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EEG Sleep - 2
EEG Sleep - 2
EEG: definition
It is record of variations in brain potential It is record of electrical activity of brain/neurons in different phases e.g. during sleep, wakefulness and epilepsy.
E.E.G
Carried out by placing electrodes on surface of scalp. Sometimes placed directly on surface of cerebral cortex, e.g., during neurosurgical operations or in experimental animals. Such a record is called ElectroCorticogram (ECOG)
E.E.G
E.E.G was 1st recorded by a German Psychiatrist Hans Berger. There are 2 methods for EEG recording Recording of EEG can be unipolar or bipolar. In unipolar EEG, active electrode is placed on surface of scalp, while inactive or indifferent is placed at a distant point, like tip of 7th cervical vertebra. In bipolar EEG, both electrodes are active & placed on surface of scalp.
E.E.G
In routine E.E.G, 20 electrodes are placed on scalp at different points to record EEG. In normal EEG, 4 types of waves can be seen: alpha, beta, theta & delta, in different phases. Character of each wave is described as 1- its intensity/voltage 2- frequency
Theta waves:
Frequency: 4-7 / sec Voltage: 10 microvolts Best recorded from parietal & temporal regions. Recorded during light sleep. Recorded in adults during states of frustration & disappointment. In children normally recorded in awake E.E.G. Also recorded in brain disorders like Grand Mal Epilepsy. In degenerative brain disorders.
Delta Waves:
Very slow waves. Frequency: 0.5 - 3 / sec Voltage: 100 microvolts Recorded in deep & restful sleep. Also recorded in coma, general anesthesia & in epilepsy. In organic brain disorders.
Some terminals are excitatory (EPSP is produced), some are inhibitory (IPSP is produced). Electrical activity recorded in EEG, is summation of EPSPs & IPSPs
It helps in diagnosis of epilepsy & its types. It helps in diagnosis of psychopathic disorders.
In Petit Mal epilepsy, there is spike & dome pattern. In Psychomotor epilepsy, mainly delta waves are seen.
Epilepsy
Epilepsy (also called seizures) is characterized by uncontrolled excessive activity of either part or all of CNS. Attack occurs when basal level of excitability of neurons crosses threshold. Epilepsy can be classified into three major types: grand mal epilepsy, petit mal epilepsy, and focal epilepsy.
Grand mal epilepsy is characterized by extreme neuronal discharges in all areas of the brain cerebral cortex, cerebrum, and brain stem. Discharges transmitted into the spinal cord sometimes cause generalized tonic seizures of the entire body, followed by alternating tonic and spasmodic muscle contractions called tonic-clonic seizures
person bites his tongue difficulty in breathing, sometimes cyanosis, urination and defecation can occurs . grand mal seizure lasts from a few sec to 3 to 4 min. It is also characterized by post seizure depression of the entire nervous system;
Focal Epilepsy
Two types 1- Jacksonian epilepsy 2- Psychomotor epilepsy Causes 1- scar tissue in brain, 2- Tumor, 3- some destroyed part of brain tissue In Jacks, wave of excitation spreads over motor cortex, it causes progressive march
Of muscle contrations throughout the opposite side of body. Beginning in mouth region and marching progressively downwards to legs.
Psychomotor epilepsy
It is characterized by emotional outburst such as abnormal rage,anxiety,fear or discomfort. There is amnesia or confused mental state for some period. The cause, are the abnormalities in temporal lobe & tumor in hypothalamus and limbic system.
SLEEP
Period of inactivity during which there is unconsciousness from which person can be aroused by sensory & other stimuli. Unconsciousness during surgical anesthesia, epilepsy & coma should not be considered as sleep.
