• 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.
• 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
• 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.
• 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).
• 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.
• 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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