| Conference Report |
how not to read an eeg: introductory statements.
- Tatum, William, DO, FAAN. Pages: S1-S3
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normal "suspicious" eeg.
- Tatum, William, DO, FAAN. Pages: S4-S11
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Show/Hide Abstract
The EEG is a unique measure of electrical brain function and is widely used in patients with seizures. Many normal variants and variations of normal EEG have a predilection for the temporal lobe and mimic epileptiform discharges. The high prevalence of temporal lobe epilepsy and the propensity for normal variants to occupy the temporal lobe may result in an undesired bias, leading to misidentification of normal waveforms. Learning the common pitfalls, such as the variations of normal EEG, benign variants, and common artifacts, are essential lessons in EEG. Continuing education and acquiring experience in EEG interpretation are the basic tools to ensure patient safety. Above all, judging the results of the EEG interpretation in light of the patient's clinical symptoms is a prerequisite to ensure proper management.(C)2013 American Academy of Neurology
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artifact-related epilepsy.
- Tatum, William, DO, FAAN. Pages: S12-S25
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Show/Hide Abstract
Potentials that do not conform to an expected electrical field generated by the brain characterize an extracerebral source or artifact. Artifact is present in virtually every EEG. It is an essential component for routine visual analysis, yet it may beguile the interpreter into falsely identifying waveforms that simulate epileptiform discharges (ED). The principal importance of artifact is represented by the frequency of its occurrence in contrast to the limited frequency of normal variants that may imitate pathologic ED. Continuous EEG monitoring has uncovered newly identified artifacts unique to prolonged recording. The combined use of video and EEG has revolutionized our ability to distinguish cerebral and extracerebral influences through behavioral correlation that is time-locked to the electrophysiologic features that are present on EEG. Guidelines exist to ensure minimal standards of recording. Precise definitions are present for ED. Still, the ability to distinguish artifact from pathologic ED requires a human element that is to provide the essential identification of an abnormal EEG. The ramification of a misinterpreted record carries an acute risk of treatment and long-term consequences for diagnosis-related harm.(C)2013 American Academy of Neurology
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pitfalls in ictal eeg interpretation: critical care and intracranial recordings.
- Gaspard, Nicolas, MD, PhD, Hirsch, Lawrence. Pages: S26-S42
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EEG is the cornerstone examination for seizure diagnosis, especially nonconvulsive seizures in the critically ill, but is still subject to many errors that can lead to a wrong diagnosis and unnecessary or inadequate treatment. Many of these pitfalls to EEG interpretation are avoidable. This article reviews common errors in EEG interpretation, focusing on ictal or potentially ictal recordings obtained in critically ill patients. Issues discussed include artifacts, nonepileptic events, equivocal EEG patterns seen in comatose patients, and quantitative EEG artifacts. This review also covers some difficulties encountered with intracranial EEG recordings in patients undergoing epilepsy surgery, including issues related to display resolution.(C)2013 American Academy of Neurology
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how to write an eeg report: dos and don'ts.
- Kaplan, Peter, MBBS, FRCP, Benbadis, Selim. Pages: S43-S46
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The EEG report is structured to include demographics of the patient studied and reason for the EEG; specifics of the EEG techniques used; a description of the patterns, frequencies, voltages, and progression of the EEG pattern that were recorded; and finally a clinical impression of the EEG significance. The interpretation should be concise, clear and to the point, avoid jargon and EEG specifics, and should be understandable by any health care practitioner.(C)2013 American Academy of Neurology
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"just like ekgs!" should eegs undergo a confirmatory interpretation by a clinical neurophysiologist?.
- Benbadis, Selim. Pages: S47-S51
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Show/Hide Abstract
The misdiagnosis of epilepsy is common and has serious consequences. A major contributor to the misdiagnosis of epilepsy is the tendency to overread normal EEGs as abnormal. In fact, the wrong diagnosis of seizures is sometimes based solely on the "abnormal" EEG. Reasons for the common overinterpretation of normal EEGs are mostly related to the lack of standards or mandatory training in EEG, and the erroneous assumption that all neurologists are trained to read EEGs. The most common overread pattern consists of benign, nonspecific, sharply contoured temporal transients. In particular, there is a common misconception that "phase reversals" are indicative of abnormality. Potential solutions include defining and ensuring EEG competency of neurologists who read EEGs, and perhaps providing a confirmatory reading by an electroencephalographer, as is done for EKGs.(C)2013 American Academy of Neurology
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how not to read an eeg: concluding statements.
- Tatum, William, DO, FAAN. Pages: S52-S53
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