EEG in Suspected Syncope: Do EEGs Ordered by Neurologists Give a Higher Yield?

2009 ◽  
Vol 36 (6) ◽  
pp. 769-773 ◽  
Author(s):  
Laurence Poliquin-Lasnier ◽  
Fraser G. A. Moore
Keyword(s):  
Patient Management ◽  
Diagnostic Yield ◽  
Epileptiform Activity ◽  
Epileptic Activity ◽  
Loss Of Consciousness ◽  
Inclusion Criteria ◽  
Physician Specialty ◽  
Convulsive Syncope ◽  
Electroencephalogram Eeg ◽  
Abnormal Eegs

Background:Prior studies have shown that the electroencephalogram (EEG) is of low diagnostic yield in the evaluation of syncope but have not looked at the yield according to referring physician specialty. The goals of this study were to determine if the yield of the EEG is higher when ordered by neurologists and whether EEGs with abnormal findings resulted in any significant change in patient management.Methods:We retrospectively reviewed the records of the EEGs requested for a clinical diagnosis of syncope, convulsive syncope, loss of consciousness, or falls from 2003 to 2007 at our institution. We obtained further information from the medical record of patients with an abnormal EEG.Results:Of 517 EEGs meeting our inclusion criteria, only 57 (11.0%) were read as abnormal. No EEG was positive for epileptiform activity and only 9 (1.6%) showed potentially epileptic activity. EEGs ordered by neurologists did not have a higher yield compared to non-neurologists. Five abnormal EEGs resulted in further investigations being ordered. One patient was ultimately started on phenytoin.Conclusions:EEGs requested for the evaluation of patients with suspected syncope have an extremely low diagnostic yield and do not significantly alter the management of the patients, regardless of the specialty of the referring physician.

scholarly journals Depth Electrode Guided Anterior Insulectomy: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Mauricio Mandel ◽  
Layton Lamsam ◽  
Pue Farooque ◽  
Dennis Spencer ◽  
Eyiyemisi Damisah
Keyword(s):  
Right Hemisphere ◽  
Preoperative Evaluation ◽  
Epileptiform Activity ◽  
Neurological Deficits ◽  
Depth Electrodes ◽  
Depth Electrode ◽  
Patient Reported ◽  
Frontal Operculum ◽  
History Of ◽  
Electroencephalogram Eeg

Abstract The insula is well established as an epileptogenic area.1 Insular epilepsy surgery demands precise anatomic knowledge2-4 and tailored removal of the epileptic zone with careful neuromonitoring.5 We present an operative video illustrating an intracranial electroencephalogram (EEG) depth electrode guided anterior insulectomy.  We report a 17-yr-old right-handed woman with a 4-yr history of medically refractory epilepsy. The patient reported daily nocturnal ictal vocalization preceded by an indescribable feeling. Preoperative evaluation was suggestive of a right frontal-temporal onset, but the noninvasive results were discordant. She underwent a combined intracranial EEG study with a frontal-parietal grid, with strips and depth electrodes covering the entire right hemisphere. Epileptiform activity was observed in contact 6 of the anterior insula electrode. The patient consented to the procedure and to the publication of her images.  A right anterior insulectomy was performed. First, a portion of the frontal operculum was resected and neuronavigation was used for the initial insula localization. However, due to unreliable neuronavigation (ie, brain shift), the medial and anterior borders of the insular resection were guided by the depth electrode reference. The patient was discharged 3 d after surgery with no neurological deficits and remains seizure free.  We demonstrate that depth electrode guided insular surgery is a safe and precise technique, leading to an optimal outcome.

scholarly journals Reassessing the value of gastroscopy for the investigation of dyspepsia

2017 ◽  
Vol 9 (1) ◽  
pp. 62-66 ◽  
Author(s):  
Hey-Long Ching ◽  
Melissa F Hale ◽  
Reena Sidhu ◽  
Mark E McAlindon
Keyword(s):  
Patient Management ◽  
Diagnostic Yield ◽  
Evaluation Study ◽  
Service Evaluation ◽  
Proton Pump Inhibitor Therapy ◽  
Endoscopic Examination ◽  
Teaching Hospitals ◽  
Outpatient Basis ◽  
Non Invasive ◽  
Royal Hallamshire Hospital

