Oleh :

Ras Syahril Rasyad

Bagian Saraf RSMH
Fakultas Kedokteran UNSRI
Palembang

The EEG As A Diagnostic Aid

EEG is used in the evaluation of:

Infectious diseases of the nervous system

Head trauma
Cerebral vascular accidents
Epilepsy
Brain tumors

EEG can also contribute as:

An indicator of brain function in metabolic

disorders
Evaluation of organic causes of psychiatric
problems
Evaluation of behavioural and adjustment
problems of children

Good EEG can be a valuable aid to the

physician.
Diagnosis cannot be made by EEG
alone and bad EEG practices are worse
than no EEG at all.

Hans Berger brain waves come from

cortical nerve cells
Can be recorded in graph form as the
Encephalogram with appropriate
techniques.
Technicals difficulties every potential
recorded with the EEG should be
considered an artefact until proven
otherwise

A talent for pattern recognition is essential

ability to discriminate actual and
artefactual.
Physical environment of the laboratory also
contributes to the ease in which the highest
standard of recording can be obtained.
Technologist should be capable of most of
aspects needed for the advantageous to the
individual patient.

Personal cleanliness

Hands should be washed thoroughly before

and after contact with the patient.
Long and unruly hair should be tied or
pinned back or kept in place with a hair
net.
Heavy perfumes should be avoided .
Nails should be trimmed and clean.
Ties and sashes should be well secured to
prevent flapping over the patient lying on a
bed or stretcher.

Jewelry should be avoided especially long

necklaces and jangling bracelets.
A clean uniform or lab coat should be worn
daily and where white clinical shoes are
worn they should be cleaned regularly.
Nylon uniforms, slips and shirts should be
avoided because they accumulate static
charges.

Laboratory

Utensils : Dividers, measuring tapes,

electrodes, and all equipment coming into
contact with the patient should be clean
and readily available all times.
Linen : Whilst the ideal would be to change
all bed linen after each patient, this is not
always possible because of restricted linen
supplies in some hospitals and laboratories.

Equipment and instruments

Cleaning of machine pens and ink wells

should be done regularly to ensure good
performance.
Recorder casing and plug box should be
cleaned daily to remove splattered ink,
spilled electrode creams, etc.

Relating to the patient

Greet the patient cheerfully and always

call him by name.
Accomodate his physical comfort as far as
is possible.
Explain clearly and precisely what an EEG
is, but do not confuse or baffle him with
medical or electronic jargon.

Explain to the patient the things that will be

required of him during the test.
Never discuss the competence or
incompetence of any member of the medical
staff with, or in front of, a patient.
Never discuss one patient with another.
Never discuss the finding of the EEG with the
patient.
When taking a history from the patient, be
discreet.

When activation procedures such as

hyperventilation, photic stimulation or sleep are
to be performed, explain carefully what is
required of the patient and mention some side
effects he may experience, but do not alarm
him.
Smoking, this should be prohibited for the
patient and the technologist.
With children, gentle assurance is essential, and
making the procedure a game is often helpful .

Tact, patience and pleasantness are the

cardinal rules with all patients.
Should you require the assistance of a
nurse, physician or orderly in dealing with
agitated or extremely ill patient, arrange
your schedule to meet the situation.
Respect the privacy of the patient.

Emergency situation and procedures

It is essential that each technologist be aware

of the laws governing his or her situation
before attempting to administer to, or deal
with, any of the following situation.

During a seizure

Do not leave the patient under any

circumstances.
The patient should be turned on his side if
possible.

The EEG machine should be kept running

throughout the seizure.
Do not try to pry the mouth in an attempt to
insert a gag or padded tounge blade.
Tight clothing should be loosened, if
necessary.
The technologist should observe and
remember the clinical manifestations of the
attack, the time and duration of the seizure,
and any precipitating factors.

In general

An accurate account of the clinical

manifestations and their order of occurence
and cessation should accompany the EEG
and a copy should be forwarded to the
referring physician or hospital chart.
If anti-convulsant medication has been
administered to arrest the seizure, the
name of drug, the time of administration
and the dosage should be recorded.

Important guidelines for observing and

recording seizures:

Ictal, Especially Onset of Seizure

Movement of limbs, onset and lateralization of

jerking, if any?
Deviation of head and/or eyes?
Dilatation or constriction of pupils?
Changes in skin colour?
Chewing or grinding of teeth?
Salivation
Loss of consciousness? (What evidence did patient
respond to questions?)
Urinary or fecal incontinence?

Post Ictal, Note Time and Details of:

Assesment of return of awareness or

consciousness, i.e. combative, drowsy but
responsive, fully alert, able to speak or
comprehend, i.e. name objects, follow
commands.
Behaviour of patient, i.e. restless automatic
movements.
Memory of attack, awareness of an aura.
Clinical complaints, i.e. headache, nausea.

