<p style="text-align: center; "><img src="@@PLUGINFILE@@/Developmental%20EEG.png" alt="Developmental EEG" width="1187" height="1000" class="img-responsive atto_image_button_middle"><br></p><p><br></p><h2><a name="_Toc29328798">Pre-natal</a></h2>

<p>At the point of conception, the strategy of the
nervous system is coded in the genes, and the brain follows a pre-defined
blueprint. The initial connectome of the brain, which comes into being very
early in development, is largely a product of genes and randomness.</p>

<p>At 4 weeks, the first brain cells, the neurons,
are establishing at 500,000 per minute. These cells will never turn over,
unlike the skin. Neurons born in fetal life function all the way into old age.
Within the first 13 weeks of life the reptilian structures of the brain are
fully formed (the brainstem, spinal cord, cerebellum, and pons). The first
stage of wiring is when fundamental networks form via an odyssey of the
neurons, which grab onto glia, to form long fibrous white mater tracks that
build the resting state networks in the brain. These are the gross networks of
the brain. <a name="_Hlk28771800">Low frequency oscillations (i.e., delta and
theta) help to coordinate long-range communications that run on these networks,
between lobes of the brain (von Stein, Chiang, &amp; Konig, 2000). </a>Similar to a musical
instrument, the longer the string, the lower the pitch (Kung, 2013). These long connections are
architecturally fundamental for the brain’s development. </p><h4><br></h4><h4>Fetal Development</h4><p style="text-align: center;"><img src="@@PLUGINFILE@@/Fetal%20Development.png" alt="Fetal Development" width="673" height="707" class="img-responsive atto_image_button_text-bottom" style="font-size: 1rem;"></p><p></p><p></p><p>By 24 weeks, the
vital organs of the fetus are well-formed, the lungs are prepared to fill with
air and the brain has billions of neurons, building 2 million connections every
second, until the brain has become a network of trillions of criss-crossing
wires with more connections than stars in the sky.In this second phase of
development, connections that will remain as integral are made, as are less
important connections. When a connection is built and strengthened, it is
reinforced and made to stay, while the less important connections atrophy and
are lost—this is called pruning. Disruption here, within the earliest steps of
development, during the creation and migration of neurons, is expected to cause
abnormalities that are easy to see, such as microcephaly and lissencephaly, if
the fetus survives.</p><h4><br></h4><h4>Lissencaphaly, where the brain does not form gyri and sulci, but
is smooth, occurs between 12 – 24 weeks of life.</h4><p><br></p><p style="text-align: center;"><span style="font-size: 1rem;">&nbsp; &nbsp; &nbsp;&nbsp;</span><span style="font-size: 1rem;">&nbsp;</span></p><p style="text-align: center;"><span style="font-size: 1rem;">&nbsp; &nbsp;</span><img src="@@PLUGINFILE@@/lissencephaly.png" alt="lissencephaly" width="461" height="307" class="img-responsive atto_image_button_middle" style="font-size: 1rem; text-align: center;"></p><p style="text-align: center;"><span style="font-size: 1rem;">&nbsp;&nbsp;</span></p><p></p><p></p><h4 style="text-align: center; "><br></h4><h4 style="text-align: center; "><br></h4><h4 style="text-align: left;">Microcephaly versus a Normal Sized Infant Skull</h4><p style="text-align: center;"><img src="@@PLUGINFILE@@/microcephaly.png" alt="microcephaly" width="819" height="472" class="img-responsive atto_image_button_text-bottom" style="font-size: 1rem;"></p><p></p><p></p><h3 style="text-align: left;"><a name="_Toc29328799">Premature Babies</a></h3>

<p style="text-align: left;">&nbsp;</p>

<p style="text-align: left;">When babies are born before they
are fully developed they lack calcification level in the skull and, for that
reason, their EEG appears of a larger amplitude than a new born baby.</p>

<p style="text-align: left;">While a burst suppression pattern
suggests a person is about to die, a premature baby will show a burst
suppression pattern, which is a normal pattern for a brain that is not ready to
be out of the womb. This pattern consists of long periods of generalized
attenuated or “flat” activity interrupted by high amplitude
bursts of mixed frequencies and waveforms. The periods of quiescence between
bursts can be as short as 6 seconds or as long as 25 to 30 seconds.</p><p style="text-align: center; "><br></p><p></p><h3 style="text-align: left;"><a name="_Toc29328800">Birth</a></h3>