ObjectiveTo evaluate the diagnostic yield of investigating dyspepsia with oesophagogastroduodenoscopy (OGD) with or without mucosal biopsy.DesignRetrospective service evaluation study.SettingTwo teaching hospitals: The Royal Hallamshire Hospital and Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, UK.Patients500 patients, 55 years of age and over, who underwent OGD to investigate dyspepsia were included. The study period included a 3-month window. All OGDs were performed on an outpatient basis.InterventionsData were extracted from electronic OGD records within the study period.Main outcome measuresDiagnostic yield provided by endoscopic examination and histological assessment.Results378 patients (75.6%) were reported to have some form of endoscopic abnormality, and 417 patients (83.4%) had biopsies taken. The most common findings at OGD were gastritis (47.2%) and oesophagitis (24.4%). Oesophagogastric malignancy was seen in 1%. Diagnoses made endoscopically or histologically that would not have been appropriately managed by empirical therapies were seen in 16.2%.ConclusionOGD in dyspepsia influences patient management in approximately one-sixth of cases. However, the majority of patients are sufficiently managed with Helicobacter pylori testing and eradication and/or a trial of proton pump inhibitor therapy. Further non-invasive approaches are needed to identify patients who need endoscopy for biopsy or therapy.

scholarly journals The impact of EEG in the diagnosis and management of patients with acute impairment of consciousness

2012 ◽  
Vol 70 (1) ◽  
pp. 34-39 ◽  
Author(s):  
João A. G. Ricardo ◽  
Marcondes C. França Jr. ◽  
Fabrício O. Lima ◽  
Clarissa L. Yassuda ◽  
Fernando Cendes
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Emergency Room ◽  
Medical Management ◽  
Clinical Management ◽  
Epileptiform Activity ◽  
Acute Setting ◽  
Diagnosis And Management ◽  
The Impact ◽  
Electroencephalogram Eeg

OBJECTIVES: To assess the frequency of electroencephalogram (EEG) requests in the emergency room (ER) and intensive care unit (ICU) for patients with impairment of consciousness (IC) and its impact in the diagnosis and management. METHODS: We followed patients who underwent routine EEG from ER and ICU with IC until discharge or death. RESULTS: During the study, 1679 EEGs were performed, with 149 (8.9%) from ER and ICU. We included 65 patients and 94 EEGs to analyze. Epileptiform activity was present in 42 (44.7%). EEG results changed clinical management in 72.2% of patients. The main reason for EEG requisition was unexplained IC, representing 36.3% of all EEGs analyzed. Eleven (33%) of these had epileptiform activity. CONCLUSION: EEG is underused in the acute setting. The frequency of epileptiform activity was high in patients with unexplained IC. EEG was helpful in confirming or ruling out the suspected initial diagnosis and changing medical management in 72% of patients.

Epileptic Encephalopathy in Adams–Oliver Syndrome Associated to a New DOCK6 Mutation: A Peculiar Behavioral Phenotype

2018 ◽  
Vol 49 (03) ◽  
pp. 217-221 ◽  
Author(s):  
Livia Pisciotta ◽  
Valeria Capra ◽  
Andrea Accogli ◽  
Thea Giacomini ◽  
Giulia Prato ◽  
...  
Keyword(s):  
Epileptiform Activity ◽  
Epileptic Encephalopathy ◽  
Compound Heterozygosity ◽  
Limb Defects ◽  
Aplasia Cutis Congenita ◽  
Scalp Defects ◽  
Brain Malformations ◽  
Limb Malformations ◽  
Electroencephalogram Eeg ◽  
Aplasia Cutis

AbstractAdams–Oliver syndrome (AOS) is characterized by a combination of congenital scalp defects (aplasia cutis congenita) and terminal transverse limb malformations of variable severity. When neurological findings are present, patients are reported as AOS variants. We describe a child with compound heterozygosity of the DOCK6 gene, aplasia cutis, terminal transverse limb defects, cardiovascular impairment, intellectual disability, and brain malformations with intracranial calcifications. He suffers from a severe refractory epileptic encephalopathy characterized by polymorphic seizures with prolonged periods of electroencephalogram (EEG), continuous epileptiform activity related to clinical inactivity, and closure of eyes with an “ON-OFF” behavior.

