito A.
Headache. 1994 Jan;34(1):53-5.
Results demonstrate that there are no significantdifferences between the control group and thetension-type headache group.
Neither were differences found in migrainewithout aura group but in migraine with aurathere was an increase of the theta/alpha ratio inthe temporal posterior and occipital zones.
This ratio could be used as a neurophysiologicalindicator in the evolution of the migraine withaura pathology.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term=%22Valdizan+JR%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term=%22Andreu+C%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term=%22Almarcegui+C%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term=%22Olivito+A%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term=%22Olivito+A%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term=%22Almarcegui+C%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term=%22Andreu+C%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term=%22Valdizan+JR%22%5BAuthor%5D7/27/2019 Eeg Migraine
13/20
Neurophysiological tests and neuroimaging procedures in non-acute
headache: guidelines and recommendations
European Journal of Neurology 2004, 11: 217224
Interictal electroencephalography (EEG) is not
routinely indicated in the diagnostic evaluation of
headache patients.
Interictal EEG is, however, indicated if theclinical history suggests a possible diagnosis of
epilepsy (differential diagnosis).
Ictal EEG could be useful in certain patients
suffering from hemiplegic and basilar migraine.
7/27/2019 Eeg Migraine
14/20
Cerebral mapping in subjects suffering from migraine with aura
Dante et al. Cephalalgia Volume 10 Issue 6 Page 279 - December 1990
Cerebralmapping of the spontaneous electroencephalographic activitywas performed in 31 subjects suffering from migraine with aura and the
results were compared with those of a matched control group.
All the patients were examined during the interictal period.
Traditional visual interpretation of EEG records was negative in all
exept five cases (16.1%) Spectral analysis showed an asymmetry in alpha total power over the
posterior regions in 13 cases (41.9%) and an asymmetry in alpha band
peak frequency in 17 (54.8%).
By means of cerebral mapping and statistical significance probability
demonstrate a significant increase in alpha total power in 13 cases
(41.9%) and a regional increase in delta and theta total power in 20
cases (64.5%).
In comparison with the control group, the migraine patients showed a
widespread increase in slow activity (theta and delta) mostly over the
temporal regions.
7/27/2019 Eeg Migraine
15/20
Review
In a few controlled and blinded studies, however, slight excess of various EEGrhythms has been found in migraine patients.
Similar prevalences of interictal EEG abnormalities have generally been found inpatients with classic and common migraine, but the diagnostic classification may nothave been precise enough in some studies.
During visual aura, either slow waves, depression of background activityamplitudeor normal EEGhave been reported.
The most definitely abnormal EEGs with unilateral or bilateral delta activityhavebeen recorded during attacks of hemiplegic migraine, and during attacks of migrainewith disturbed consciousness.
The relationship between migraine and epilepsyhas still not been adequatelyclarified. The connection seems to exist in several small entities (e.g. migraine-likeheadache as an epileptic manifestation, epileptic seizures triggered by epilepticattacks, and possibly in epilepsies with occipital spike waves), but it is seemingly not"fundamental".
Newer methods, i.e. EEG frequency analysis and topographic brain mapping, arepromising tools in this field. So far, mostly small studies have been published withsomewhat inconsistent results. A pattern of increased alpha rhythm variability(and/or asymmetry) in the headache-free phase seems to emerge, however.
7/27/2019 Eeg Migraine
16/20
Evidence Migraine TTH
1987 Posterior-anterior spreading of slow activities
Depression of alpha activity contralateral
Reduction of alpha and theta activity.
-
1990 High amplitude theta on 0(1) and alpha on
0(1) and T6Increase in alpha total power
Regional increase in delta and theta total
power
Widespread increase in slow activity (theta
and delta) mostly over the temporal regions.
No marker
1991 Increase of the theta/alpha ratio in the
temporal posterior and occipital zones.
No marker
1992 Decrement of alpha rhythm power, during rest
Increment of alpha power at during IPS
No marker
1992 EMG studies are normal. Temporalis exteroceptive silent period
1994 Prominent photic driving at high flash
frequencies (H-response)
No abnormality
1994 children Theta/alpha ratio in the temporal posterior and
occipital zones
No abnormality
Review Slight excess of various EEG rhythms
slow waves.
Depression of background activity amplitude
Unilateral or bilateral delta activity
Normal EEG
Increased alpha rhythm variability (and/or
asymmetry) in the headache-free phase
7/27/2019 Eeg Migraine
17/20
THE
RECOMMENDATIONS
7/27/2019 Eeg Migraine
18/20
The EEG is not usefulin the routineevaluation
of patients with headache.
This does not exclude the use of EEG toevaluate headache patients with associated
symptoms suggesting a seizure disorder,
such as atypical migrainous aura or episodic
loss of consciousness.
Assuming head-imaging capabilities are readily
available, EEG is not recommendedto exclude
a structural cause for headache (option).
7/27/2019 Eeg Migraine
19/20
CONCLUSION
7/27/2019 Eeg Migraine
20/20
Current QEEG methods are not routinely
indicatedin the diagnostic evaluation of
headache patients.
Quantitative frequency analysis of EEG
must always be recorded with raw EEG
dataand interpreted by a skilled physicianin order to avoid misinterpretationof
technical artifacts, normal state
fluctuations and various physiologicalrhythms.