<p style="text-align: left;">By the time a baby is born, the creation of
neurons is virtually complete. Neurons continue to grow dendritic branches well
after birth. At birth, a baby’s brain is less than 1 pound of gelatinous
tissue. This is the foundation of the unconscious processes. During this time,
as well, delta is prominent because the white matter is not yet myelinated.
Consequentially, infants spend a
great deal of time in&nbsp;<a href="https://en.wikipedia.org/wiki/Slow-wave_sleep" title="Slow-wave sleep">slow-wave
sleep</a>, and thus have delta
wave activity as their predominant wave form. Analysis of the&nbsp;<a href="https://en.wikipedia.org/wiki/Wakefulness" title="Wakefulness">waking</a>&nbsp;EEG of a&nbsp;<a href="https://en.wikipedia.org/wiki/Newborn" title="Newborn">newborn</a>&nbsp;infant indicates that delta
wave activity is predominant in that age, and still appears in a waking EEG of
five-year-olds.<a href="https://en.wikipedia.org/wiki/Delta_wave#cite_note-isbn0-632-05361-5-14"><sup>[14]</sup></a><sup></sup></p><p style="text-align: left;"><span style="font-size: 1rem;">The neonatal weeks are crucial for the
neurophysiological effects of nursing on the somato-sensory projection areas of
the mouth and the relevant associative cortical areas. Chugani et al. (1987)
have shown in PET recordings that during the first weeks of life there is an
increase in blood flow in those brain structures (brain stem, cerebellum,
striatum and the sensory areas of the cortex) that participate in nursing
responses. At six months, the </span><i style="font-size: 1rem;">theta </i><span style="font-size: 1rem;">rhythm prevailed in&nbsp;</span></p><p style="text-align: left;">both hemispheres, but had a
right hemisphere posterior maximum. Paul et al. (1996) have shown in infants
from the age of 2 to 26 weeks that feeding is connected with an amplitude
increase and a growing degree of synchronization in the EEG, with an exception
of the age of 10 weeks, when no significant EEG changes were recorded. This
newly acquired neurophysiological organization between subcortical and cortical
structures can give rise to a synchronized activity in wide brain areas (Scher,
1989). The special kind of <i>θ</i>-activity
whose activation we were able to recognize during feeding in 6 month-old
infants has been termed hedonic <i>θ</i>-activity
by Maulsby (1971).</p>

<h3 style="text-align: left;"><a name="_Toc29328801">Vision</a></h3>

<p style="text-align: left;">New synapses are
created at a staggering rate in the infant brain. IN BA 17 alone, over ½
million per second are developed between 2 and 4 months of age. In fetu development
also destroys connections (107). Initially the baby sees as though they were
looking at a faded photograph through a tube. This prevents excess stimuli. </p><h3 style="text-align: left;"><a name="_Toc29328802">Breastfeeding</a></h3>

<p style="text-align: left;">Because the primary
source of activity of the EEG is in the cortical neural processes, the change
in the EEG pattern in newborn infants during the feeding processes may be
indicative of a shaping of a primitive protomental image, i.e. a sensory memory
formation at the cortical level, that starts after birth and runs in parallel
to the deep automatic brain functions regulating the reflexive and autonomous
neural events of the nursing exchanges. This may be important, since the
participation of the cortex in the effects of newborn feeding has not been
recognized before and its plausible implications for the bodily self experience
(the nascent body ego) is so far unknown, in contrast to the relatively
well-known role of the brain stem and the diencephalic structures that regulate
the sucking reflex, the homeostasis of vital biological func- tions and the
basic affective processes (Damasio, 1996, 2000; Lehtonen, 2006; Watt, 2003).</p>

