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http://dx.doi.org/10.15324/kjcls.2021.53.4.296

Common Practices in Clinical Electroencephalography  

Hyun, Soon-Chul (Department of Neurology, Samsung Medical Center)
Kim, Dongyeop (Department of Neurology, Samsung Medical Center)
Publication Information
Korean Journal of Clinical Laboratory Science / v.53, no.4, 2021 , pp. 296-308 More about this Journal
Abstract
Electroencephalography (EEG) provides the most accurate and quickest diagnosis of epilepsy. It is also an important examination for the real-time evaluation of brain function and seizures, no matter where. In the field of epilepsy, it is appropriate for a clinical pathologist with considerable knowledge of EEG and clinical experience to perform the role of a Physician Assistant (PA). The electrode attachment method is based on the international 10-20 system. The EEG reading is mainly taken by longitudinal bipolar montage. However, a reading using only one montage may result in an error. Hence, two or more montages should be used for readings according to the clinical situation. In the EEG, electric potentials are seen as contour lines. The most important principle in EEG reading is under-reading, not over-reading. The higher the repetitions of the EEG recording, the greater the sensitivity of the reading. For a good reading, the EEG recording must be of good quality. So, the relationship between the neurologist and the EEG technician is very important. In the future, it is expected that the field of activities of the EEG technician with abundant EEG reading experience and clinical practical knowledge will be further expanded.
Keywords
Electroencephalography; Epilepsy; Montage; Seizure; Under-reading;
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1 Gonzalez-Martinez J, Bulacio J, Alexopoulos A, Jehi L, Bingaman W, Najm I. Stereoelectroencephalography in the "difficult to localize" refractory focal epilepsy: early experience from a north american epilepsy center. Epilepsia. 2013;54:323-330. https://doi.org/10.1111/j.1528-1167.2012.03672.x   DOI
2 Jung JW, Kim SE, Lee TY, Heo K. The relationship between febrile convulsion and temporal lobe epilepsy: is febrile convulsion a preferential association with temporal lobe epilepsy? J Korean Neurol Assoc. 2000;18:409-413.
3 Fountain NB, Van Ness PC, Swain-Eng R, Tonn S, Bever CT Jr. American academy of neurology epilepsy measure development panel and the American medical association-convened physician consortium for performance improvement independent measure development process. Quality improvement in neurology: AAN epilepsy quality measures: report of the quality measurement and reporting subcommittee of the american academy of neurology. Neurology. 2011;76:94-99. https://doi.org/10.1212/WNL.0b013e318203e9d1   DOI
4 Schaul N. The fundamental neural mechanisms of electroencephalography. J Clin Neurophysiol. 1998;106:101-107. https://doi.org/10.1016/S0013-4694(97)00111-9   DOI
5 Benbadis SR, O'Neill E, Tatum WO, Heriaud L. Outcome of prolonged video-EEG monitoring at a typical referral epilepsy center. Epilepsia. 2004;45:1150-1153. https://doi.org/10.1111/j.0013-9580.2004.14504.x   DOI
6 Benbadis SR, Lin K. Errors in EEG interpretation and misdiagnosis of epilepsy. Eur Neurol. 2008;59:267-271. https://doi.org/10.1159/000115641   DOI
7 Benbadis SR, Tatum WO. Overinterpretation of EEGs and misdiagnosis of epilepsy. J Clin Neurophysiol. 2003;20:42-44.   DOI
8 Wennberg R, Valiante T, Cheyne D. EEG and MEG in mesial temporal lobe epilepsy: where do the spikes really come from? J Clin Neurophysiol. 2011;122:1295-1313. https://doi.org/10.1016/j.clinph.2010.11.019   DOI
9 Coyne MF. Technical tips: polarity and localization. Am J Electroneurodiagnostic Technol. 2005:45:262-270. https://doi.org/10.1080/1086508X.2005.11079543   DOI
10 Koo DL, Seo DW. Intraoperative and extraoperative neurophysiological monitoring in epilepsy surgery. J Intraoper Neurophysiol. 2021;3:16-22. https://doi.org/10.33523/join.2021.3.1.16   DOI
11 Kennedy JD, Schuele SU. Neocortical temporal lobe epilepsy. J Clin Neurophysiol. 2012;29:366-370. https://doi.org/10.1097/WNP.0b013e31826bd78b   DOI
12 Glover JR, Raghaven N, Ktonas PY, Frost JD. Context-based automated detection of epileptogenic sharp transients in the EEG: elimination of false positives. IEEE Trans Biomed Eng. 1989;36:519-527. https://doi.org/10.1109/10.24253   DOI
13 Kim KD, Kim KD, Cho YW, Kang BG, Choi JH, Sohn SI, et al. Subdural strip electrode studies in temporal lobe epilepsy: relation between interhemispheric propagation time and surgical outcome. J Korean Neurol Assoc. 2002;20:497-503.
