Am. J. END Technol, 40:121-136, 2000 © ASET, fowa Manipulating the Magic of Digital EEG: Montage Reformatting and Filtering Terrence D. Lagerlund, M.D., Ph.D. Department of Neurology Mayo Clinic and Mayo Foundation Rochester, Minnesota ABSTRACT. A digital EEG system allows the montage and filter settings to be determined at the time the EEG is reviewed, rather than at the time it is recorded. The EEG is recorded with minimally restrictive analog filter settings and with potentials at all electrodes measured with respect to a single common reference. A computer can then process the data as they are displayed on a screen or print- er, reformatting the original referential montage to any desired ref- erential or bipolar montage and digitally filtering the data as needed. If necessary, the same segment of EEG can be displayed repeatedly, using different montages and filters. This results in a significant ad- vantage of digital EEG systems over analog, with better ability to distinguish normal from abnormal and epileptiform from nonepilep- tiform patterns. The Laplacian montage and spatial filtering of EEG using principal component analysis are other potentially useful dig- ital techniques, which may aid the interpretation of EEGs. KEY WORDS. Digital EEG, digital filtering, montage refor- matting, spatial filtering. INTRODUCTION Electroencephalographers often encounter records in which a transient phe- nomenon, such as an epileptic interictal or ictal discharge, is displayed in such a way that its localization or interpretation is in doubt because the EEG was recorded with analog techniques using a montage that was not optimal. Certain montages (e.g., referential, longitudinal bipolar, or transverse bipolar) are best for interpreting certain EEG phenomena but unsuitable for others. Similarly Received for publication: November 22. 1999, 121122 DIGITAL EEG there are times when a transient phenomenon is recorded while the ERG analog filter settings are inappropriate. For example, a seizure discharge may be con- taminated by muscle artifact that could have been reduced or eliminated by use of a high-frequency filter, or focal slow waves may be more prominent if a less restrictive low-frequency filter setting had been used. A digital or computer-based EEG system can eliminate this problem by allowing the montage and filter settings to be determined at the time the EEG is reviewed, rather than at the time it is recorded. The amplifiers used for re- cording have minimally restrictive analog filter settings such as 0.3 to 100 Hz, and a single common reference is used for all electrodes. A computer then pro- cesses the data as they are displayed on a screen or a printer, digitally filtering the data as needed and reformatting the original referential montage to any de- sired referential or bipolar montage. Digital EEG instruments provide a “live” or “real-time” display for the technologist. This “live” EEG may be displayed using any desired montage and filter settings. The settings used by the technologist during recording, however, have no effect on the EEG data stored on disk for later review. The stored data always represent the common reference montage and analog filter settings de- termined by the amplifier hardware, which cannot usually be changed without installing a new amplifier with different characteristics. During later review of the EEG, these same stored data are displayed using montage and filter settings chosen at the time of review. Many (though not all) digital EEG systems do store the montage name and filter settings used by the technologist during re- cording in such a way that later, during review, a reader may elect to view the EEG using the montage and filter settings that the technologist had used during recording. However, the reader always has the freedom to change from these settings to any desired montages and filters. Some readers may use the technol- ogist’s settings when reading most of the recording; other readers may read most of the recording using a few favored montages and filters, ignoring the technol- ogist’s choices at recording time. In effect, when using a digital EEG instrument, the need for the technologist to select the best montage and