Short-Duration Epileptic Discharges Show a Distinct Phase Preference During Ongoing Hippocampal Slow Oscillations

2010 ◽  
Vol 104 (4) ◽  
pp. 2194-2202 ◽  
Author(s):  
Philip H. de Guzman ◽  
Farhang Nazer ◽  
Clayton T. Dickson
Keyword(s):  
Short Duration ◽  
Temporal Lobe ◽  
Slow Wave ◽  
Rem Sleep ◽  
Slow Wave Sleep ◽  
Epileptiform Activity ◽  
Epileptic Activity ◽  
Network Synchronization ◽  
State Dependent ◽  
Oscillatory Pattern

Non-REM (slow-wave) sleep has been shown to facilitate temporal lobe epileptiform events, whereas REM sleep seems more restrictive. This state-dependent modulation may be the result of the enhancement of excitatory synaptic transmission and/or the degree of network synchronization expressed within the hippocampus of the temporal lobe. The slow oscillation (SO), a ∼1 Hz oscillatory pattern expressed during non-REM sleep and urethane anesthesia, has been recently shown to facilitate the generation, maintenance, and propagation of stimulus-evoked epileptiform activity in the hippocampus. To further address the state-dependent modulation of epileptic activity during the SO, we studied the properties of short-duration interictal-like activity generated by focal application of penicillin in the hippocampus of urethane-anesthetized rats. Epileptiform spikes were larger but only slightly more prevalent during the SO as opposed to the theta (REM-like) state. More notably, however, epileptic spikes had a significant tendency to occur just following the peak negativity of ongoing SO cycles. Because of the known phase-dependent changes in 1) synaptic excitability (just following the positive peak of the SO) and 2) network synchronization (during the negative peak of the SO), these results suggest that it is the synchrony and not the changes in synaptic excitability that lead to the facilitation of epileptiform activity during sleep-like slow wave states.

scholarly journals Melatonin versus chloral hydrate as the sedating agent in performing electroencephalogram in paediatric patients

2017 ◽  
Vol 04 (01) ◽  
pp. 051-054 ◽  
Author(s):  
C. Yuen ◽  
W. Cherk ◽  
T. Fung ◽  
C. Ho ◽  
K. Chan ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Detection Rate ◽  
Chloral Hydrate ◽  
Epileptic Activity ◽  
Regional Hospital ◽  
High Quality ◽  
Safe Alternative ◽  
Chi Squared ◽  
Patients With Epilepsy ◽  
Abnormal Eegs

AbstractElectroencephalography (EEG) is a valuable tool in the diagnosis of epilepsy. The attainment of a high quality EEG requires patient's co-operation which is particularly difficult in children. Chloral hydrate has been used as a sedating agent in EEGs but it has potential serious adverse effects and anti-epileptic activity. Melatonin is used increasingly in different investigations as a safe alternative. Our study is to compare their effectiveness as sedating agents in performing EEGs and the detection rate of abnormal EEGs. This is a retrospective study performed in a regional hospital in Hong Kong. One hundred and ninety two EEG studies were included from December 2010 to July 2014. One hundred and two children were given chloral hydrate (50 mg/Kg) in the first half of the period and 90 children were given melatonin (3 mg for =< 5 years or 6 mg for >= 5 year) in the later half. The two groups are compared with Pearson's Chi-squared test with Yates’ continuity correction. The successful rate in sedation was similar between the two groups while the pick up rate of abnormal EEGs was 52.56% in the melatonin group and 21.57% in the chloral hydrate group (p < 0.05). Subgroup analysis among patients with epilepsy or mental retardation and intellectual disability shared same findings with higher detection rate of abnormal EEGs in the melatonin group. No side effect was documented in the study. Compare with chloral hydrate, melatonin is a safe and effective alternative and probably has less interference with the electrographic activity.

scholarly journals The neuropsychological outcomes of non-fatal strangulation in domestic and sexual violence: A systematic review.

2020 ◽  
Author(s):  
Helen Bichard ◽  
Christopher Byrne ◽  
Christopher W N Saville ◽  
Rudi Coetzer
Keyword(s):  
Acquired Brain Injury ◽  
Speech Disorders ◽  
Self Report ◽  
Loss Of Consciousness ◽  
Inclusion Criteria ◽  
Control Groups ◽  
Physiological Mechanisms ◽  
Ischaemic Injury ◽  
Neuropsychological Outcomes ◽  
And Control

This paper reviews the neurological, cognitive, psychological, and behavioural outcomes of non-fatal strangulation and, given shared physiological mechanisms, asks whether the hypoxic-ischaemic literature can serve as a proxy. 27 empirical, peer-reviewed studies meeting the inclusion criteria were found. Neurological consequences included loss of consciousness, indicating at least mild acquired brain injury, stroke, seizures, motor and speech disorders, and paralysis. Psychological outcomes included PTSD, depression, suicidality, and dissociation. Cognitive and behavioural sequelae were described less frequently, but included amnesia and compliance. Overall, the evidence suggested strangulation in IPV and sexual assault can share all the serious consequences of hypoxic-ischaemic injury, but carries additional neuropsychological burden. However, no papers used formal neuropsychological assessment: the majority were medical case studies, or based on self-report. There is therefore a need for further neuropsychological research, focusing on cognitive and behavioural outcomes, using standardised tools, and control groups where possible. This is urgent, given societal normalisation of strangulation, and consent to ‘rough sex’ being used as a legal defence. We also discuss broader implications: the popularity of the ‘choking game’ with teenagers, and carotid injuries within mixed martial arts.

