2017 EEG Board Preparation ABRET Part 2 Exam – Classroom
PURCHASING ABRET PART 1 AND PART 2 TOGETHER?
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Congratulations on successfully passing Part 1. Now let’s get started to help you reach that final goal of R. EEG T.
Just like Part 1 Part 2 is not just another book to read. Study at your own pace as you watch Larry thoroughly explain each EEG topic in this online VIDEO course.
This comprehensive board preparation course will prepare the experienced technologist for Part 2 of the American Board of Electroencephalographic and Evoked Potential Technologists (ABRET®) EEG credential examination.
Part 2 consists of 200 written multiple choice questions. Larry Head Institute’s Board Preparation course follows the ABRET outline.
- Effect of Neurological Disorders on EEG
- Considerations in the Recording
- EEG Recording and Pattern Recognition
- Modification of Recording Strategy
- 20% (40 questions)
- 10% (20 questions)
- 40% (80 questions)
- 30% (60 questions)
Effect of Neurological Disorders on EEG
Seizures, epileptic syndromes and classifications
Toxic and metabolic disorders
These Neurologic Disorders are the primary reason EEGs are performed. The technologist must be familiar with the symptoms of each disorder and what the EEG looks like. Each disorder and its effect on the EEG recording will be thoroughly explained by Larry.
CNS Infection – Meningitis, brain abscess, Encephalitis, Herpes Simplex encephalitis, Subacute Sclerosing Panencephalitis (SSPE), and Creutzfeldt-Jacob Disease (CJD) will be analyzed. Each can have similar symptoms yet striking differences in EEG patterns.
Psychiatric Disorders – Depression, Anxiety, Schizophrenia, OCD and Bipolar disorder. Although the EEG in these disorders is non-specific it can be a useful confirmation tool in the hands of an experienced clinician. Listen as Larry describes each and explains why the EEG is not diagnostic.
Seizures, Epileptic Syndromes and Classifications
Partial Seizures – Simple Partial (motor, sensory, autonomic and psychic), Complex Partial (impaired consciousness at onset and/or simple partial followed by impaired consciousness), and Partial seizures evolving to generalized tonic-clonic (Simple to GTC and Complex to GTC). Follow Larry as points out the EEG characteristics of each of these types of partial seizures.
Generalized Seizures – Tonic-clonic (grand mal), Absence (petit mal), Myoclonic, Atonic (drop attacks), Tonic (drop attacks), Clonic and Combinations. Larry will show you how to recognize EEG characteristics of each seizure type.
Toxic and Metabolic Disorders – Encephalopathies (hepatic, renal, diabetic, anoxic and toxic) are examples of toxic and metabolic disorders. The EEG can be helpful in confirming the diagnosis of each. We will review the symptoms and see how the EEG manifests in each.
Tumors – Types (primary, non-primary, metastatic) and Symptoms. Tumors are tissue growths that cause devastating symptoms. The technologist must understand each type, symptoms, and the EEG characteristics. We will review each type, learn the symptoms, and see how the EEG is affected.
Vascular Disease – Types of stroke (ischemic, hemorrhagic) and symptoms. The EEG signal seen in cerebral vascular accidents will be discussed.
Degenerative Diseases – Alzheimer’s, Multiple Sclerosis, Parkinson’s and Huntington’s Chorea are devastating diseases plaguing many. It is a must for the technologist to understand the disease process of each and how the EEG pattern presents.
Headache – Migraine and Non-migraine headaches are common. We will differentiate these types and look at the EEG signal most commonly seen.
Head Injury – Concussion, Contusion, Laceration, Subdural hematoma, and Epidural hematoma range from minor to life threatening injuries. Symptoms of each will be discussed as well as the effects each has on the EEG signal.
Considerations in the Recording
Communication with patient
Contraindications to activation
Effects of medications on recording and patients
Coma and altered mental status
Managing clinical events
Communication with patient – How to communicate with a patient is vital to obtaining an interpretable EEG. The technologist’s role as an information transcriber, comforter to anxious patients, and knowing what and what not to discuss with a patient are discussed.
Age-specific considerations – How to deal with neonates, pediatric and the adult patient is imperative. When is the best time to perform the EEG for a neonate? Documentation of gestational, chronological, and conceptional age, notations and observation, modified electrode placement for small head size will be reviewed. Required recording time to include awake and active and quiet sleep stages are considerations for recording neonates. Pediatric considerations include comforting the patient and explaining the procedure in a way to calm a child. Geriatric patients and the mentally impaired present their own set of challenges when recording EEG. This review will address each of these and more.
Contraindications to activation – Larry will discuss when activation procedures should not be performed and adverse affects of each.
Effects of medications on recording and patients – The more common medications prescribed for neurology patients will be reviewed. Medications, the disorder or disease for which they are used, and their effect on the EEG and the patient will be described in detail.
Coma and altered mental status – Dealing with and recording the EEG on a comatose patient can be challenging. Larry will discuss how the EEG may be helpful in determining the depth and severity of the coma, how the EEG can aid in suggesting a possible cause for the coma, and what the EEG actually displays in the comatose state. Differing levels on consciousness will be reviewed as well as stimulation techniques. Specific patterns such as IRDA, spindle coma, alpha coma, and burst suppression seen during coma will be thoroughly explained.
Managing clinical events – How to identify and care for the patient during seizure and cardiac/respiratory arrest is of utmost importance. Follow Larry as he explains how to care for the patient that is having a clinical episode.
Infection control – We will discuss how to prevent cross contamination between patients and how to clean electrodes between uses. Sources and sites, modes of transmission, standard precautions, non-critical, semi-critical, and critical items specific to EEG, will be discussed thoroughly.