filters to demonstrate the EEG findings is lessened, but not eliminated. REFORMATTING TO REFERENTIAL OR BIPOLAR MONTAGES To generate a derivation such as Ol — O02, which does not exist in the EEG as recorded, the EEG display software looks for two existing channels, one of which records O1 against a reference electrode and the other of which records O2 against the same reference, and then subtracts the 2 channels. That is, O1 — 02 = (O1 — R) — (02 — R), where R is the reference. This allows new ref- erential and bipolar montages to be formed. For example, suppose that recorded EEG data include the following channels:DIGITAL EEG 123 Channel Derivation 1 Fpl - Cz 2 Fp2 - Cz 3 F3 - Cz 4 F4 - Cz 5 C3 - Cz 6 C4 — Cz 7 P3 - Cz 8 P4-Cz 9 Ol - Cz 10 02 - Cz Then subtracting pairs of channels as follows can create a new bipolar montage. Channels Derivation ch L — ch3 Fpl - F3 ch3 -ch5S F3 - C3 ch 5 - ch7 C3 — P3 ch7 -ch9 P3 - O1 ch2-ch4 Fp2 - F4 ch 4 — ch6 Fa - C4 ch 6 — ch8 C4 — P4 ch 8 — ch 10 P4 —- 02 Averaging data from two or more existing electrodes can create new ref- erence electrodes. For example, suppose an EEG is recorded with a Cz reference. A new derivation such as O1 — Ab (where Ab represents the average of the ear electrodes, whose effect is similar to a “tied ear” reference) can be calculated as follows: O1 — Ab = (O1 — Cz) — 0.5{Al — Cz) — 0.5(A2 — Cz). Figure 1.A. through 1.C. shows the same interictal discharges viewed with various mon- tages (one as recorded, two after reformatting). THE LAPLACIAN (SOURCE CURRENT DENSITY) MONTAGE Although referential and bipolar montages have commonly been used for many years, the Laplacian or source current density montage (Galambos et al. > FIG. 1. An EEG recording shows a broadly contoured V wave and right temporal wicket waves during sleep. A. As recorded from a CPz reference. B. Reformatted to average ear (Ab) reference. C. Reformatted to longitudinal bipolar montage. D. Refor- matted to longitudinal Laplacian montage.124 DIGITAL EEG No a LI inna an nolo ahh Apna man ts Mh Renner nen mone tee Le Aan en et perenne annette robert ay moka wl a IDA A a men, iret i Ha Perabo Ne Waren pon Man ade rene ch Rene Ni AA ae Pe aot er, VR avant NR ey mah igre ye naa — wot ~wne ony eee iN, een Ane at Iw phn orto pay i, wr AN Nang wy mete Ma ant inn ANN! Winn! per sab “oat ent Ae pias s ween UP tap rn ane omryary one wane foes oo a B nn capnmenspmn eanerina een Ment AA ely vn Mh ne any thy AN nana an tenn f as Deis mae Seyi ns cranecens Awe wn an As ow Neat Pattyn or A ‘anh at oA nmaeipar etal Ap nerd naa te oH pode eee Manes “op an Laibar vfs LoS arn Psy py BelN Piva, in I “aah aioe sa filers ene wavs FN a eh fa NP pv enely WAAC oN cit = vs Newent inrnontg oe romevet Aantal ahah Parham ntante ne nary s Lala ea nay yl a Alicae =e ehimbcamueorn WN NON, “Ha Lewy onyeta th Seon oes AH (n FIG. 3. An ictal EEG recording. A. Without filtering. B. After use of a 2 to 15 Hz digital band-pass filter to reduce unwanted muscle and electrode artifact. Nav represents a neighborhood average reference (Laplacian montage)., ooo = SS arr a ” rows mr me wh Sousa AY oh ” Aa t “yi a Fa132 DIGITAL EEG Ann B LJ 1: rere 7 2 rrr 3 rer e mo : ro ——— ‘ ri , ruc : cra > PhO! 1 he fae 1 {___ fe BI 12 ore — t ha reo “ ron 1s Face fT he com — I” icoz 2 vrore Le le ren bs me im ce C fe wena L 2 Fone FIG. 4. Principal component analysis (PCA) applied to an EEG containing ocular move- ment artifacts. A. A 5-s epoch of EEG with a 24-channel bipolar montage. On the right is the mapping matrix resulting from PCA as a histogram for each channel. B. The 24 principal components resulting from PCA. C.