epilepsy – qEEGsupport.com

Electroencephalography (EEG) Underused Investigative Tool in Hospitals, Study Finds

A retrospective study of patients who had in-hospital electroencephalography (EEG) has established that EEG is a valuable tool that could be deployed more widely to identify treatable causes of impaired consciousness in the hospital setting.

The study is published in the April issue of the Mayo Clinic Proceedings.

Altered mental status (AMS) and paroxysmal spells of uncertain origin are common among hospitalized patients. Impaired consciousness can sometimes be linked to metabolic or cardiac causes, but some of these spells may represent seizures or non-convulsive epilepsy, which can be detected only by electroencephalography (EEG). Although EEG is the key test in making these diagnoses, it is relatively underused in the inpatient setting owing to lack of availability and neurologic consultation at many hospitals in the United States.

Electroencephalographic Cerebral Dysrhythmic Abnormalities in the Trinity of Nonepileptic General Population, Neuropsychiatric, and Neurobehavioral Disorders

Subclinical electroencephalographic epileptiform discharges in neurobehavioral disorders are not uncommon. The clinical significance and behavioral, diagnostic, and therapeutic implications of this EEG cerebral dysrhythmia have not been fully examined. Currently the only connotation for distinctive epileptiform electroencephalographic patterns is epileptic seizures. Given the prevailing dogma of not treating EEGs, these potential aberrations are either disregarded as irrelevant or are misattributed to indicate epilepsy. This article reappraises the literature on paroxysmal EEG dysrhythmia in normative studies of the healthy nonepileptic general populations, neuropsychiatry,
and in neurobehavioral disorders. These EEG aberrations may be reflective of underlying morpho-functional brain abnormalities that underpin various neurobehavioral disturbances.

Real the full article here – Electroencephalographic Cerebral Dysrhythmic Abnormalities in the Trinity of Nonepileptic General Population, Neuropsychiatric, and Neurobehavioral Disorders

(The Journal of Neuropsychiatry and Clinical Neurosciences 2008; 20:7?22)

Clinical Policy Bulletin: Quantitative EEG (Brain Mapping) from Aetna

Recently Released Clinical Policy Bulletin: Quantitative EEG (Brain Mapping) from Aetna

It is no surprise when insurance companies find ways to restrict what they will cover as a service for their clients, whether flood insurance liability insurance, or any other branch of this financial industry. This is especially true for medical insurance companies, which are always finding reasons to restrict payments.

This decision restricts the payment for a qEEG to be an extension of the analysis of an EEG analysis, which makes the qEEG a medical procedure requiring licensure adequate to provide credentials to do a medical EEG interpretation. If further restricts the payments to applications that match the American Academy of Neurology position paper, which approves the technique in vascular cases, encephalopathies such as dementia cases, or for epilepsy, as well as longer term EEG monitoring, where quantitative analysis allows the selection of segments for review visually, assisting the electroencephalographer in eliminating long time segments from detailed analysis.

Specifically restricted from payment are these applications:

How EEG can Show an Epileptogenic Process

This is the first of a few posts with a variety of ways the EEG can show an epileptogenic process. The morphology of the underlying process are quite dramatically varied.

The two images below show the referential and sequential montage display of an active right temporal-parietal spike and slow wave focus, seen in a child clinically diagnosed with an attachment disorder. There was no history of convulsion, nor any suspicion of the actual underlying pathophysiological basis for the behavioral presentation.

Epilepsy and EEG

Epilepsy and EEG have been inextricably linked since the 1930s, when Frederick and Erna Gibbs discovered that epileptic events were visible in the EEG. The evolution of other medical imaging in the 1970s and 1980s provided a better way to localize tumors, and the clinical use tapered off in areas other than epilepsy and encephalopathies. Even with the multiplicity of other methods, the EEG remains the gold standard for identification of epilepsy.

In modern neuroscience centers, the EEG is still the tool of choice in evaluation of convulsive epilepsy, as well as some other non-convulsive forms, such as staring episodes seen in “absence epilepsy” typically as a 3/second spike and wave dominant anteriorly, or temporal lobe epilepsy, which is seen as a “notched” slow wave discharge fronto-temporally.