EEG Recording and Pattern Recognition
Correlating patient behaviors
Normal Adult, Pediatric, and Neonatal EEG
Localization and polarity
Identifying and correlating artifacts
Correlation of history with specific EEG patterns (breech, JCD, etc)
Documentation – We will explain how to properly document instrument settings, artifacts, patient movement & changes in body position, levels of consciousness, and stimulation techniques.
Correlating patient behaviors
Normal Adult, Pediatric, and Neonatal EEG – Larry will review relevant terminology including frequency, voltage, location, symmetry, periodic, variability, duration, morphology, polarity, synchrony and reactivity. He will introduce normal adult EEG patterns including alpha, beta, theta, lambda, wickets, breach rhythm, SREDA, posterior slow waves of youth, Mu rhythm, RMTD, 14 & 6 positive spikes, 6 Hz spike & wave and BETS. Then he will move into sleep patterns including stage N1 (alpha attenuation, slow rolling eye movements, POSTS & vertex sharp waves), stage N2 (sleep spindles and K complexes), stage N3 (slow wave sleep) and stage R (rapid eye movement and saw-tooth waves). EEG waveforms and patterns specific to the pediatric and neonatal patient will be discuss thoroughly. These include for the neonatal EEG the definition of gestational, chronological, and conceptional age, modified electrode placement for a small head circumference, suggested montage, monitoring of non-cerebral parameters, stimulation techniques, documentation, characteristics and assessment of the neonatal EEG during wakefulness, active and quiet sleep, Trace Discontinue, Trace Alternant, and concluding with a detailed review of the neonatal EEG maturation. Pediatric EEG will be reviewed thoroughly. When the alpha rhythm presents, trace alternant, O waves and EEG patterns such as Posterior Slow Wave of Youth, HV Buildup, LAMBDA, POSTS, and Hypnogogic Hypersynchrony will be discussed in detail. Synchrony and symmetry between hemispheres will be reviewed. Sleep spindles, K-complexes will be addressed.
Abnormal EEG – Finally, Larry will review abnormal patterns including background changes, FIRDA, PLEDS, Alpha Coma, Burst Suppression, Herpes Simplex, ECI, delta (monomorphic & polymorphic), OIRDA, BIPLEDS, Triphasic Waves, CJD, 3 Hz Spike & Wave, and Generalized Spike & Wave seen in the adult. Pediatric abnormalities include benign rolandic spikes, absence seizures, Juvenile Myoclonic Epilepsy, Landau-Kleffner Syndrome, West Syndrome and the Hypsarrhythmia EEG pattern, Lennox-Gastaut Syndrome and slow spike and wave, and Sturge-Weber Syndrome are all covered in detail. Each will be reviewed regarding symptoms, medications, and EEG patterns.
Montage selection – Selecting the appropriate montage at the right time can be critical to proper interpretation of the EEG recording. Based on what is detected in the EEG a montage change may be in order. Larry will help you understand the different types of montages and the advantages and disadvantages of each.
Localization and polarity – Localization techniques are a skill needed by the EEG technologist. Being able to determine where a focus originates and it polarity is helpful when analyzing normal and abnormal patterns and identifying and differentiating artifact from cerebral activity. Larry will review the differential amplifier, montage types & localization techniques, and the polarity square. Additionally, students will be given the opportunity to work through examples practicing their skills at determining montage, focus, field and polarity.
Activation techniques – Hyperventilation, photic stimulation, and sleep are common activation techniques routinely performed during the EEG test. Larry will describe why and how each is performed, contraindications, artifacts commonly seen, normal and abnormal responses.
Identifying and correlating artifacts – Larry will review physiologic (muscle, eye, sweat, cardiac, mouth and movement) and non-physiologic (electrode, electrical and environment) artifacts, recognition techniques and how to document each. Also discussed will be skills to differentiate artifacts from cerebral activity.
Troubleshooting – We will explain how to identify problems, trace the problem to the cause, introduce a troubleshooting checklist and the describe how to properly eliminate and/or monitor problems.
Correlation of history with specific EEG patterns (breech, JCD, etc) – Few, but some, EEG patterns are diagnostic. Larry will help you understand how to correlate a patient history with a specific pattern.
Modification of Recording Strategy
Selection of recording parameters
Use of filters
ECI recordings and guidelines
Measurements of frequency, voltage and duration
Identifying clinical events
Non-standard montages and electrode placements
Non-standard activation procedures
Electrographic correlates – Recognizing EEG patterns is absolutely necessary. This topic is intermixed with other topics and covered completely.
Selection of recording parameters – The EEG instrument parameters are adjusted to more precisely acquire EEG data. The technologist must understand when an instrument control should be changed in order to enhance the recording and how to make those changes. Larry will discuss sensitivity, filters (HF, LF & Time Constant, 60 Hz), paper speed and how each is used and just as importantly, when not to make a change.
Use of filters – The different types of filters (HF, LF & Time Constant, 60 Hz) are explained thoroughly. The effect each has on the EEG signal will be reviewed. High pass and low pass filter terminology will be explained.
ECI recordings and guidelines – Larry will explain how brain death recordings must be recorded. Instrument settings, ECI montage design, non-cerebral parameters, and patient stimulation techniques and rationale will be defined. ACNS Guidelines will be outlined.
Measurements of frequency, voltage and duration – Larry will discuss the sensitivity pie and the relationship of voltage, amplitude and sensitivity. Additionally, he will discuss frequency and duration, paper speed, and the measurements, formulas & calculation methods for each. Students will come away with a complete understanding of how to calculate measurements.
Monitoring techniques – This is covered in other sections.
Identifying clinical events – This is covered in the managing clinical events section.
Non-standard montages and electrode placements – This is covered in the Montage Selection section.
Non-standard activation procedures – Pharmacological Activation and Reflex Epilepsy are discussed.