<p style="text-align: left;">In another study
penetrating the same developmental phenomena, Paul et al. (1996) have shown in
infants from the age of 2 to 26 weeks that feeding is connected with an
amplitude increase and a growing degree of synchronization in the EEG, with an
exception of the age of 10 weeks, when no significant EEG changes were
recorded. These observations are quite in line with our findings. Chugani et
al. (1987) have shown in PET recordings that during the first weeks of life
there is an increase in blood flow in those brain structures (brain stem,
cerebellum, striatum and the sensory areas of the cortex) that participate in
nursing responses. These references, though short and selected, illu- minate
the wide scope of physiological phenomena that are connected with nursing and
the multiple changes in the psychophysiological state of the offspring that
occur in infant care.</p><h3 style="text-align: left;"><a name="_Toc29328803">Auditory Perception</a></h3>

<p style="text-align: left;">Long
before the infant can comprehend language or speak a single word, it has a
repertoire of signals to communicate its internal states. Experimental studies suggest the infant is
endowed immediately after birth with a readiness to differentiate the mother’s
voice from a non-mother voice (Fifer and Moon, 1994). During
this fundamental period, the child’s innate neoverbal abilities are hugely
influenced by social and emotional factors. Developments occur due to dialogic
“face engagements where the emotionally-attuned mother shares in and
articulates the child’s emotional state.&nbsp;
In these experiences, the infant reads the
mother’s face for positive emotions, appraisals of relevant and interesting
interactions and events. &nbsp;</p>

<p style="text-align: left;">By Approximately one year of
age comes the emergence of single word speech. At this stage, the infant
increasingly attends to both the visual and auditory stimulation of his
caretakers’ faces. The visual information received from faces is utilized in
speech perception (Green &amp; Kuhl, 1989).</p><h3 style="text-align: left;"><a name="_Toc29328804">Hypnagogic Hypersynchrony</a></h3>

<p style="text-align: left;">Hypnagogic Hypersynchrony
(HH) is the pattern seen in infants and children during the transition from
drowsiness to sleep. It consists of high amplitude, paroxysmal, bilateral,
rhythmic bursts of 3 to 5 Hz waves. Unlike, POSTS, which live in the occipital
leads, HH is a diffuse pattern, tending towards anterior dominance. It may
emerge as early as 4 months but is seen in the majority of infants between 6 to
8 months old. HH may be continuous from ages 8 to 12 months but as the child
ages a more paroxysmal type of HH is seen. The pattern begins to dissolve by
age 2 years and is usually gone by age 12 years. Since this is only a
transition pattern, it will disappear once N2 sleep is reached. At three
months, the distinctive pattern of hypnagogic hypersynchrony emerges replacing
the high amplitude 2 to 3 Hz rhythm seen during drowsiness. This high amplitude
bisynchronous rhythmic 3 to 6 Hz activity can be paroxysmal or continuous for
several minutes either at the beginning or end of the sleep cycle.</p><p style="text-align: left;"><span style="color: rgb(55, 71, 79); font-family: &quot;Open Sans&quot;; font-size: 1.286rem;">Hypnogogic Hypersynchrony</span></p><img src="@@PLUGINFILE@@/Hypnogogic%20hypersynchrony.png" alt="Hypnogogic hypersynchrony" width="603" height="386" class="img-responsive atto_image_button_left" style="text-align: center; "><p style="text-align: center;"><br></p><p></p>

<p style="text-align: center; ">After 3
months of age, all NREM and REM sleep stages show maturation as well as
development of new patterns. REM now only occupies 25% of the total sleep time.
During NREM sleep, patterns reach mature formations. Sleep spindles are fully
developed, synchronous, and symmetrical by 2 years. The amplitude and incidence
of V-waves and K-complexes decrease at 3 to 4 years until the adult waveform is
attained.</p><p style="text-align: center;"><br></p><p></p><p style="text-align: center; "><br></p><p style="text-align: center; "><br></p><p></p><p style="text-align: center; ">&nbsp;</p><p style="text-align: center; "><br></p>

<h2 style="text-align: left;"><a name="_Toc29328805">Pediatric EEG (Age 1 to Adolescence)</a></h2>

<p style="text-align: left;">A child has
hundreds of trillions of connections in the brain, twice as many as the adult.
Experience determines which of these connections to take away and which of them
to leave. This pruning process is what learning is, on a neurodevelopmental
level. As the child grows into a adult, the brain becomes more and more complex.</p>

