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  • VA EEGs
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Ordering EEGs
  • EEGs and evoked potentials are ordered through CPRS.
  • Bring up the consult order form and look under the "Neurology Procedures" section.
  • Include information about why the study is being ordered. "Seizures" doesn't count. Put in either a description of the spell, the diagnosis you are trying to confirm or rule out, etc.
  • If you ordering SSEPs (somatosensory evoked potentials) put in which limb(s) you want.
  • For any in house EEG request, please let Sue know as early as possible in the day.
  • In the vast majority of cases, EEGs can't be obtained overnight or on weekends. In these cases, status epilepticus must be treated clinically, OR patient transfer arranged to UofM for LTM EEG.


Performing EEGs (and other Neurology procedures)
  • Sue is the technologist who does EEGs and evoked potential studies. Her office is B447 (2 doors down from the resident room).
  • EEGs can be performed most days of the week, but check with Sue if you have a specific day you want an EEG performed.
  • Evoked potential studies are only done on certain days. Check with Sue for the schedule.


Reading EEGs
  • The senior resident is expected to read EEGs throughout the month.
  • The EEG reading room is at the end of the hall in the Neurology offices area on the 4th floor.
  • There are 2 computers in the reading room:
    1. One with internet access and CPRS access. It works like all the other computers in the VA. Login as you would for any other VA computer.
    2. One with the EEG program (NicVue) on it. This computer is not connected to the internet and does not have CPRS.
  • When Sue has performed an EEG, she will leave a consult sheet in the bottom right desk drawer (red folder).
  • Login to the EEG computer using the ID and password you can get from Sue.
  • The EEG program is very similar to the EEG program at the U except for a few minor differences. The one major difference is marking the EEG.
  • To make a mark in the EEG:
    1. Drag one of the boxes from the right hand corner of the screen to the point in the EEG you want to mark.
    2. A window will open where you can type in your comment. If you chose the comment box, it will be blank except for what you write. If you chose another box, it will leave the predetermined name in place such as "Seizure - whatever you typed".
    3. To delete a comment, right click on the box on the EEG and select "delete".
    4. When you are done reading an EEG, save the EEG if you made comments that you want to leave in place for when you staff later.
  • It's a good idea to keep notes on the EEGs you read, either on paper or in an unsigned note on CPRS.


Staffing EEGs
  • EEGs at the VA can only be staffed with certain approved attendings:
    • Jack Parent (the primary EEG staffing attending at the VA)
    • Bill Stacey
  • Talk to Dr. Parent to arrange a time to staff EEGs; he will staff about once every 2 weeks.
  • If you need an emergent review of an EEG:
    1. Print out the portion of the EEG that is concerning (cntrl + print-screen, paste into Paint document, then print)
    2. Fax the printouts to Dr. Parent or another epilepsy attending if he is not available.  Make sure there is no patient information visible anywhere on the item you are faxing.
  • You should make every effort to staff all EEGs by the end of the month.
  • If is ok to pass off 1-2 EEGs if:
    1. They were performed on the last 1-2 days.
    2. Dr. Parent was not available to staff in the last days of the month.
    3. You are moving on to a difficult month (i.e. consult senior or ward senior).
  • It is not ok to leave more than 1-2 EEGs for the next senior to read.
  • If you have several EEGs left to read and/or staff, this must be done on your own time during your next rotation.
  • When you have staffed the EEGs and put the report into CPRS, please place the EEG consults in Sue's office B447 (can slide under the door). This is how she will know the EEG has been read.


EEG reports

1. Create new note, "EEG consult"; associate it with the EEG order.

2. Write the report according to the template, below.

3. Once the note is done, Click on the "Change" button in the upper right hand corner of the note.

4. Change the author to the attending. You may have to reassociate the note with the EEG consult (button in bottom left of the window, re-click the old EEG order).

5. Right click on note and click "edit encounter information", put in a diagnosis on left upper box (AMS, epilepsy, spell, etc) and also the EEG procedure on the middle upper box (length of EEG, awake vs. asleep, etc). 

6. Save without signature; once you do this, you will no longer no able to access/edit the note.

Use the following template for your EEG notes:
VA EEG Template

Date of EEG:
Date of EEG read by the resident:
Date of EEG read by the staff neurologist:

Brief History:

Medications:

States observed: awake, drowsy, <_____> and asleep

Background: The background during quiet wakefulness consists of a mixture of frequencies, including a symmetric, well-modulated and reactive <___> Hz rhythm. The dominant rhythm is intermixed with some low-voltage fast activity and scattered theta elements.

  • With drowsiness, there is dropout of the alpha rhythm and theta frequency activity becomes more conspicuous over midline regions. No focal features or asymmetries are present (or describe abnormalities).
  • With sleep, slow activity becomes more conspicuous and symmetric vertex waves and sleep spindles appear over the midline.  No focal features or asymmetries are present (or describe abnormalities).

Abnormal findings: <_____> none

Photic stimulation: <_____> symmetric photic driving

Hyperventilation: <_____> physiologic slowing

Clinical observations: <_____> no events

EKG findings: <_____> normal sinus rhythm

Interpretation: Normal EEG. No evidence of neuronal dysfunction, epileptiform discharges, or seizures were recorded. <_____> Abnormal EEG.

This report was written by <____> for Jack Parent MD, who personally reviewed the EEG tracing and formulated the interpretation.

 

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