electroencephalography (EEG)
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Indications
- diagnosis of convulsive disorders
- evaluation of epilepsy, seizures
- evaluation of non-convulsive status epilepticus in hospitalized elderly with refractory delirium[8]
- evaluation for epilepsy surgery
- evaluation of epilepsy, seizures
- infantile spasm[4]
- viral encephalitis
- Creutzfeldt-Jakob disease
- evaluation of coma
Clinical significance
- 40-50% sensitive in diagnosing epilepsy[1]
- 7% of general medical inpatients in 1 study had seizures on EEG[3]
- burst suppression pattern on electroencephalogram is a sensitive early marker (48 hours) of poor outcome (no sedation) in comatose patients
Procedure
- wake-sleep EEG after sleep deprivation
- chloral hydrate 500-1000 mg for sedation on call to the EEG lab
- < 2 hours of sleep overnight preceding the EEG
- epileptiform discharges
- may be seen in the waking state
- sometimes more clearly detected in drowsiness of stage 2 sleep
- activation procedures can unmask seizure foci
- hyperventilation
- photic stimulation)
- T1 & T2 leads assess activity over the temporal lobes
- awake EEG
- delirium &/or dementia-related encephalopathy
- abnormal slow wave activity
- paroxysmal discharges
- global vs focal abnormalities
- delirium &/or dementia-related encephalopathy
- QEEG mapping
- polysomnography or sleep EEG
- 60 of minutes EEG recording for capturing events of clinical significance[7]
Interpretation
Patterns:
- Herpes simplex encephalitis:
- periodic lateralizing epileptiform discharges emanating from the temporal lobes
- hepatic encephalopathy:
- triphasic waves
- Creutzfeldt-Jacob disease:
- bilateral synchronous repetitive sharp waves
More general terms
More specific terms
- electrocorticogram at surgery
- electroencephalography during extracranial surgery
- electroencephalography for coma
- electroencephalography for seizure
- Fastball EEG
- Neuropsychiatric EEG-Based Assessment Aid (NEBA)
Additional terms
References
- ↑ 1.0 1.1 Medical Knowledge Self Assessment Program (MKSAP) 11, 19. American College of Physicians, Philadelphia 1998, 2021
- ↑ Dr. Cook's guide to ordering EEG tests. MentalHealth@ucla-edu
- ↑ 3.0 3.1 Betjemann JP et al. Diagnostic yield of electroencephalography in a general inpatient population. Mayo Clin Proc 2013 Apr; 88:326 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23541007
- ↑ 4.0 4.1 Deprecated Reference
- ↑ Claassen J, Taccone FS, Horn P et al Recommendations on the use of EEG monitoring in critically ill patients: consensus statement from the neurointensive care section of the ESICM. Intensive Care Med. 2013 Aug;39(8):1337-51 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23653183
- ↑ Kennedy JD, Gerard EE. Continuous EEG monitoring in the intensive care unit. Curr Neurol Neurosci Rep. 2012 Aug;12(4):419-28. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22653639
- ↑ 7.0 7.1 Burkholder DB et al. Routine vs extended outpatient EEG for the detection of interictal epileptiform discharges. Neurology 2016 Mar 16; PMID: https://www.ncbi.nlm.nih.gov/pubmed/26984946
- ↑ 8.0 8.1 NEJM Knowledge+. Question of the Week. Oct 11, 2016 http://knowledgeplus.nejm.org/question-of-week/1296/
- ↑ Herman ST, Abend NS, Bleck TP et al Consensus statement on continuous EEG in critically ill adults and children, part I: indications. J Clin Neurophysiol. 2015 Apr;32(2):87-95. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25626778 Free PMC Article
Herman ST, Abend NS, Bleck TP et al Consensus statement on continuous EEG in critically ill adults and children, part II: personnel, technical specifications, and clinical practice. J Clin Neurophysiol. 2015 Apr;32(2):96-108. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25626777 Free PMC Article - ↑ Booth CM, Boone RH, Tomlinson G, Detsky AS. Is this patient dead, vegetative, or severely neurologically impaired? Assessing outcome for comatose survivors of cardiac arrest. JAMA. 2004 Feb 18;291(7):870-9. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/14970067
- ↑ Wijdicks EF, Hijdra A, Young GB, Bassetti CL, Wiebe S; Quality Standards Subcommittee of the American Academy of Neurology. Practice parameter: prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2006 Jul 25;67(2):203-10. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16864809 Review.