Top Banner

Click here to load reader

of 27

Mu rhythm

Jan 19, 2017

Download

Health & Medicine

Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript

MU Rhythm

By: Mohibullah Fazli KakarTrainee of NeurophysiologyFrench Medical HospitalMU Rhythm

Mu rhythmPhysiologic EEG finding of no clinical significance. Central rhythm of an alpha frequency band (810 Hz) with an arciforme configuration, intermix or alternate with beta activity. Occurs in less than 5% of children younger than 4 years of age and in 1820% between the age of 8 and 16 years. Not blocked with eye opening, but blocked by touch, movement of limbs (especially contralateral limbs) or thought of movement. Usually asymmetric, asynchronous and independent in the two hemispheres.

Mu rhythmConsistent asymmetry of amplitude or frequency of mu suggests an abnormality on the side of lower amplitude or frequency. Believed to be the rhythm of the sensorimotor cortex at rest. Prominent in the patients with underneath skull defect (breach rhythm). Paradoxical mu rhythm induced by contralateral movement or touch after the mu rhythm has dropped out in drowsiness. Paradoxical AR may be induced at the same time.

Mu RhythmMu is a central rhythm of an alpha frequency band (810 Hz) with an aciform configuration. Mu rhythm occurs in less than 5% of children younger than 4 years and has the adult incidence of 1820% between the age of 8 and 16 years. It is not blocked with eye opening, but blocked by touch, movement of limbs (especially contralateral limbs), or thought of movement. Mu rhythm is usually asymmetric, asynchronous, and seen independently in the two hemispheres. It may present on only one side.

Mu Rhythm Mu rhythm is believed to be the rhythm of the sensorimotor cortex at rest. Mu rhythm is prominent in the patients with underneath skull defect (breach rhythm).Mu is a physiologic EEG finding of no clinical significance

Mu Rhythm

Mu Rhythm in Young ChildA 3-year-old girl who underwent epilepsy surgery in the right frontal-temporal region. EEG shows breach rhythm with higher amplitude of mu rhythm at the C4 electrode. In infants and young children whose alpha rhythm is still less than 6 Hz, mu rhythm can lack its characteristic waveform

Mu Rhythm in Young Child

Breach Rhythm; Prominent Mu Rhythm During Photic StimulationEEG of a 12-year-old boy with recurrent syncope shows prominent mu during photic stimulation.Mu rhythm is enhanced during photic stimulation and pattern vision

Breach Rhythm; Prominent Mu Rhythm During Photic Stimulation

Breach Rhythm; Prominent Mu RhythmA 9-year-old boy with a history of right occipital ganglioglioma resection. T1-weighted coronal and sagittal MRIs with GAD reveal skull defects and an area of previous surgical resection (arrow head). EEG during wakefulness with eye opening shows frequent runs of asymmetrical rhythmic 9 Hz arc-like activity in the central regions which is higher in amplitude on the right side

Breach Rhythm; Prominent Mu Rhythm

Breach Rhythm; Prominent Mu RhythmThe arc-like activity in the central regions is attenuated by left hand movement. This is consistent with mu rhythm which can become very prominent beneath a skull defect. Sometimes, mu rhythm can simulate ictal EEG activity especially in patients with skull defects; therefore, activation procedures such as limb movement are very important in their differentiation

Breach Rhythm; Prominent Mu Rhythm

Mu Rhythm activated by Intermittent Photic StimulationMu rhythm is enhanced during intermittent photic stimulation77 and pattern vision78. It is maximally expressed at C3 and C4 electrodes, and occasionally at Cz. Some spread to the parietal region is not uncommon. In older children and adults, the most common frequency is 10 Hz, slightly higher than alpha frequencies

Mu Rhythm activated by Intermittent Photic Stimulation

Mu Rhythm in Subdural EEG MonitoringSubdural recording during wakefulness showing a run of mu rhythm. Harmonic of the mu rhythm is morefrequently seen in intracranial EEG. In addition, the mu rhythm usually shows sharper morphology, as the scalp and skull act as a high-frequency filter passing lower frequencies more than higher frequencies. Disappearance during limb movement helps to differentiate the mu rhythm from a spike run.

Mu Rhythm in Subdural EEG Monitoring

Mu Rhythm in Depth EEG (Bipolar)Mu rhythm during bipolar run of the combined depth electrode-subdural EEG recording during wakefulness. The wave disappeared during sleep and was attenuated by limb movement (not shown).

Mu Rhythm in Depth EEG (Bipolar)

Mu Rhythm in Depth EEG Implantation During SeizureIntracranial EEG shows mu rhythm (in the box) during the seizure with the epileptogenic focus at DC3 (depth electrode contact #3) (arrow). Mu rhythm disappears during the burst of ictal EEG activity. Recognition of mu rhythm prevents misinterpretation of mu as an ictal EEG activity in the DD3 electrode which can cause false localization of epileptogenic onset

Mu Rhythm in Depth EEG Implantation During Seizure

Alpha and Mu RhythmEye opening (open arrow) attenuates the alpha rhythm but reveals a prominent mu rhythm (C3 and C4) at the same frequency (11 Hz).Note lateral eye movement (X) after the eye opening.Mu is an arc-like central rhythm with negative sharp component and positive slow component. The frequency is similar to alpha rhythm and it is intermixed with 20-Hz betaactivity. It is located at the C3, C4, and Cz electrodes. It is not blocked by eye opening but is attenuated by movement of extremities or thinking about moving with greater eff ecton opposite hand. The apiculate phase may resemble spikes.

Alpha and Mu RhythmArcade, comb, and wicket rhythms, owing to its morphology. have an arciform morphology. Occurs in waking over the central regions, especially the C3, Cz, and C4 contacts (Fig. 2). It is closely associated with the sensorimotor cortex, hence the term mu, for motor. Mu exhibits a frequency in the.. Niedermeyer observed this rhythm in approx 14% of adolescents EEG tracings, and less often in younger children and the elderly. Reactivityattenuates with . With direct cortical recording methods (skull breach), a 20-Hz beta activity may be observed from the sensorimotor cortex, with similar reactivity. Thus, the scalp-recorded mu is likely a subharmonic of this underlying rhythm.Mu is usually observed bilaterally with shifting predominance; it may, however, be asymmetrical and asynchronous explain some instances of highly lateralized mu rhythms. Exclusively lateralized mu should raise a suspicion of an abnormality in the hemisphere mu activity.Sometimes, focal mu activity in the setting of a bony defect of the skull may be so sharp and of higher voltage as to falsely mimic an epileptogenic focus.

Alpha and Mu Rhythm

Alpha and Mu Rhythm

Reference: Atlas of Pediatric EEG