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  • • Suspected epilepsy.

    • Suspected ongoing seizures or subclinical status epilepticus.

    • Epilepsy characterization.

    • Unexplained encephalopathy or coma.

    • Monitoring medication-induced coma.

    • Paralyzed patients with possible seizures.

    • Medication titration.

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  • • Scalp abrasion after prolonged monitoring is a minor risk.

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  • • Automatic spike and seizure detection paradigms are not sensitive or specific enough to base clinical decisions on at this time.

    • Cardiac and respiratory artifacts are often misinterpreted as epileptiform.

    • Patients with focal (localization related) epilepsy may have normal or near normal interictal electroencephalograms (EEGs).

    • In neonates, there is a paucity of clear epileptiform abnormalities even in patients with frequent seizures, thus prolonged monitoring should be strongly considered in place of routine studies.

    • EEG must be considered in clinical context.

    • An abnormal EEG is not always suggestive of epilepsy and may reflect a nonepileptic encephalopathy.

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  • • The EEG is not painful or dangerous, although the placement of the electrodes may require the child’s restraint for a few minutes.

    • Patient’s hair should be washed and free of oils and chemical agents prior to the study; any braids in hair need to be removed.

    • Metal EEG electrodes are placed over the scalp in standardized positions and fixed with a variety of specialty adhesives.

    • • The glue can leave a small red welt on the scalp, which will resolve in a few days.

      • Alcohol can be helpful in removing stuck adhesive.

    • Impedance is checked to determine appropriate electrical connectivity.

    • The electrode wires are attached to the head box, which is then attached to the monitoring unit (usually a computer with screen for EEG display).

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  • • The study is performed by placing electrodes each approximately the size of a pea on the scalp and affixing them with some type of adhesive (usually paste or glue).

    • Most commonly, 21 electrodes are affixed.

    • The electrodes are connected to the EEG machine by thin wires usually pulled together into a “ponytail.”

    • The patient may be asked to perform certain “maneuvers” that may bring out EEG abnormalities.

    • • Intermittently closing his or her eyes.

      • Watching flashing strobe lights.

      • Hyperventilating for 2–3 minutes.

    • Sleep is often important to capture as well, and parents may be asked to keep their child awake on the night before the study.

    • A routine outpatient EEG usually is performed for approximately 45–60 minutes but longer studies may be required.

    • After the EEG is complete, the electrodes can be easily removed after the EEG machine is turned off.

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  • • A normal EEG result rarely rules out the possibility of seizures just as an abnormal EEG may not diagnose epilepsy or risk of recurrent seizures.

    • EEG must be used in the context of a neurologic evaluation and only rarely can replace it entirely.

    • Appropriate filters should be placed on the recording to minimize electrical and mechanical interference.

    • A montage (display paradigm ...

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