scholarly journals A STUDY ON COMPARATIVE YIELDS OF STANDARD SHORT TERM ELECTROENCEPHALOGRAM AND LONG TERM ELECTROENCEPHALOGRAM RECORDING IN SUSPECTED EPILEPSY PATIENTS

2021 ◽  
Vol 71 (5) ◽  
pp. 1727-31
Author(s):  
Saima Shafait ◽  
Wasim Alamgir ◽  
Imran Ahmad ◽  
Saeed Arif ◽  
Jahanzeb Liaqat ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Extended Period ◽  
Final Analysis ◽  
Epileptiform Discharge ◽  
Military Hospital ◽  
Recording Time ◽  
Epileptiform Discharges ◽  
Interictal Epileptiform Discharges ◽  
Interictal Epileptiform Discharge ◽  
Electroencephalogram Eeg

Objective: To compare the yield of interictal epileptiform discharges on prolonged (1-2 hours) electroencephalogram (EEG) as compared to standard routine (30 minutes) electroencephalogram (EEG). Study Design: Comparative observational study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi from Oct 2019 to Sep 2020. Methodology: A total of 364 outdoor patients with suspected epilepsy were recruited for the study. Out of these 55 electroencephalograms were excluded after applying exclusion criteria and 309 were included for final analysis. Electro-encephalograms were recorded using a 10-20 international system of electrode placement. The duration of each standard electroencephalogram was 30 minutes. It was followed by recording for an extended period of 60 minutes at least. The time to the appearance of the first abnormal interictal epileptiform discharge was noted. For analytical purposes, epileptiform discharges were classified as “early” if they appeared within the first 30 minutes and as “late” if appeared afterward. All electro-encephalograms were evaluated independently by two neurologists. Results: A total of 309 electroencephalograms were included for final analysis. Interictal epileptiform discharges were seen in 48 (15.6%) recordings. The mean time to appearance of first interictal epileptiform discharge was 14.6 ± 19.09 minutes. In 36 (11.7%) cases, discharges appeared early (within the first 30 minutes) whereas in the remaining 12 (3.9%) cases, discharges appeared late. This translates into a 33% increase in the diagnostic yield of electroencephalogram with an extended period of recording. Conclusion: Extending the electroencephalogram recording time results in a significantly better diagnostic yield of outdoor electroencephalogram.

scholarly journals Peculiarities of organization of bioelectric brain activity in subclinical stage of epilepsy

2017 ◽  
Vol 25 (3) ◽  
pp. 399-403
Author(s):  
V. V. Sychev ◽  
V. N. Sychev ◽  
N. V. Shatrova
Keyword(s):  
Fourier Analysis ◽  
Right Hemisphere ◽  
Brain Activity ◽  
Epileptiform Activity ◽  
Clinical Manifestations ◽  
Bioelectric Activity ◽  
Left And Right ◽  
Electroencephalogram Eeg ◽  
The Brain

According to some authors, changes in the electroencephalogram (EEG) in the absence of clinical paroxysmal manifestations should be considered as subclinical epileptic manifestations. Verification of this hypothesis on the basis of the auto-spectral Fourier analysis of the EEG was the purpose of this work. Were examined in 27 women, mean age of 35.4±2.48 years, right-handed, without paroxysmal clinical and EEG manifestations (first group) and 25 women, mean age of 36.2±2.17 years, right-handed, without paroxysmal clinical manifestations, but with epileptiform activity on EEG (second group). In the second group were registered the increase in faverage of the brain EEG (p<0.001), while was increased faverage both of the left and right hemisphere (p<0.01). Zonal peculiarities of bioelectric activity of a brain of the second group surveyed was a significant increase in faverage EEG in all investigated leads (p<0.01), resulting in total liquidation of zonal differences (p>0.05). The results of the analysis allowed to conclude that the registration of the EEG epileptiform paroxysmal phenomena without clinical manifestations should be considered as a subclinical stage of epilepsy.

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