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Seizures or behaviors.... How can we tell?

EEG tells the story of children and parents struggling with behaviors

page of EEG waveforms
EEG Seizure Activity

With so much of the world focusing on mental health and its affects, EEG has become an essential tool for physicians in determining an accurate treatment path. The EEG sample above is one case of an 8 year old with fits and behaviors of altered mental status, repetitive speech and unable to follow directions. These "fits" lasted from 60 seconds to 3 minutes and happened multiple times a day. The parents felt lost and scared. The patient could not help her "fits". Most clinical staff had the impression that these were behaviors. While waiting for a pediatric psych facility to accept transfer, an EEG was ordered as a "rule out" attempt to diagnose pseudo-seizure behavior.

As it turns out, this patient had focal motor seizures causing automatisms, speech disturbance, crying tantrum behaviors and partial response capabilities. If you are questioning a sudden change in behavior in a loved one or child, EEG is a non-invasive tool that can help your care team find answers.

As a technician, how do we help?

Tip #1 - Document it or it didn't happen

One of the first rules we have in healthcare is documentation. As trained EEG technicians, we know the history we get, if any, may lead to more questions than answers. Document what you see on the EEG. Document what you see the patient doing in the recording. Ask the questions that may help find the answers. How often does this happen? What time does this most frequently happen? Describe the events as the patient or family see them.

Tip #2 - Go back to basics

Age?- 8 years old, recognize age related patterns

Level of consciousness- awake, muscle artifact, eye movement, PDR (obscured by event in this sample)

Where is the activity happening? What channels? What part of the brain do these channels represent?- Right sided frontocentral focus, Frontal lobe controls personality and Broca's area that controls speech formation.

What is the patient doing? - repeating words and statements "where is my mom? open the door!" Sliding down the bed, crying and unresponsive to commands.

Is this a normal or abnormal pattern?- Abnormal

Verify the activity- Changing the montage can help us determine if the activity is real or artifact. If the activity stays in the same channels, most likely real. If it disappears, most likely artifact.

Tip #3 - Make it personal, but not too personal!

Relate to your patients and family. Explain what you are doing in terms they can understand. Read the room and make it a less stressful situation if you can. It's essential that a technician gains the trust of the patient and or caregivers. It allows us to get a better test for the physician and be a more effective part of the healthcare team. Don't go too far! Be sure to NOT give results or impressions of what you see to family, patients or other staff. Remember your role and certification or licensure.

Tip #4 - Patient care is what we are here for!

In this example, a family was faced with their young child being placed in a pediatric psychiatric facility. Staff and physicians alike were convinced this was behavior. EEG testing was added as an afterthought to "rule out" seizures. As it turned out, this was actually seizure behavior all along. Now this family can move forward with the proper treatment and a child gets a chance to not have a psychiatric record follow her into adulthood.

Tip #5 - It's not just arts and crafts.

Trained technicians delivering proper testing can mean the difference for the rest of someone's life. Take care and take pride in all that you do. Ask for help. Ask for a second opinion. Review physician reports, if you can, to see if you saw what the physician did. The best way we can help is to deliver top notch care to patients and families in their most vulnerable times. What we do and how we do it matters! Improper recording techniques can lead to incorrect diagnosis and cause hardship in the way of unnecessary medications and expensive follow up testing.

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