Brain Imaging in Psychiatry

Dr.
Aneel Kumar
EEG and Brain Imaging in Psychiatry

Electroencephalography
Electrode placement
usually according to the International 10-20 System which entails measurements
from:
the nasion
the inion
the right auricular depression
the left auricular depression
sphenoidal electrodes (between the mandibular coronoid notch and the zygoma)
can be used to obtain readings from the inferior temporal lobe
nasopharyngeal leads (in the superior part of the nasopharynx) can be used to get
readings from the inferior and medial temporal lobe
Wave characteristics
amplitudes range from 5-150 V
frequencies range from 1-40 Hz
spikes are transient high peaks that last less than 80 ms
sharp waves are sharply-defined waves that rise rapidly, fall more slowly, and last
more than 80 ms
Frequency ranges
1.
Delta (< 4 Hz):
a)
diffusely distributed across scalp in sleeping adults and in children
b)
abnormal in non-sleeping adults
2.
Theta (4-7 Hz):
a)
transient theta components found in 15 % of the normal population
3.
Alpha (8-13 Hz):
a)
prominent over occipital region
b)
accentuated by eye closure and attenuated by attention
c)
a consistent difference of 1 Hz or more between hemispheres is
pathological
d)
slowing is seen in early PHENYTOIN toxicity
4.
Beta (14 Hz and above):
a)
principally frontolateral
b)
may be enhanced by anxiety, alcohol, and drugs (barbiturates,
benzodiazepines)
5.
Mu (arch-like 7-11 Hz waves):
a)
over precentral areas
b)
occurs over the motor cortex and is related to motor activity
c)
attenuated by contralateral limb movements
6.
Lambda:
a)
single sharp waves in occipital region
1
b)
7.
usually associated with visual scanning and is related to ocular

movements during visual attention
c)
occurs when eyes are open
Vertex waves:
a)
electronegative sharp wave over vertex
b)
evoked by auditory stimulus
The Normal EEG

infants have slower and usually higher amplitude rhythms
asynchronous at first, and easily disturbed mature rhythms develop between 2 and
6 years
adults usually show either alpha posteriorly and beta anteriorly, but generalized lowamplitude beta may be present established by puberty
when subject is drowsy, alpha becomes intermittent and theta appears
in old age:
alpha frequency slows
delta activity is decreased
Changes in EEG patterns
Diffuse lesions
rhythmic slowing
occasionally periodic discharges
Focal lesions
polymorphic, arrhythmic, unreactive delta
periodic lateralized epileptiform discharges
Epilepsy
1.
initial interictal EEG is abnormal in 50-75 %
2.
with repeated recordings, 90-95 % will show abnormalities
3.
2 % of normal population have abnormalities considered to be epileptiform
4.
Absence seizures :
a)
3 Hz spike and wave
b)
4 Hz spike and wave in juvenile
5.
Primary generalized tonic-clonic seizures :
a)
interictal : bursts of spike and wave
b)
ictal :
i)
10 Hz fast activity during tonic phase
ii)
lower-frequency spike and wave complexes during clonic phase
c)
postictal : generalized slowing delta range
6.
Myoclonic epilepsy :
a)
polyspike and wave
7.
Partial (focal) epilepsy :
a)
interictal : focal spikes or sharp waves
b)
ictal : focal rhythmic discharge
2
Periodic complexes
Herpes simplex encephalitis
CJD (in late stages)
subacute sclerosing panencephalitis
Triphasic waves
liver, renal hypoxia, or metabolic encephalopathies
Frontal intermittent rhythmic delta activity (FIRDA)
metabolic encephalopathy
brain stem dysfunction
Alpha coma
widespread, non-reactive alpha-range activity
generalized encephalopathy
Burst-suppression
high-voltage bursts, followed by periods of extreme suppression
occurs within bihemispheric insult and deep anaesthesia
Drugs
CHLORPROMAZINE
increased delta
decreased beta
i.e. increases slow wave activity
PHENYTOIN
slowing of alpha
BENZODIAZEPINES
increased fast wave (beta) activity
ALCOHOL
increased beta (i.e. fast wave)
CARBAMAZEPINE
increased fast wave
antidepressants (both TCAs and SSRIs):
slowing of alpha
increased slow wave (delta) activity
Personality disorder
increased slow waves (theta) in 31-58 % of psychopaths
changes more right sided
positive spike seen in 40-45 % of aggressive and impulsive psychopaths
Anxiety
increased beta activity
Hypnosis
similar to the normal relaxed, waking state
3
Neuroimaging techniques
Exposure to radioactive substances
PET and SPECT
Exposure to ionizing radiation
CT
PET
SPECT
fMRI (not regular MRI)
Computerized Tomography
Schizophrenia
enlarged lateral ventricles
third ventricle enlargement
cortical atrophy (CA)
Affective disorders
similar to schizophrenia, but less marked
late onset depressives show more abnormalities than early-onset patients
more association with cognitive impairment and higher mortality
Dementia
ventricular enlargement (VE) is marked in AD
patchy atrophy and multiple lucencies in multi-infarct dementia
atrophy of caudate and fronto-temporal region in Huntingtons chorea
hypodensities in basal ganglia in Wilsons disease
severe bilateral atrophy of anterior frontal lobes in Picks disease
cortical and subcortical atrophy in Parkinsons disease
Alcoholism
VE and CA seen in chronic alcoholics
CA related to extent of cognitive impairment
Magnetic resonance imaging (MRI)