14 Abel TJ, Osorio RV, Amorim-Leite R, Mathieu F, Kahane P, Minotti L, et al. Frameless robot-assisted stereoelectroencephalography in children: technical aspects and comparison with Talairach frame technique. J Neurosurg Pediatr. 2018;22:37-46. https://doi.org/10.3171/2018.1.PEDS17435   DOI
15 Heo SH, Park HI. Depression and anxiety in the epileptic patients: the association with demographic and seizure-related variables. J Korean Neurol Assoc. 2009;27:375-383.
16 Cockerell OC, Johnson AL, Sander JWAS, Hart YM, Shorvon SD. Remission of epilepsy: results from the national general practice study of epilepsy. Lancet. 1995;346:140-144. https://doi.org/10.1016/S0140-6736(95)91208-8   DOI
17 Bearden S. EEG reviewing/recording strategy. Am J Electroneurodiagnostic Technol. 2007;47:1-19. https://doi.org/10.1080/1086508X.2007.11079605   DOI
18 Abraham K, Marsan CA. Patterns of cortical discharges and their relation to routine scalp electroencephalography. Electroencephalography and Clin Neurophysiol. 1958;10:447-461. https://doi.org/10.1016/0013-4694(58)90006-3   DOI
19 Jr Engel J. ILAE classification of epilepsy syndromes. J Epilepsy Res. 2006;70:5-10. https://doi.org/10.1016/j.eplepsyres.2005.11.014   DOI
20 Berg AT, Berkovic SF, Brodie MJ, Buchhalter J, Cross JH, Boas WVE, et al. Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE commission on classification and terminology, 2005-2009. Epilepsia. 2010;51:676-685. https://doi.org/10.1111/j.1528-1167.2010.02522.x   DOI
21 Swinkels WA, Kuyk J, Spinhoven. Psychiatric comorbidity in epilepsy. Epilepsy Behav. 2005;7:37-50. https://doi.org/10.1016/j.yebeh.2005.04.012   DOI
22 Tatum WO, Rubboli G, Kaplan PW, Mirsatari SM, Gloss D, Caboclo LO, et al. Clinical utility of EEG in diagnosing and monitoring epilepsy in adults. J Clin Neurophysiol. 2018;129:1056-1082. https://doi.org/10.1016/j.clinph.2018.01.019   DOI
23 Mullin JP, Shriver M, Alomar S, Najm I, Bulacio J, Chauvel P, et al. Is SEEG safe? A systematic review and meta-analysis of stereo-electroencephalography-related complications. Epilepsia. 2016;57:386-401. https://doi.org/10.1111/epi.13298   DOI
24 Sellers MC, Worrell AR, Andal ELC, Woods LR, Carlile JA, Wagner EE, et al. Technical tips: electrode application and preventing skin breakdown techniques. Am J Electroneurodiagnostic Technol. 2011;51:206-219. https://doi.org/10.1080/1086508X.2011.11079821   DOI
25 Schijns OEMG, Hoogland G, Kubben PL, Koehler PJ. The start and development of epilepsy surgery in Europe: a historical review. Neurosurg Rev. 2015;38:447-461. https://doi.org/ 10.1007/s10143-015-0641-3   DOI
26 Dekaban AS, Sadowsky D. Changes in brain weights during the span of human life: relation of brain weights to body heights and body weights. Ann Neurology. 1978;4:345-356. https://doi.org/10.1002/ana.410040410   DOI
27 Lee SY, Chung SE, Kim DW, Eun SH, Kang HC, Cho YW, et al. Estimating the prevalence of treated epilepsy using administrative health data and its validity: ESSENCE study. J Clin Neurol. 2016;12:434-440. https://doi.org/10.3988/jcn.2016.12.4.434   DOI
28 Acharya JN, Hani AJ, Thirumala P, Tsuchida TN. American clinical neurophysiology society guideline 3: a proposal for standard montages to be used in clinical EEG. J Clin Neurophysiol. 2016;56:253-260. https://doi.org/10.1080/21646821.2016.1245559   DOI
29 Speckmann EJ, Elger CE. Introduction to the neurophysiological basis of the EEG and DC potentials, In: Niedermeyer E. Electroencephalography: basic principles, clinical applications and related fields, 4th ed. Baltimore: Williams & Wilkins. 1999;15-27.