-E. The EEG reconstructed in turn from each of components 1-3. F. The EEG reconstructed from components 4-24; ocular Movement artifacts are nearly removed. (Reprinted by permission from Lagerlund et al. 1997.) the contribution of each component to each channel) as a set of histograms, one for each channel. Figure 4.B. shows the 24 principal components resulting from PCA. Figures 4.C. through 4.E. show the EEG reconstructed in tum from each of components 1 through 3. Component 1 contains vertical eye movement arti- facts, and 2 contains horizontal eye movement artifacts; component 3 contains another ocular movement-telated waveform; other components not shown con- tain other parts of the EEG. Figure 4.F shows the EEG reconstructed from components 4 through 24; ocular movement artifacts are nearly removed. Figure 5.A. shows a 12-s epoch of EEG from this patient at the end of a partial seizure, with rhythmic and polymorphic delta activity obscured by ocular movement artifacts. Figure 5.B. shows the same BEG after applying the spatial filter, ocular movement artifacts were largely removed, allowing the underlying slow waves to be seen. Some slow components in the frontal channels are attenuated but not removed; they are probably not ocular movement artifacts. Spatial filtering using PCA is a useful method of removing artifacts or otherDIGITAL EEG 133 Tt opp Fy S wy oc IS athe — bs = uA Mat 4 B See ee FIG. 4. Continued. unwanted features of an EEG while preserving or effectively enhancing other features. In effect, the method uses the spatial distribution across channels of artifacts or other waveforms as a “signature” of the feature to be eliminated. All waveforms having the same spatial distribution are canceled out, and wave- forms distributed differently are preserved. Thus, the “spatial filter” is analogous in some respects to a digital “temporal filter” designed to remove some fre- quencies from the EEG while preserving others. Designing a custom spatial filter is not much more time consuming than designing a custom high-frequency, low- frequency, or band-pass digital filter. However, the spatial filter should generally be used on only the patient's recording that was used to perform the PCA and create the filter, which limits the versatility of custom spatial filters. The method works well for eliminating artifacts or activity with relatively high amplitudes and with a spatial distribution that remains constant throughout the EEG. Ocular movement and electrocardiographic artifact often have these characteristics. The method works less well for artifacts of relatively low am-134 DIGITAL EEG FIG. 4. Continued. plitude and changing spatial characteristics, such as electromyographic artifact and some electrode artifacts. Although elimination of these may not be achieved, a significant reduction may still be attained (Lagerlund et al. 1997). ADVANTAGES OF INTERPRETATION OF DIGITAL EEG Digital EEG has come into widespread use as an alternative to conventional, analog paper EEG, but the question remains as to whether the interpretation of clinical EEGs is more accurate using digital as opposed to conventional tech- nology. A recent study suggested that this is the case (Levy et al. 1998). In this study, EEGs recorded on a digital EEG system were read in one of three ways: on a paper printout (without using digital features of montage reformatting or filtering), on screen (again without using digital features), or on screen using all the features of digital EEG, including montage reformatting and filtering. FourDIGITAL EEG 135 FIG. 5. Spatial filtering of ocular movement artifacts with use of the principal com- ponent analysis results in FIG. 4. A. A 12-s epoch of EEG on the same subject as in Figure 4. B. The same EEG after applying the spatial filter. (Reprinted by permission from Lagerlund et al. 1997.)136 DIGITAL EEG board-certified clinical neurophysiologists reviewed the same records, and inter- rater agreement was quantified with a statistical measure (kappa). The agreement was substantially higher when readers had access to the digital reformatting features (e.g., 0.81 for records read with digital features versus 0.61 for records tead without these features). To the extent that agreement is an indicator of the quality of a measurement technique, these findings were thought to indicate that the availability of digital features improves the interpretation of clinical EEGs and the diagnostic utility of EEG. Address reprint requests to: Terrence D. Lagerlund, M.D., Mayo Clinic, 200 First Street SW, Rochester, MN 55905. REFERENCES American Electroencephalographic Society (AEEGS). Guideline thirteen: Guidelines for stan dard electrode position nomenclature. J Clin Neurophysiol 1994; 11:111-13. 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