Principle
strong magnetic fields cause proton spin axes to align, and when rf waves are
administered, the protons jump to a higher quantum level and then return, emitting
wave frequencies which can be measured
4
Applications
MRI can be used to obtain information about:
high-resolution structural images
neuronal membrane phospholipid metabolism (using 31P MRS)
concentration of fluorine-containing drugs and metabolites (using 19F MRS)
lithium concentrations
regional blood flow (using fMRI)
Schizophrenia
agenesis of corpus callosum, cavum septum pellucidum
reduction in size of mesial temporal lobe and superior temporal gyrus (especially on
the left
smaller frontal lobes
larger basal ganglia structures
Affective disorders
white matter hyperintensity lesions in bipolar patients and particularly in elderly
depressives
some reports of reduction in size of caudate and putamen nuclei in depression
Alzheimers disease
selective loss of hippocampal tissue
Substance abuse
reduction in cortical grey matter and T1 changes correlate with cognitive impairment
in alcoholics
some reports of white matter hyperintensities in opiate addicts
Autism
hypoplasia of 4th ventricle and cerebellar vermis
Gilles de la Tourettes syndrome
asymmetry and/ or reduction in basal ganglia structures
Multiple sclerosis
especially useful for showing plaques and areas of demyelination
Functional MRI
uses exogenous contrast agents, or the endogenous contrast agent effect of
deoxyhaemoglobin in blood
can achieve high spatial and temporal resolution images of brain activity
Single photon emission (computerized) tomography (SPET; SPECT)

Principle
uses single photon (gamma ray) emitting isotopes, e.g. xenon 133, technetium 99
given IV or inhaled
the resolution is generally lower than PET
Applications
SPET can give information about:
regional cerebral blood flow (rCBF)
ligand binding
Clinical uses include:
Alzheimers disease
when the symptomatology (e.g. hallucinations, epilepsy) occurs at a time when
the patient is not near a scanner; a suitable ligand (e.g. 99m-technetium) can be
given at the material time and the patient scanned afterwards
Schizophrenia
reduced rCBF in frontal regions hypofrontality
Affective disorders
as that in schizophrenia, with reversal after antidepressant therapy
Alzheimers disease
decreased rCBF in posterior parietal and temporal regions
Xenon inhalation
shows failure of activation of frontal lobes in schizophrenics performing the
Wisconsin Card Sorting Test
Positron emission tomography (PET)

unstable isotopes (oxygen 15, fluorine 18, carbon 11), generated from a cyclotron,
emit gamma rays when penetrating tissue
the radioactive substance can be given IV or inhaled
Applications
PET can give information about:
metabolic changes
regional cerebral blood flow (rCBF)
ligand binding
Clinical uses include:
cerebrovascular disease
Alzheimers disease
epilepsy, prior to neurosurgery
head injury
6
Panic disorder
decreased activity in the right parahippocampus demonstrated
OCD
hypermetabolism in orbitofrontal cortex and caudate nucleus; normalizes with
treatment

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Dr.

EEG and Brain Imaging in Psychiatry

usually associated with visual scanning and is related to ocular

The Normal EEG

Magnetic resonance imaging (MRI)

Single photon emission (computerized) tomography (SPET; SPECT)

Positron emission tomography (PET)

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