30 Kuratani J, Pearl PL, Sullivan L, Riel-Romero RMS, Cheek J, Stecker MM, et al. American clinical neurophysiology society guideline 5: minimum technical standards for pediatric electroencephalography. J Clin Neurophysiol. 2016;56:266-275. https://doi.org/10.1080/21646821.2016.1245568   DOI
31 Klass DW. The continuing challenge of artifacts in the EEG. Am J Electroneurodiagnostic Technol. 1995;35:239-269. https://doi.org/10.1080/00029238.1995.11080524   DOI
32 Hong SB, Jung KY. Basic electrophysiology of the electroencephalography. J Korean Neurol Assoc. 2003;21:225-238.
33 Buzsaki G, Traub RD, et al, The cellular basis of EEG activity. In: Ebersole JS, Pedley TA. Current practice of clinical electroencephalography, 3rd ed. Philadelphia: Lippincott Williams & Wilkins. 2003;1-11.
34 Hirsch LJ, Fong MWK, Leitinger M, LaRoche SM, Beniczky S, Abend NS, et al. American clinical neurophysiology society's standardized critical care EEG terminology: 2021 version. J Clin Neurophysiol. 2021;38:1-29. https://doi.org/10.1097/WNP.0000000000000806   DOI
35 Kim YS, Seo DW, Hong SB. Differential findings of ictal EEG pattern between mesial and neocortical temporal lobe epilepsies. J Korean Neurol Assoc. 1998;16:293-301.
36 Tatum WO, Dworetzky BA, Schomer DL. Artifact and recording concepts in EEG. J Clin Neurophysiol. 2011;28:252-263. https://doi.org/10.1097/WNP.0b013e31821c3c93   DOI
37 Sinha SR, Sullivan LR, Sabau D, Orta DSJ, Dombrowski KE, Halford JJ, et al. American clinical neurophysiology society guideline 1: minimum technical requirements for performing clinical electroencephalography. J Clin Neurophysiol. 2016;56:235-244. https://doi.org/10.1080/21646821.2016.1245527   DOI
38 Acharya JN, Hani AJ, Cheek J, Thirumala P, Tsuchida TN. American clinical neurophysiology society guideline 2: guidelines for standard electrode position nomenclature. J Clin Neurophysiol. 2016;56:245-252. https://doi.org/10.1080/21646821.2016.1245558   DOI
39 DeBurgo M. Alternative reference electrode placements. Am J Electroneurodiagnostic Technol. 2007;47:203-215. https://doi.org/10.1080/1086508X.2007.11079632   DOI
40 Tatum WO, Dworetzky BA, Freeman WD, Schomer DL. Artifact: recording EEG in special care units. J Clin Neurophysiol. 2011;28:264-277. https://doi.org/10.1097/WNP   DOI
41 Izac MSM. Basic anatomy and physiology of sleep. Am J Electroneurodiagnostic Technol. 2006;46:18-38. https://doi.org/10.1080/1086508X.2006.11079555   DOI
42 Tatum WO 4th. Antiepileptic drugs: adverse effects and drug interactions. Continuum Lifelong Learning Neurol. 2010;16:136-158. https://doi.org/10.1212/01.CON.0000368236.41986.24   DOI
43 Smith SJM. EEG in the diagnosis, classification, and management of patients with epilepsy. J Neurol Neurosurgery Psychiatry. 2005;76:ii2-ii7. http://doi.org/10.1136/jnnp.2005.069245   DOI
44 Halford JJ, Sabau D, Drislane FW, Tsuchida TN, Sinha SR. American clinical neurophysiology society guideline 4: recording clinical EEG on digital media. J Clin Neurophysiol. 2016;56:261-265. https://doi.org/10.1080/21646821.2016.1245563   DOI
45 Cockerell OC. The mortality of epilepsy. Curr opin neurol. 1996;9:93-96. https://doi.org/10.1097/00019052-199604000-00006   DOI
46 Oh DH, Park WG, Lee YJ, Kim HT, Kim SH. Kim JH, et al. Seizure-related injuries in epileptic patients. J Korean Neurol Assoc. 1998;16:474-479.
