Proposed Guideline: Minimum standards for recording routine and sleep EEG
A working group of the ILAE and IFCN (International Federation of Clinical Neurophysiology) developed a proposal for joint minimum standards for recording routine and sleep EEGs.
Draft guideline: Joint ILAE and IFCN minimum standards for recording routine and sleep EEG
The proposal comprises 16 recommendations.
Public comments are now closed and available for review below.
8 July 2022
Thank you for the opportunity to review this document. I congratulate the authors on their work.
It might be helpful to include a statement on how this document relates to existing guidance established by regional/national societies and local institutions. A global minimum standard has advantages in clinical care and research. At the same time, local considerations may warrant modification of practices, or additional standards. Perhaps establishing these minimal standards as global best practices, while also affirming the value of regional guidance and local/institutional modifications would be appropriate. (This would avoid unintended confusion about whether the IFCN minimum standards render regional/institutional standards null.) This could be a general statement or with reference to ADAPTE or a similar tool.
Regarding indications for EEG, the statement that there is "no evidence" regarding indications for routine and sleep EEG could be clarified. There are numerous studies demonstrating the yield of EEG in various conditions, and/or describing diagnostic findings on EEG. The literature search for this PICO included only papers specifically referring to "indications" or "referral", which may have limited the results. (For example, a study demonstrating the yield of routine EEG in childhood absence epilepsy would be relevant, but would not result given the search parameters.) It might be more accurate to say that while there is copious direct and indirect evidence regarding the utility of routine EEG, it is of a scope that prohibits exhaustive systematic review. At the same time, a focused search did not find direct studies of specific indications or referral criteria for routine EEG, which is why the Delphi was used for this PICO.
7 July 2022
Joint ILAE and IFCN minimum standards for recording routine and sleep EEG
Comments from ASET – The Neurodiagnostic Society
- First sentence, “…and in selected disorders of brain dysfunction1,2.”
- Comment: And is a strong correlator to encephalopathic functioning
- Second paragraph, “Routine EEG with activation procedures corresponds to the basic level and sleep induction is used at the advanced recording level.”
- Comment: Basic EEG level should include sleep induction, if necessary, rather than doing a repeat EEG.
- Comment: I would argue that an attempt to obtain sleep, as a minimal standard, should be part of the “basic level”, which supports the articulation in this article which emphasizes its provocative effect upon epileptiform discharges. In our lab, we always attempt to obtain sleep with “routine EEGs”, and often are successful.
- Grammatical: Use of “artifact” and “artefact” should be consistent throughout the document.
- Third paragraph, “The minimum standards represent a set of standards…”
- Comment: Rephrase to “The minimum requirements represent a set of standards…” or “The minimum standards represent a set of criteria…”, or other modification.
- Fourth paragraph, “…within 28 members the European…”
- Comment: Insert “of” – “…of the European…”
- Fifth paragraph: “The lack of… guideline for…”
- Comment: Should be plural – “guidelines”
- Sixth paragraph, “…being responsible of EEG recordings…”
- Comment: Replace “of” with “for” – “…responsible for EEG recordings…”
2.1. Insert “was” into the second sentence to read, “The working group was composed of…”
2.4. Insert “of” into first sentence to read, “…were defined for each of five clinical questions.”
2.4.2. “Studies that addressed recording electrode array and montages…”
- Comment: Equally important, if not more so, is equidistant, properly measured 10-20 placement.
2.4.5. “…non-epileptic psychogenic seizures…”
- Comment: The proper term is psychogenic nonepileptic event (PNEE), not seizures. Here and throughout the document, replace “seizures” in “non-epileptic psychogenic seizures” with “events”.
3.2.1. Rephrase first sentence to “recommended” (i.e., not “suggested”) to read as: “For routine EEG, the use of either gold or silver/silver-chloride cup electrodes individually applied with electrode paste or gel are recommended as the most optimal and accurate method.”