<p style="text-align: left;">As the baby grows into an adult,
their processing rate also speeds up, from 4Hz at 4 months of age, 6Hz at 12
months of age, and finally 8Hz by 3 years of age. B the time the child reaches
10 (some say even 15) years of age, their alpha peak frequency (also called
posterior dominant rhythm) has sped up to 10Hz, roughly, where it will stay
until they reach their later 50s.</p><h3 style="text-align: left;"><a name="_Toc29328806">Language and Auditory
Perception</a></h3>

<p style="text-align: left;">While 13-month-old
babies listen and understand with both cerebral hemispheres, but by 20 months
the language center of the brain has begun to shift to the left hemisphere,
where the majority of adult process primary auditory information (Wernicke’s
and Broca’s areas). The brain will begin to specialize in languages that it
knows best, and this language will trigger the left hemisphere. Foreign
languages will still access the right hemisphere (one of the reasons
introducing multiple languages to your child is beneficial to their
neurological development).</p>

<h2 style="text-align: left;"><a name="_Toc29328807"></a><a name="_Toc16242767">Posterior Slow Waves of Youth</a> (PSWY)</h2><p></p><h4 style="text-align: center; "><br></h4><h4 style="text-align: center; ">Posterior Slow Waves of Youth in a 2 <sup>1/2</sup> year old
male</h4><img src="@@PLUGINFILE@@/Posterior%20Slow%20Waves%20of%20Youth.png" alt="Posterior Slow Waves of Youth" width="625" height="604" class="img-responsive atto_image_button_left" style="text-align: center; "><p style="text-align: center;"><span style="font-size: 1rem;">Posterior slow waves of youth are physiologically high-voltage theta or delta waves most commonly seen in children aged 8–14 years, but uncommon in children under 2 years. PSWYs &nbsp;occur in 15% of healthy individuals aged 16–20 years but are rare in adults above 21 years of age. These are slow theta and delta waves that are intermixed with alpha waves. They attenuate with eyes opening and they occur as sporadic single waves or as bursts of transient waves interspersed by one or several seconds or regular background activity. PSOY are usually bisynchronous but can have shifting symmetry (Stern 2005).</span></p><p></p><p style="text-align: center;"><br></p><p></p><p style="text-align: center; "><br></p><p style="text-align: center; "><br></p><p style="text-align: center; "><br></p><p style="text-align: center; "><br></p><p style="text-align: center; "><br></p><p></p><h3 style="text-align: left;"><a name="_Toc29328808">POSTS</a></h3>

<p style="text-align: left;">Appearing
in children, Positive Occipital Sharp Transients of Sleep (POSTS) are surface
positive monophasic or diphasic waves are occipital in origin and synchronized,
although they can be asymmetric between posterior electrode arrays. POSTS
appear around age 5 years as the occipital delta of sleep begins to decrease
(Yamada and Meng 2010). Transient and sharp in nature, they are high amplitude
4 to 5 Hz runs, lasting 1 to 2 seconds, and repeating every 4 to 6 seconds.
They are seen during late N1 sleep stage and disappear with deep sleep.</p><h4 style="text-align: center; "><br></h4><h4 style="text-align: left;">Positive Occipital Sharp Transients in a child drifting into
NREM2 sleep</h4><p style="text-align: center;"><span style="font-size: 1rem;">&nbsp;</span><img src="@@PLUGINFILE@@/POSTS.png" alt="Positive Occipital Sharp Transients " width="639" height="513" class="img-responsive atto_image_button_middle" style="font-size: 1rem; text-align: center;"></p><p></p><p style="text-align: center; "><br></p><p style="text-align: left;"><a name="_Toc29328809" style="color: rgb(55, 71, 79); font-family: &quot;Open Sans&quot;; font-size: 1.715rem; background-color: rgb(255, 255, 255);">OIRDA</a><br></p><p><a name="_Toc29328809"></a></p><p style="text-align: left;"><a name="_Hlk505064545">OIRDA
stands for occipital intermittent delta activity. OIRDA is a delta pattern that
often spreads from the occipital leads to the posterior temporal regions on
both the right and the left hemispheres. This pattern is usually seen in
children, however the clinical significance of it is not yet agreed upon within
the neurological community. While OIRDA has been linked to epileptic disorders,
it has also been linked to encephalopathy. There are some cases of OIRDA
reported that have not deomnstrated pathological significance. </a></p><h4 style="text-align: left;">OIRDA seen in a 10-year old girl</h4><p style="text-align: center;"><img src="@@PLUGINFILE@@/OIRDA.png" alt="OIRDA" width="1007" height="750" class="img-responsive atto_image_button_text-bottom" style="font-size: 1rem;"></p><p></p><h2 style="text-align: left;"><a name="_Toc29328810">Adolescence</a></h2>

