EEG technique and Treatment of Rolandic Epilepsy treatment?.

Looking at the EEG patterns periodically at certain time difference, could be week or month in between, Yamanashi and his colleague found that there is a repetitive high frequency EEG waveform abnormality that can be used to strategies for treatment?. Although, it is a brief study on small number of children's, EEG recordings and the abnormal waveform morphology is one of the or the only way to ascertain what to do with such epileptic patient, actually, while referring to the recent reviews in this field, I found this compelling review article   by Dr.Markand, MD (see at the bottom after the Yamanashi's work).

What was their research model and study is about:

A total of ten children between the ages of three and ten with recurrent seizures and 12 patients aged between four and seven years who experienced isolated seizures were enrolled in the study, with seizure recurrence and prolonged high-frequency EEG paroxysm data being correlated by the scientists.
Repeated EEG recordings were taken every three months, with clinical and EEG follow-up performed for four or more years. It was discovered that seizure recurrence and extended periods of high-frequency paroxysmal EEG abnormalities for more than 6 months after onset were significantly linked.

New study shows how EEG can aid rolandic epilepsy treatment

Posted May 21 2014 in epilepsy in children and its treatment

A new study from Japan has shed light on how electroencephalogram (EEG) techniques can be useful in aiding the treatment of patients with rolandic epilepsy.

This form of epilepsy is generally associated with favourable outcomes, with a moderate proportion of cases characterised by isolated seizure events, meaning continuous treatment need only be considered only for those affected by frequent seizures.

As such, the new research from the University of Yamanashi aimed to identify EEG criteria related to seizure recurrence in rolandic epilepsy, in order to help guide treatment strategies for those in this patient group.


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The review article that I mentioned above:

a good read to get the background idea of how the neurophysiologist, neurologist or clinicians can discern the EEG patterns:

Seminars in Neurology

Pearls, Perils, and Pitfalls In the Use of the Electroencephalogram

Omkar N. Markand, MD, FRCPC

 An EEG is the most common and most useful test performed in evaluating patients suspected of epilepsy. There are many areas where an EEG has unique contributions. The value of an EEG lies in the fact that it not only shows specific ictal discharges during a clinical seizure but also characteristic epileptiform abnormalities in a high proportion of epileptic patients even in the interictal period. Furthermore, an EEG may be the only test demonstrating focal abnormalities responsible for the patient's epileptic seizures. Specific patterns in the EEG make it possible to classify the seizure type, which is an essential prerequisite to institute proper antiepileptic medication. An EEG is indispensable for the diagnosis of nonconvulsive epileptic status presenting as prolonged "twilight" state or a prolonged episode of abnormal behavior. In a patient with bizarre motor activity, the recording of an EEG during such an episode may be the only way to establish whether the abnormal behavior is due to an epileptic seizure or a nonepileptic event, physiologic or nonphysiologic. Finally, the EEG is indispensable to localize the epileptogenic (seizure producing) zone before resective surgery (excision of the epileptogenic zone) is undertaken in a patient with medically refractory focal epilepsy.

Electroretinogram by Donnell J Creel

Figure Reference: Med.Utah.edu (linked, pl click)

In general, intraopertive neurophysiological monitoring teams do not conduct ERG or EOG in the Operating room set up, it is rather cumbersome and difficult to get a reliable readings combined with the difficulty of placing the recording electrode and risks that are associated with the procedure.  However, Donnell in its Chapter on"The electroretinogram" presents the latest developments that record the status of retinal function using skin electrodes and he also sheds light on the recent advancement in ERG the multifocal retiongram. Whether you are going to conduct this test or not, if you are interested in all the evoked potentials and the basics, this is an excellent reading material. Enjoy.

 The Electroretinogram: Clinical Applications by Donnell J. Creel

Electrophysiological testing of patients with retinal disease began in clinical departments in the late nineteen forties. Under the influence of the Swedish pioneers, Holmgren (1865) and Granit (1933), the electroretinogram was being dissected into component parts and early intraretinal electrode studies were beginning to tell which cells or cell layers gave rise to the various components. A detailed discussion of the electroretinogram, or ERG as it is commonly abbreviated, is found in the accompanying chapter by Ido Perlman. A little after the introduction of the ERG as a test of the state of the patient’s retina, another diagnostic test called the electrooculogram (EOG) was introduced to the clinic (Arden et al., 1962). The EOG had advantages over the ERG in that electrodes did not touch the surface of the eye. The changes in the standing potential across the eyeball were recorded by skin electrodes during simple eye movements and after exposure to periods of light and dark. Over the years ERG recording techniques have become progressively more sophisticated in the clinical setting. With the advent of perimetry, optical coherence tomography (OCT) and pattern ERG techniques, more precise mapping of dysfunctional areas of the retina is now possible. The most recent advance in ERG technology is the multifocal electroretinogram (mfERG). The mfERG provides a detailed assessment of the health of the central retina.

Anesthesia and Neuromonitoring by Reza Gorji, MD

Reza Gorji from University of NY writes at the Neuroanesthesia.net about various neuromonitoring methods and the effect of anesthesia, what types of anesthetic agent is advisable for certain types of EPs and EEGs during surgical procedures.

Anesthesia and Neuromonitoring: Electroencephalography and Evoked Potentials Reza Gorji, MD, Department of Anesthesiology, University Hospital, State University of NY, Syracuse, NY

• Anesthesia and Neuromonitoring (EEG & EP) Patients undergoing neurologic/orthopedic procedures involving the peripheral and central nervous system may be at increased risk from hypoxia/ischemia to vital neurologic structures. Intraoperative neuromonitoring may improve patient outcome by:
  

a. Allowing early detection of ischemia/hypoxia before irreversible damageoccurs

b. Indicating the need for operative intervention (shunts placed in carotid surgery) to minimize nerve damage The role of anesthesiology in neuromonitoring is one of understanding the appropriate anesthetic techniques, applying knowledge of medicine, surgery, physiology and pharmacology to get the best possible outcome.

This monograph will discuss the

various clinically important neuromonitors and offer solutions as they apply to clinical anesthesia.

It is divided in 3 broad sections: Electroencephalography, sensory evoked potentials and motor evoked potentials.