3.2.1. Second sentence regarding head caps.
- Comment: One size does not fit all, electrode placement is not accurate due to hair or lack of hair and skull deformities, etc. These factors could lead to misdiagnosis of abnormal EEG patterns and normal variants as well as false positives for asymmetries. These factors should be taken into consideration to provide the most optimal care for patients.
- Comment: While use of head caps could benefit patients in areas where technologists are not available (rural, underdeveloped areas), we hope the ILAE would recognize the IFCN standard as the recommended gold standard first, with the use of caps a secondary consideration in areas of need or in emergency situations when patient care need is acute.
- Comment: As important as interelectrode distances are, notably within the context of interpatient variability in skull size and shape, equidistant 10-20 placement specific to each patient is paramount. Note that minor deviations from equidistant placement can lead to EEG channels with minimal deflection, thereby severely limiting diagnostic potency.
3.2.1. Replace 10-20 array with 10-10 array when referencing the subtemporal electrode chain.
- Comment: Recommend rephrasing this sentence to include the International 10-20 Standard for Electrode Placement is recommended (not suggested) as the gold standard.
3.2.1 Second paragraph regarding ECG
- Comment: Replace "may" with "must" use one channel to record ECG. From confirming ECG artifact (which itself reduces chance of interpreting false positives) to identifying potentially fatal cardiac abnormalities (notably in the context of clinical events suspicious for seizures), ECG recording is a necessity.
3.2.1 Second paragraph regarding EOG
- Comment: Eye lead placement to distinguish eye movement artifacts from frontal slowing should be placed in suborbital locations to demonstrate in phase or out of phase potentials compared to FP1 and FP2.
- Comment: 1. EOG leads section should be prioritized (moved above) the EMG electrode placement. 2. EOG leads which are placed infra-orbitally (both below the eyes) provide clear confirmation if concerning frontal activity is authentic (i.e., activity is either in-phase or out-of-phase with Fp1 and Fp2; for example, GRDA vs eye movement). 3. Eye leads should be emphasized as a minimum requirement, not option, as their potential for discerning artifact from cortically originating activity is significant. There are sources which endorse both eye leads being placed below the eyes.
3.2.2. Regarding phrase, “…skin abrasion is still required…but not proposed 31.”
- Comment: Reference to ASET's Skin Safety Guideline
3.2.3. First paragraph: Artefact or artifact?
3.2.3. Second paragraph regarding low frequency filter setting
- Comment: There is no source included that supports a 0.5 Hz low filter setting recommendation, and does not align with the ACNS guideline (section 3.4) of a standard use of 1 Hz. Neonate patients of course are an exception.
3.2.3. Second paragraph, last sentence, “…apply…and adjust…filters if needed.”
- Comment: A best practice should include the disclaimer/caveat that altering the filter settings can lead to drastic misrepresentation of actual cortical signal.
3.3. Third paragraph, “…recommend of at least 20 minutes of technically satisfactory recording…”
- Comment: Delete “of” to read, “…recommend at least 20 minutes…”
- Comment: 20 minutes does not include a biological calibration or channel test. This should be mentioned in the document.
3.4.4. Recommendation: Last sentence regarding use of chloral hydrate:
- Comment: There is no mention of The Joint Commission (TJC) requirements while administering sedation. While I understand some countries do not follow TJC requirements, there should be some mention of adhering to established protocols for monitoring the patient during sedation, to create a safe environment for the patient.
- Comment: Some studies show it is effective and safe, but those studies are also facilities that currently possess ways to safely monitor sedation and vital signs. In many labs, chloral hydrate is given prior to the patient's arrival or by a parent or guardian upon arrival. The EEG is run as normal with no sedation nurse or continuous vital signs. In my opinion and experience over 22 years, I have personally found chloral hydrate administered to young children or developmentally delayed children and adults and it has only resulted in a paradoxical reaction of aggression and hyperactivity. There have been instances in other outpatient procedures where chloral hydrate has resulted in the death of children. Even one death simply to acquire sleep on an EEG is one too many.