Lack of SLEEP
Sleep is essential for normal life. It restores a balance between different parts of nervous system. If a person is not allowed to sleep for 2-3 days, certain effects are seen: Loss of concentration Slow thought making Loss of memory irritability
Lack of SLEEP
If insomnia is further prolonged, person may develop: Dysarthria (defect of speech) Tremors Abnormal gait
Requirement of SLEEP
Varies with age: Infants: 20-24 hrs Young children: 12 hrs Young adults: 7-9 hrs Old age: 5-7 hrs
Types of SLEEP
SLOW WAVE / NonREM sleep / Delta wave sleep REM sleep / paradoxical sleep
Types of SLEEP
SLOW WAVE / Non-REM sleep / Delta wave sleep 75% sleep Dreaming without memory Increased parasympathetic stimulation Decreased muscle tone Bed-wetting in children Increased muscle tone, muscle twitching & convulsions. REM sleep / paradoxical sleep
Types of SLEEP
SLOW WAVE / Non-REM REM sleep / paradoxical sleep sleep / Delta wave sleep Decreased heart rate Decreased respiratory rate Pupil constriction Easy to arouse from sleep Brain is not active Irregular heart rate Irregular respiratory rate No constriction of pupil Difficult to arouse from sleep, but gets up spontaneously in the morning Brain is active
Types of SLEEP
SLOW WAVE / Non- REM sleep / REM sleep / Delta paradoxical sleep wave sleep
Mechanism of sleep
There is a cycle of wakefulness & sleep. When a person is awake, gradually neurons in reticular activating system become less & less active & there is also activation of certain sleep centers. This results into sleep.
Mechanism of sleep
During hours of sleep, neurons in reticular activating system become progressively more & more active, leading to wakefulness.
Sleep centers:
1) LOCUS CERULEUS: Location: At junction of midbrain & pons. Neurons in this locus secrete nor epinephrine at nerve endings of nerve fibers. Nerve fibers from these neurons pass to reticular formation.
Sleep centers:
This center (Locus Ceruleus) is involved in REM sleep, when brain is highly active. So perhaps nor-epinephrine secreting neurons are involved (sympathetic stimulation in REM sleep)
Ach secreting neurons in reticular formation of upper brain-stem are also involved.
Sleep centers:
2) RAPHE MAGNUS NUCLEUS: Midline linear nuclei in upper pons & lower medulla. Fibers from here pass to reticular formation, hypothalamus, limbic system & also spinal cord. These fibers synapse with pain-inhibitory neurons in dorsal horn of spinal cord (analgesia system).
Sleep centers:
There is release of serotonin at nerve endings of these fibers. Raphe Magnus Nucleus is involved in Deep Slow Wave sleep (NREM sleep). Serotonin inhibitors wakefulness.
Stimulation of SCN of Anterior hypothalamus, certain thalamic nuclei & portion of nucleus of tractus solitarius NREM sleep.
When muramyl dipeptide is injected to some other animal, it immediately passes into sleep.
DISORDERS OF SLEEP:
1) Somnambulism / sleep walking 2) Bedwetting in children 3) Bruxism 4) Insomnia 5) Narcolepsy 6) Sleep apnea
2) Bedwetting in children
Also called Nocturnal enuresis. May be due to parasympathetic dominance, as it occurs in slow wave sleep.
3) Bruxism
Teeth grinding Occurs during active sleep (REM sleep)
4) Insomnia
Inability to sleep, although sufficient facilities & time is available for sleep. Reason: Psychological or medical.
5) Narcolepsy:
There are attacks of intense desire to sleep during day time Person cannot resist to sleep in the day Attack may last for seconds to minutes
Cause of Narcolepsy:
Etiology: Considered to be hypothalamic disorder
Evidence: Other features of hypothalamic disorders are present, e.g., obesity, polyuria, sexual retardation.
6) Sleep apnea
During sleep, breathing stops suddenly. May be repeated 100s of times in severe cases. When breathing stops, person wakes up, takes a few breaths & then tries to go to sleep.
6) Sleep apnea
In the morning, person is fatigued & drowsy. There may be features of respiratory failure without respiratory disease.
6) Sleep apnea
ETIOLOGY: Exact cause ??