Cardiac and/or respiratory arrest

Ensure a clear airway (insert airway if

available). Remove dentures if present.
Call for help but do not leave the patient.
Administer artificial respiration (mouth-tomouth) and external cardiac resuscitation
if you are qualified to do so. You should be.

Descriptive terminology
Since the wave patterns and frequencies
recorded by the EEG are believed to be a
result of fluctuation of extracellular
currents generated by cortical cells and
modified by midbrain-diencephalic
activity a constanly changing and often
complex picture evolves.
The EEG may present widespread or
localized abnormalities.

The following terminology is often used in

the description of the changes which may
occur; fusing of frequencies, variations
in amplitude, synchrony and symmetry
and complex harmonics are but a few of
the possiblities.

Amplitude

Height or distance from baseline to the top of a

wave or complex.
The maximum departure of the value of an
alternating current or wave from the average value.

Amorphous

Arrhythmic

No rhythmic, irregularly varying in occurence

Bilateral Synchrony

Having no definite form

Without developed structural organization

A discharge with primary origin in subcortical

structures, appearing more or less symmetrically
and synchronously from both hemispheres.

Bilateral

From both sides (hemisphere).

Biphasic

Bipolar

one negative and one

2

From two poles, as a magnet or battery +.

Burst

Having two phases,

positive.

A sudden emegence or braking through of other

frequencies.

Centrencephalic

Originating in centrencephalic structures or

diencephalon.

Continuous

Contralateral

Cycles per second.

Hertz (HZ)

Diffuse

The opposite side.

C.P.S.

Without stop, present throughout the record.

From all areas of the head

Dominant

Uppermost. Most marked or obvious. Paramount.

Dysrhytmic

Epileptogenic

Arising from disturbed brain tissue, causing epiliepsy.

Epileptoform

Having no rhytm, frequently a fusing of more than two

frequencies. Term often used to describe a record with
excessive slow or fast activity.

Resembling wave forms often associated with the

diagnosis of epilepsy such as spike or spike an wave
bursts.

Episodic

A set or group of waves that stand out or apart from

others at a particular time.

Fluctuating

Focal

The area closest to the source of the electrical

field whose potential gradients are being
measured. Restricted to one brain region.

Frequency

Constantly changing.

The number of cycles unit of time.

Generalized

From all regions of the head.

Homologous

Ipsilateral

On the same side.

Isoelectric

Having the same relative position, proportion,

value or structure. (In the other hemisphere).

Having the same or no electrical potential; as,

isoelectric points.

Lateralized

Affecting one hemisphere only.

Localized

Monopolar

From a single pole. Old term now replaced by

referential electrode recording.

Paroxysmal

Circumscribed area as in a focus.

The sudden appearance of a wave group of waves

from a relatively oraganized background, and
subsiding quickly.

Periodic

Occuring at regular intervals. E.g. every 1-2

seconds.

Polymorphic

Rhytm

Regularity of flow of movement in time. Marked

regular occurence or alteration in feature.

Semi-rhytmic

Occuring in varying forms with many shapes

and configurations.

Not fully rhytmic.

Sinusoid

A curve of sines, S-shaped

Symmetry

Synchrony

Passing quickly from existence. Shifting and changing in

form and appearance.

Unilateral

Degree of correspondence of phase of waveforms between

two points.

Transient

Degree of correspondence in size and shape between two

points.

Restricted to or appearing only on one side (hemisphere).

Voltage

An electrical potential or potential difference expressed in

volts. Often used colloquially to the amplitude of a waveform
or discharge.

The most common causes of electrode

artefacts are as follows:

Poorly or unevenly chlorided electrodes.

Poor application.
Faults in the electrode construction.
Frayed wires.
Poor connections either at the shank or disc.
Poor (unequal) inter-electrode scalp
ressistances.

Physiological artefacts

Pulsation
EKG
Eye movement

CHEMICAL
Hyperventilation
Most misinterpreted procedure in EEG. Major use in
activating 3/sec. Spike and wave bursts.
Metrazol-Megimide Injection
Major use in activating focal seizures with aura, as
presurgical work-up.
Miscellanous

PHYSICAL SENSORY
Photic Stimulation
May induce: (1) Recruiting (Driving)
(2) Photo myoclonic response
(3) Photo convulsive response
Limited value in diagnosis because of wide overlap between
normal and epileptic responses.

PHYSICAL-CYCLIC
Sleep
Valuable activation procedure for spike foci primarily, but
useful in provoking many abnormalities. Drowsiness and
light sleeo are most useful stages.
Sleep deprivation