- “Chloral hydrate is no longer recommended for sedation in children and is not available in many countries, including the United States. Some countries have removed chloral hydrate from national health formularies because of potential carcinogenicity although the risk of cancer from a single dose is inconclusive [Sahyoun, Krauss 2012. Clinical implications of pharmacokinetics and pharmacodynamics of procedural sedation agents in children. Curr Opin Pediatr. 24(2):225–32; American Academy of Pediatrics Committee on Drugs and Committee on Environmental Health. Use of chloral hydrate for sedation in children. 1993. Pediatrics. 92(3):471–3.].”
188.8.131.52. Second paragraph, “…baseline was found in of 23.7%...” – Delete “of”.
184.108.40.206. Consider moving contraindications for HV here instead of 220.127.116.11.
18.104.22.168. Second paragraph, replace “seizures” with “events” (x2 occurrences in this paragraph).
22.214.171.124. If not covered elsewhere, should stress the importance of the minimal brightness as well as distance between face and light source.
126.96.36.199. Consider moving contraindications for HV and photic stimulation here instead of 188.8.131.52.
184.108.40.206. Replace “seizures” with “events” (x2 occurrences in this paragraph).
- “…but low for photic stimulation and other type of stimulation.”
- “type” should be plural.
- Comment: Since photic stimulation has such a significant effect on eliciting psychogenic nonepileptic events, the capture of such an event in a patient suspected of having seizures carries a tremendous value. By eliminating epilepsy as the etiology (those patients with both epileptic seizures and psychogenic events not withstanding) in patients with concerning clinical phenomena, the net gain in diagnostics resolution supports the inclusion of photic as a minimal standard.
- “Asking the patient to blink, close and open eyes documents artefacts…”
- Artefact or artifact?
- Comment: It should be included here that a sustained period of eye closure during wakefulness is also very important as it uncovers the patients posterior dominant rhythm frequency, thereby assisting with determining of they are encephalopathic (or if there is hemispheric asymmetry in voltage and/or frequency which carries its own implications).
- “… the potential benefits as well as adverse effects of activations…”
- Comment: Although noted below in section, 220.127.116.11., clear explicit contraindications for HV are necessary to include, notably if the patient has a history of stroke, has pulmonary disease, has a significant cardiac history, or has sickle cell trait. Contraindications should be addressed earlier in the document (before section 18.104.22.168.).
- “… also increase the occurrence of non-epileptic seizures. Patient has right to know…”
- Replace “seizures” with “events”
- Add ‘the’ to read, “Patient has the right to know…”
- The EEG technician…”
- Comment: Replace technician (x 2 in this section) with technologist see Definition of a Qualified Neurodiagnostic Technologist
- "Patients are monitored for a spontaneous response and after the offset of discharge asked what they were told.”
- Add a comma following the word, “discharge”
- Comment: Important not to say the phrase too close to the end of the discharge, or they will likely recite it, which will be very misleading.
22.214.171.124. Hyperventilation protocol
- Comment: Replace “windmill” with “pinwheel”
- Comment: Replace technician (x 2 in this section) with technologist see Definition of a Qualified Neurodiagnostic Technologist
- Add “of” in third sentence to read, “encourage the patient and rates of breathing effort…”
- “Routine and sleep EEG have an established role in clinical diagnosis of epilepsy.”
- Comment: Extends beyond to include providing real-time evidence of encephalopathic state, focal cortical dysfunction, and dysmaturity.
7 July 2022
7 July 2022
Many thanks for taking the initiative and carrying through this very important work!
3.1 and Table 2: In Table 2 'Indications for non-emergent EEG' point 4 reads: 'Changes in seizure pattern'
In my view, this point needs to be clarified. What type of changes? I have not found any clear answers in the papers referred to in the text. There are far too many unnecessary EEGs done after minor modifications in ASM where the referring doctor wants to know if the EEG has "improved". Flink et al write in the European guidelines from 2002 (ref 17): "The EEG is not useful in following the therapeutic effect of antiepileptic drugs (AEDs) as interictal epileptiform activity is affected very little by AEDs. An exception is absence epilepsy where the quantification of spike-wave episodes is helpful in following the effect of treatment."