47 Josephson CB, Rahey S, Sadler RM. Neurocardiogenic syncope: frequency and consequences of its misdiagnosis as epilepsy. Can J Neurol Sci. 2007;34:221-224. https://doi.org/10.1017/S0317167100006089   DOI
48 Shorvon SD. The etiologic classification of epilepsy. Epilepsia. 2011;52:1052-1057. https://doi.org/10.1111/j.1528-1167.2011.03041.x   DOI
49 Sillanpaa M. Remission of seizures and predictors of intractability in long-term follow up. Epilepsia. 1993;34:930-936. https://doi.org/10.1111/j.1528-1157.1993.tb02114.x   DOI
50 Benbadis SR, Tatum WO, Vale FL. When drugs don't work: an algorithmic approach to medically intractable epilepsy. Neurology. 2000;55:1780-1784. https://doi.org/10.1212/wnl.55.12.1780   DOI
51 Kwan P, Brodie MJ. Early identification of refractory epilepsy. N Engl J Med. 2000;342:314-319. https://doi.org/10.1056/NEJM200002033420503   DOI
52 Moon HJ, Kim KT, Kang KW, Kim SY, Koo YS, Lee SY. Epilepsy and mortality. J Korean Neurol Assoc. 2020;38:1-8. http://doi.org/10.17340/jkna.2020.1.1   DOI
53 Seeck M, Koessler L, Bast T, Leijten F, Michel C, Baumgartner C, et al. The standardized EEG electrode array of the IFCN. J Clin Neurophysiol. 2017;128:2070-2077. https://doi.org/10.1016/j.clinph.2017.06.254   DOI
54 Uldall P, Alving J, Hansen LK, Kibaek M, Buchholt J. The misdiagnosis of epilepsy in children admitted to a tertiary epilepsy centre with paroxysmal events. Arch Dis Child. 2006;91:219-221. https://doi.org/10.1136/adc.2004.064477   DOI
55 Seo DW. An easy style of EEG. 1st ed. Seoul: Koonja Publish; 2010
56 Gaitatzis A, Sander JW. The mortality of epilepsy revisited. Epileptic Disord. 2004;6:3-13.
57 Office of the President. 2020 [Internet]. Seoul: Office of the President [cited 2021 October 16]. Available from: https://www1.president.go.kr/petitions/586400.
58 Tatum WO 4th, Husain AM, Benbadis SR, Kaplan PW. Normal adult EEG and patterns of uncertain significance. J Clin Neurophysiol. 2006;23:194-207. https://doi.org/10.1097/01.wnp.0000220110.92126.a6   DOI
59 Suh HA, Kim SE, Yum MS, You SJ, Kim DS, Ko TS. Clinical indications and efficacies of video-electroencephalographic monitoring in the diagnosis and treatment of childhood epilepsy. J Korean Epilepsy Soc. 2006;10:118-124.