Effects of subject’s wakefulness state and health status on approximated entropy during eye opening and closure test of routine EEG examination

This study tested a novel method designed to provide useful information for medical diagnosis and treatment. We measured electroencephalography (EEG) during a test of eye opening and closing, a common test in routine EEG examination. This test is mainly used for measuring the degree of alpha blocking and sensitivity during eyes opening and closing. However, because these factors depend on the subject’s awareness, drowsiness can interfere with accurate diagnosis. We sought to determine the optimal EEG frequency band and optimal brain region for distinguishing healthy individuals from patients suffering from several neurophysiological diseases (including dementia, cerebrovascular disorder, schizophrenia, alcoholism, and epilepsy) while fully awake, and while in an early drowsy state. We tested four groups of subjects (awake healthy subjects, drowsy healthy subjects, awake patients and drowsy patients). The complexity of EEG band frequencies over five lobes in the human brain was analyzed using wavelet-based approximate entropy (ApEn). Two-way analysis of variance tested the effects of the two factors of interest (subjects’ health state, and subjects’ wakefulness state) on five different lobes of the brain during eyes opening and closing. The complexity of the theta and delta bands over frontal and central regions, respectively, was significantly greater in the healthy state during eyes opening. In contrast, patients exhibited increased complexity of gamma band activity over the temporal region only, during eyes-close. The early drowsy state and wakefulness state increased the complexity of theta band activity over the temporal region only during eyes-close and eyes-open states respectively, and this change was significantly greater in control subjects compared with patients. We propose that this method may be useful in routine EEG examination, to aid medical doctors and clinicians in distinguishing healthy individuals from patients, regardless of whether the subject is fully awake or in the early stages of drowsiness.