As a frequent EEG-reader of epilepsy surgery work-ups, my experience matches well with that of long term EEG-recordings from implanted devices where interictal epileptiform activity can vary substantially in the same patient over time, and often within just a few hours, although no changes in ASM were done.
I sometimes also get EEG referrals for patients who have suffered a seizure after being seizure free for a long time (without any other obvious cause). I normally question these referrals and how a new EEG would change clinical management. In conclusion, I think point 4 in Table 2: 'changes in seizure pattern' would benefit from a clarification, or perhaps re-wording if you are referring to re-classification of e.g. focal – generalized seizures.
3.5 I have three questions/points for discussion and possibly clarification regarding hyperventilation and intermittent photic stimulation.
Age: You state that hyperventilation has its greatest yield in younger patient groups. Older age group have medical contraindications in a higher rate (although one study, ref 82, found it safe in patients up to 97 years of age). Absence seizures also very rarely present after 30 years of age. Have you discussed only recommending hyperventilation as a standard for patients up to 40 or 50 years of age or similar?
Repeated activation: If a patient has performed HV or IPS in a previous EEG recording, should they as a standard repeat it in the following EEGs? Patients with previous photoparoxysmal response: Should patients with previous photoparoxysmal response (especially generalized) undergo IPS again? They risk a provoked seizure.
Josefin Nilsson, MD, PhD
6 July 2022
Thanks for the comprehensive proposal...
Regarding sleep induction with Melatonin- First dose recommended is 0.3 mg/kg for children weighing less than 10 kg, 3 mg for children weighing 10-15 kg and 6 mg for those weighing more than 15 kg. If the child does not sleep after 45 minutes, an augmentation dose can be given, which is half of 1st dose, the maximum combined dose permitted is 10 mg. No difference in efficacy or tolerability was found in a Randomized controlled trial. Lalwani S, Srivastava K et al. Efficacy and tolerability of Melatonin vs Triclofos to achieve sleep for pediatric EEG: A single blind RCT. Eur J Ped Neurol June 2021.
Regarding photic stimulation- The duration of flashes, their frequencies and the duration between the flashes should be specified. The sentences in the table are confusing and should be reworded in the table.
Regarding EO/EC- What is the optimum duration for eye open/ eye closed? Usually we do eyes closed for 10 seconds (1 page) followed by eyes open for one page, also very frequent eye blinking should be avoided.
Regarding other provocation methods- In specific conditions like tactile stimulus/auditory stimulus induced myoclonic seizures, these maneuvers can be utilized. In West syndrome, awakening after sleep record is a strong provocative method to elicit and record spasms. Fixation Off sensitivity (FOS) by wearing dark goggles can be utilized where specific syndrome is suspected.
Dr. Kavita Srivastava
6 July 2022
I congratulate the group on putting together the document and would like to provide a few comments:
I would like the authors to reconsider the statement that “In the previous guidelines of recording EEG [17,21,29], technical standards were based on expert opinion and not on scientific studies.” for the following reason:
It is true, that the ACNS Guidelines from 2016 do not explicitly describe methods, however the disclaimer of the “American Clinical Neurophysiology Society Guideline 1: Minimum Technical Requirements for Performing Clinical Electroencephalography” states that the guideline “… is based on an assessment of current scientific and clinical information. … The clinical context section is made available to place the evidence-based guidelines into perspective with current practice habits and challenges.” The American Clinical Neurophysiology Society Guideline 1: Minimum Technical Requirements for Performing Clinical Electroencephalography (reference #29) is written by 9 authors, and there are 11 references provided. The authors in the proposed ILAE/IFCN guideline struggled to come up with the PICO question on the minimal technical standards and had to use Delphi method and discussion to reach consensus. This method largely relies on experts’ opinion in this case of at most 10 authors to reach consensus when at least 2/3 of the authors are in agreement.