<p style="text-align: left;">The teenage brain is the final
frontier of immense neural development The focus of brain development at this
point is the pre-frontal cortex. This region, “the fourth brain,” allows us to
make future plans, and is involved in personal responsibility, morality, and self-control.
This maturation process shapes personality, behavior and identity.&nbsp; During this time girls are dealing with the
flux of estrogen and progesterone, and for boys the production of testosterone
increases. This all occurs in the limbic system, generated by the hypothalamus,
which can lead to emotional lability and moodiness. </p>

<p style="text-align: left;">Adolescents create
melatonin on a different schedule than adults, which makes them stay up at
night about two hours later. This s one of the reasons teenager sleep until
noon on weekends (when they’re not in school). In addition, teenage brains need
more sleep than adults (9-10 hours compared to 8).</p><h2 style="text-align: left;"><a name="_Toc29328811">Adult</a></h2>

<p style="text-align: left;">Stem cells in a
new brain are prolific, but in an adult brain, few neurons are produced and
most stem cells remain inactive. It is from age 25 until about 55 (or later
50s) that we are at the seeming apex of our development as humans. Our sleep
cycles remain constant, our hormones are also reliable, and we are relatively
stable (barring insult). Inless otherwise mentioned herein, when EEG is
referenced, in general, it is referenced in view of the normal, healthy adult
bran. </p>

<h2 style="text-align: left;"><a name="_Toc29328812">Senior</a></h2>

<p style="text-align: left;">One of the
fundamental components of how we age has to do with the maintenance of physical
exercise. In addition, mental activity and heredity play big roles in our
ageing process, but when we exercise, we create more brain-derived neurotrophic
factor (BDNF) which fertilizes brain cells and propels the growth of new neurons.
Studies have found that rodents who exercise produce two times as much BDNF as
their ore sedentary counterparts. The brains of elderly people who exercise are
in far better shape, on average, than those who don’t.</p><p></p><p style="text-align: left;">Similar to the body, in a
metaphorical sense, the brain is like a muscle. The more that you exercise it
with information and novelty, the better it gets. Suddenly, at seventy, you
realize the declines of your twilight years have aggregated and that you are
not cognitively what you used to be. The more unfamiliar the information, the
more trouble you are going to have as an elderly person. A perfect example is
the difficulty many baby boomers have with computers, if they did not adopt use
of the new hardware (and software) and maintain abreast of the changes as they
aged.</p>

<p style="text-align: left;">When we learn
something new, neurons in the hippocampus send messages across the gaps that
connect the terminal buttons, strengthening networks associated with learning. Essential
to the strength of the connections are calcium molecules, which go into a
neuron and make the connection more reliable. Calcium travels through NMDA
receptors, which are inextricably linked to cognitive decline in age. NMDA
receptors are glutamate receptor and ion channel proteins found in nerve
cells. These receptors are very important for controlling synaptic plasticity
and memory function.</p><p style="text-align: left;">While we may see
the diseases and pathologies related to age wreak havoc on the body, they area
also wreaking havoc on the brain. As we age, our processing rate slows down
from its peak (typically 9 -11 Hz) to a slowed version. We become less able to
retain new information and the areas of the brain most recently developed for
evolution are the most vulnerable. This is notably the temporal lobes and the
pre-frontal cortex (in combination responsible for auditory processing, memory
and executive functioning).</p><p style="text-align: left;"><br></p><p></p><p></p>