Using EEG in a Consultative Role

ABSTRACT

The electroencephalogram (EEG) is a long-used tool assisting health care providers with the diagnosis, management, and treatment of various neurological disorders. This article highlights several scenarios in which a consultant may utilize the routine EEG in managing specific neurological cases. Eight case scenarios from a tertiary referral hospital are presented for the reader's consideration. Scenarios selected are new-onset seizures, encephalopathy, syncope, dementia, brain death, hypoxic-ischemic encephalopathy, status epilepticus, and migraine. A history in each condition is presented and is followed by a discussion of how useful an EEG may be in these specific situations. These eight cases highlight specific learning points where the EEG may be useful and how it can be practically incorporated into care of patients. Understanding how the EEG may be useful in the presented cases will allow the efficient and effective use of the EEG in similar clinical scenarios.

Electroencephalogram (EEG) - seizures/status epilepticus - dementia - syncope - brain death - encephalopathy

REFERENCES

• 1 Cooper R, Osselton J W, Shaw J C. Origins of the electroencephalogram. In: Cooper R, Osselton JW, Shaw JC, eds. EEG Technology 2nd ed. London: Butterworth 1974: 1-2
• 2 Klass D W, Westmoreland B F. General principles and adult electroencephalograms. In: Daube JR, ed. Electroencephalography New York: Oxford University Press 2002: 77-107
• 3 Niedermeyer E. Abnormal EEG patterns: epileptic and paroxysmal. In: Niedermeyer E, DaSilva EL, eds. Electroencephalography Basic Principles, Clinical Applications and Related Fields 4th ed. Baltimore: Williams & Wilkins 1999: 234-260
• 4 Hahn J S, Tharp B R. Neonatal and pediatric electroencephalography. In: Aminoff MJ, ed. Electrodiagnosis in Clinical Neurology 4th ed. Philadelphia: Churchill Livingstone 1999: 113-123
• 5 Klass D W, Westmoreland B F. Electroencephalography: general principles and adult electroencephalograms. In: Daube JR, ed. Clinical Neurophysiology 2nd ed. New York: Oxford University Press 2002: 77-107
• 6 Salinsky M, Kanter R, Dashieff R. Effectiveness of multiple EEGs in supporting the diagnosis of epilepsy: an operational curve.  Epilepsia . 1987;  28 331-334
• 7 Shin C. Prolonged video electroencephalography. In: Daube JR, ed. Clinical Neurophysiology 2nd ed. New York: Oxford University Press 2002: 129-135
• 8 Sharbrough F W, Messich J M, Sundt T M. Correlation of continuous EEG with blood flow measurements during carotid endarterectomy.  Stroke . 1973;  4 674-684
• 9 Benson F D, Blumer D. EEG evaluation of the patient with dementia. In: Benson FD, Blumer D, eds. Psychiatric Aspects of Neurological Diseases Vol. 1. New York: Grune & Stratton 1975: 63-82
• 10 Brenner R P, Reynolds C F, Ulrich R F. EEG findings in depressive pseudodementia and dementia with secondary depression.  Electroencephalogr Clin Neurophysiol . 1989;  72 298-304
• 11 Cummings J L, Benson F D. Laboratory aids in the diagnosis of dementia. In: Cummings JL, Benson FD, eds. Dementia: A Clinical Approach Boston: Butterworth-Heinemann 1992: 347-362
• 12 Verma N P, Greiffenstein M P, Verma N, King S D, Caldwell D L. Electrophysiologic validation of 2 categories of dementia: cortical and subcortical.  Clin Electroencephalogr . 1987;  18 26-32
• 13 Brenner R P, Shaul N. Periodic EEG patterns: classifications, clinical correlation and pathophysiology.  J Clin Neurophysiol . 1990;  7 249-267
• 14 Chiaflo N, Fuentes A, Galvez S. Serial EEG's: findings in 27 cases of Creutzfeldt-Jakob disease.  Arch Neurol . 1980;  37 143-145
• 15 Lee R G, Blair R DG. Evolution of EEG and visual evoked response changes in Creutzfeldt-Jakob disease.  Electroencephalogr Clin Neurophysiol . 1973;  35 133-142
• 16 Levy S R, Chiappa K H, Burke C J, Young R R. Early evolution and incidence of electroencephalographic abnormalities in Creutzfeldt-Jakob disease.  J Clin Neurophysiol . 1986;  3 1-21
• 17 Daly D D, Pedley T A. Epilepsy and syncope. In: Daly DD, ed. Current Practice of Clinical Electroencephalography 2nd ed. New York: Raven Press 1979: 269-334
• 18 DeMaria A A, Westmoreland B F, Sharbrough F W. EEG in cough syncope.  Neurology . 1984;  34 371-374
• 19 Asokan G, Pareja T, Niedermeyer E. Temporal minor slow and sharp EEG activity and cerebral vascular disorder.  Clin Electroencephalogr . 1987;  18 201-210
• 20 Drake M E, Huber S J, Pakalnis A, Denio L C. Computerized EEG spectral analysis in migraine and tension headaches.  J Clin Neurophysiol . 1987;  4 301
• 21 Gibbs F A, Gibbs E L. Atlas of Electroencephalography.  Vol. 3. Reading, MA: Addison-Wesley; 1964
• 22 Gorman M J, Welch K MA. Cerebral blood flow and migraine. In: Phillips JW, ed. The Regulation of Cerebral Blood Flow Boca Raton, FL: CRC Press 1993: 399-410
• 23 Westmoreland B. EEG in the evaluation of headaches. In: Niedermeyer E, DaSilva F, eds. Current Practice of Clinical Electroencephalography New York: Raven Press 1978: 381-394
• 24 American Electroencephalographic Society Guidelines in Electroencephalography, Evoked Potential, and Polysomnography.  J Clin Neurophysiol . 1994;  11 1-147
• 25 Buchner H, Schuchardt V. Reliability of electroencephalogram in the diagnosis of brain death.  Eur Neurol . 1990;  30 138-141
• 26 Brierley J B, Graham D H, Adams J H, Simpson J A. The threshold and neuropathology of cerebral “anoxic-ischemic” cell change.  Arch Neurol . 1973;  29 367-374
• 27 Pampliglione G. Seizures after resuscitation.  Electroencephalogr Clin Neurophysiol . 1964;  17 474
• 28 Van der Drift J H A. The EEG in cerebrovascular disease. In: Vinken PJ, Bruyn GW, eds. Handbook of Clinical Neurology Vol 11. Amsterdam: North Holland 1972: 267-291
• 29 Westmoreland B F, Klass D W, Sharbrough F M, Reagan T J. Alpha-coma. Electroencephalographic, pathologic and etiologic correlations.  Arch Neurol . 1972;  32 713-718
• 30 Hockaday J M, Potts F, Epstein E, Bonazzi A, Schwab R. EEG changes in acute cerebral anoxia from cardiac or respiratory arrest.  Electroencephalogr Clin Neurophysiol . 1965;  18 575-586
• 31 Engle J. Status epilepticus. In: Engle J, ed. Seizures and Epilepsy Philadelphia: FA Davis 1989: 256-280