I propose either eliminating the sentence “In the previous guidelines of recording EEG [17,21,29], technical standards were based on expert opinion and not on scientific studies.” OR making a statement that prior guidelines faced similar struggles in identifying Class I or II evidence for establishing minimal technical standards in performing routine EEGs.
The purpose of the proposed guideline should be clear as its limitations. The proposed Joint ILAE and IFCN Guideline on Minimum Standards for Recording Routine and Sleep EEG should not supersede ACNS guidelines as the latter are being used for establishing standards of quality of care in the USA locations and practices, EEG laboratory certifications and are the basis for testing and certification through the American Board of Clinical Neurophysiology (ABCN).
It should be added to Conclusions that “present document is not meant to replace other societal guidelines currently used for establishing national standards of quality of care”.
Thank you very much for consideration and congratulations again on brining the document to the finishing line!
Olga Selioutski, DO
6 July 2022
The working group of the ILAE and IFCN’s joint proposal encompassing minimum standards for recording standard and sleep EEG succeeds in providing a useful evidence-based assessment in this CPG. The group is to be congratulated for their rigor to identify and classify the data on standard EEG according to ILAE/IFCN standards for developing a CPG. I enjoyed and appreciated the detail and specificity on the targeted goals outlined by the PICO questions.
I’ve only a couple of suggestions meant to be constructive and potentially enhance this excellent work. Because there are other similar guidelines, outlining them in the Introduction to identify similarities and differences would help underscore the novelty of this work as a (? registered vs non-registered) systematic review and unite the international community. My main suggestion is to make the recommendations more succinct. Some approximate 2 pages, and it would seem more adaptable if the summary statements were abbreviated. Eliminating review information (all true) would serve to highlight the evidence-based focus. In the Discussion, reiterating the limitations (i.e., EEG devoid of video) and weak/conditional recommendations may add flexibility if combined with local institutional safety standards and country-specific resources. In addition, referencing other forms of EEG recording (i.e., AEEG/VEM) in the Discussion would position standard EEG in light of other techniques (i.e., deleting Table 5 in favor of citating LTVEM/AEEG that target seizure monitoring).
Minor comments involve technical recording specifying use of EKG in all EEGs (eye movement monitors in most, and EMG in some cases) seems a good point to emphasize if this reached consensus by the working group. Eliminating the reference to chloral hydrate may be a good idea too given safety, availability, and regulatory hurdles to impede usage. Relative to technologist’s attendance, supervision for the entire EEG recording seems prudent to ensure safety (vs parents for a “few minutes”) if this was the group's opinion.
William O. Tatum
6 July 2022
- The ideal time to record EEG after any suspicion of epilepsy/syndrome of epilepsy? Any time frame to record EEG after any suspected epilepsy?
- How frequently should we record EEG during drug withdrawal and while monitoring on any medication?
- What is the minimum requirements of the EEG lab/room?
- What is the minimum requirement/eligibility for recording EEG and analysing/interpreting EEG?
- Information on the preparation of patient before doing EEG, including scalp preparation, holding other medications?
- Other alternative drugs to assist in sleep induction where melatonin is not available?
- Should chloral hydrate be the alternative to melatonin?
- Should we stop recording EEG if we see photomyogenic reaction during photic stimulation?
- Any recommendation for the range of time duration for the prolonged hyperventilation when considered beneficial?
5 July 2022
- The use of a literature survey is a bit difficult as for the most important questions there was no literature support, and this proposed guideline becomes just another expert consensus statement. This is one situation where expert consensus is very useful and can override the literature. There are many obvious good practices that are so standard that they have never been studied.
- The authors of the guideline recommend a minimal sampling rate of 256Hz but a high frequency filter of 70Hz. Clearly there would be little to no impact of changing the sampling rate to 200Hz when the 7Hz HFF is used so this sample rate seems inconsistent with the filter setting recommendations.
- The section on impedances is a bit misleading. The impedance check is important but the most critical issue is a manual evaluation of the quality of the EEG on each channel and a search for means to improve the quality of that recording. This is a very important step and needs to be emphasized. Electrodes can be bad even with a normal impedance.
- The guideline states that there must be a MINIMUM of 2 EMG channels if there is a movement to be monitored. What is more important is that what is recorded is verified and recording the movement in question well. This can be done with ONE channel, but even 10 channels of EMG recording don’t help if they are not of good quality. The authors should emphasize the importance of care in selecting and verifying the electrode recording and not simply state the number of channels.
- Regarding table 5 the testing during a seizure. There is nothing stating that with a long seizure urgent help should be summoned, and there is no mention about assuring patient safety like putting up bed rails and making sure that the patient is not in danger. It would be nice if possible under certain circumstances to check vital signs and pulse oximetry.
- Table 3 recommends the use of an electrode cap. However, there is no literature produced to support this. In a guideline that is literature driven, this recommendation should either be supported, removed or at least the degree of expert consensus should be shown. I would recommend that since the authors used a Delphi process it would be useful to know the final degree of consensus for each factor that was just expert consensus.
- All of the references to the IFCN 25 channel montage were in articles that I would have to pay to purchase. Please place a link where something as important as this can be seen by any lab looking for guidance.
Mark Menniti Stecker
4 July 2022
The guidelines cover most aspects for routine EEG studies. However, there are a substantial number of children with autistic spectrum disorders and developmental disorders who are poorly cooperative and very hyperactive for EEG recording. They require modification of standard protocols especially for sleep EEG recording. In our recently submitted paper on this topic (Manuscript number EPI-00584-2022) to Epilepsia, we proposed a set of guidelines and protocols for this group of children including use of net electrodes, scheduling the test in the afternoon, recording for at least 2-3 hours, maximum efforts to obtain sleep record, use of melatonin if needed and a sleep deprivation protocol. It will be extremely useful for centers caring for this group of children if the ILAE and IFCN guidelines on recording could include this subgroup.
3 July 2022
Dear Authors of the guideline!
Georgian Chapter of ILAE, especially clinical neurophysiologists and EEG technicians, are infinitely grateful to the working group of the ILAE and IFCN for their hard work on the Proposed Guideline. This proposal is very helpful, and thanks to this our coworkers will certainly have more confidence in how to record routine and sleep EEGs. We have no questions.
Wishing you all the best,
Giorgi Japaridze and Sofia Kasradze
24 June 2022
- This study goes into the technical aspects of the recording of routine EEG and sleep EEG. However even within routine EEG and sleep EEG video now is routinely acquired also.
- There should be minimum standards for consent: for example consent to take a video, how the video can be used for clinical purposes alone or for teaching should there be an attack.
- In addition should the consent be signed.
- Should there be an information sheet for the patient and the risks of photic stimulation and hyperventilation in inducing a seizure.
- In the appendix section it includes one indication for an EEG being for risk stratification for the withdrawal of antiepileptic drugs. If photic stimulation was performed and a seizure was induced, a patient who had been seizure free could potentially be stopped from driving.
- Regarding the camera: Should there be a minimum standard of 1 camera or 2 cameras. Often the orientation of the camera is recording the patient's behaviour from the side. Should there be a recommendation regarding the orientation of the camera such that it is recording of a full frontal face or a full frontal body for instance.
- Regarding the qualifications for the health care staff recording of the EEG, this should be alluded to. It should be accepted that in the Western world those qualifications may differ from the developing world.
- Should there be a minimum standard of the number of EEGs that a physiologist has recorded before they are recording EEGs independently. This is an important aspect of quality control.
- The same arguments should be made regarding reporting of EEGs. This study goes into little detail as regards the reporting of an EEG. Is a 6 month fellowship a sufficient qualification for reporting EEGs?
- There was some discussion and recommendations regarding how much data to keep. It recommended keeping all the EEG and also clips of video-EEG of attacks. It was also discussed how long a routine EEG should continue for. However it does not discuss how long the raw data should be kept.
- In the transferring of data issues such as security and passwords need to be documented.
- There was no discussion as regards back up of data. In modern times data is often going to a single server that is backed up. This was lacking in this paper.
24 June 2022
3.2.1. Replace 10-20 array with 10-10 array where referencing the subtemporal electrode chain.
3.2.1 Replace "may" with "must" use one channel to record ECG.
3.2.1 Eye lead placement to distinguish eye movement artifacts from frontal slowing should be placed in suborbital locations to demonstrate in phase or out of phase potentials compared to FP1 and FP2.
3.2.2 3.2.2 See ASET's Skin Safety Guideline https://www.aset.org/wp-content/uploads/2022/01/Skin-Safety-During-EEG-Procedures-–-A-Guideline-to-Improving-Outcome-Addendum-Neonatal-Continuous-EEG.pdf
126.96.36.199 Consider moving contraindications for HV here instead of 188.8.131.52.
184.108.40.206 Consider moving contraindications for HV and photic stimulation here instead of 220.127.116.11.
3.5.4 Replace technician with technologist see Definition of a Qualified Neurodiagnostic Technologist: https://www.aset.org/wp-content/uploads/2022/01/Definition-of-a-Qualified-Neurodiagnostic-Technologist.pdf
18.104.22.168 Replace technician with technologist see Definition of a Qualified Neurodiagnostic Technologist: https://www.aset.org/wp-content/uploads/2022/01/Definition-of-a-Qualified-Neurodiagnostic-Technologist.pdf
23 June 2022
I would like to comment the following:
- We have great success with partial sleep deprivation in kids younger than 12 years of age.
- In our setting we only use melatonin for EEG sedation and find having parents sleep deprive ADHD and autistic kids over a few days help with achieving sleep. This can only happen with co-operation from parents.
- I agree with Aleksei Rakitin about having an alarm or a bell to call for help when the patient is having a seizure i.e in our setting for the nurse to assist mum or caregiver who comes with the child.
15 June 2022
I have several comments regarding general safety issues of routine/sleep EEG.
- Routine-EEG room should be equipped with an alarm button for a case in which the patient has a seizure and the nurse is at that moment alone with the patient. The nurse should have the possibility to call for help without leaving the patient alone during the seizure or post-seizure confusion. Additionally, what is opinion of the working group regarding the availability of i/v diazepam/midazolam in a routine EEG room? This could be needed for stopping long seizures (more than 5 min) or in the case of postictal aggressive behavior.
- Should the patient be monitored by the nurse or technician during sleep-EEG? Usually, during sleep-EEG the patient is alone in the room for hours (in our center 4 h), and with sleep-deprivation there is a small risk to provoke a seizure. The working group stated that there are no studies evaluating the safety of partial or full sleep deprivation. What about the risk of SUDEP or trauma during seizure or postictal confusion? From my experience every year we have at least 2-3 seizures during sleep-EEG.
13 June 2022
Routine eeg should be 40 min. And filter setting HFF-70Hz and LFF -1 Hz. Notch always on. And Do eye open and eye close for 20 sec and do HV and after hV 20 min for sleep.
9 June 2022
Any recommendations on doing hyperventilation during the COVID pandemic? Mask or no mask? Do you require all patients for prolonged EEG to have prior negative RT PCR or antigen testing?
Does photic stimulation require eyes to be open?
9 June 2022
Please could table 2 state “ Clinical suspicion of epileptic seizure or epilepsy” rather than “Clinical suspicion of seizure or epilepsy”? Seizure is still used in many contexts to generically mean episodes including non-epileptic seizures. Using epileptic seizure I think would help affirm the intended indication for EEG, and reduce chance that EEG is done for any seizure. For example, not indicated for reflex anoxic seizures, non-epileptic seizure, syncope with seizure components, etc.
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