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    Renard Christian
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    SD EEG

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    6 views5 pages

    SD Eeg

    Uploaded by

    Renard Christian

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    of 5
    a SECTION EDITOR: DAVID E. PLEASURE, MD The Sleep-Deprived Electroencephalogram Evidence and Practice Thomas H. Glick, MD Background: sleep deprivation for the ini ‘encephalogram for suspected seizures isa widespread but inconsistent practice not informed by balanced evi- dence. Daily practice suggests that nonneurologists are confused by the meaning and value of, and indications for, “sleep” (tracing) vs “sleep deprivation” (and other alternatives). They need specific, informed guidance from general neurologists on best practices, Lelectro- Objectives: To document illustratively the variability ‘of neurologists’ practices, the level of relevant informa- tion among nonneurologists, and the current state of pub- lished evidence; and to stimulate formulation of consen- sus advisories, Design and Setting: | surveyed knowledge and prac- tices of (1) nonneurologistsin a community teaching hos- pital; (2) local and national neurologists and epileptolo- _ists; (3) electroencephalogram laboratory protocols; and (4) textbook accounts and recommendations and the rel ‘evant journal literature, National professional organiza tions were contacted for advisories or guidelines. Results: Most nonneurologists surveyed misunder- vs “sleep-deprived” electroencephalo- grams and thelr actual protocols, They ate unaware of evidence on benefits vs burdens. Neurologists’ practices are inconsistent. Experts generally agree that sleep dep- rivation produces substantial activation of interictal leptiform discharges beyond the activation of sleep per se. However, most published recommendations and in- terviewed epileptologists do not stiggest sleep depriva- on for the initial electroencephalogram because of “in- convenience” (burdens) for the patient. Evidence-based or reasoned guidance is minimal, and professional soci- ties have not issued advisories. Coneluston: Confusion over sleep deprivation, dispari- ties between evidence and recommendations, and incon- sistent practices create a need for expert consensus for guidance, as well as comparative research on alternative methods of increasing diagnostic yield “Arch Neurol, 2002;59:1235-1239 EUROLOGISTS AND non- neurologists alike need to specify what type of ele troencephalogram (EEG) to order initially for pa- rology, and perhaps in all of medicine, is ordered by nonneurologists with so litle understanding of the added value, added burden, and expert practices asthe sleep- deprived EEG. From the Department of ‘Neurology, Harvard Medical ‘School, Boston, Mass, and Division of Neurology Department of Medicine, The Canbridge Health Alliance, ‘Cambridge, Mas. ‘Downloaded From: http:/archneur,jamane (s with suspected seizures. Whether these physicians designate a “sleep” oF a “sleep-deprived” EEG, or merely a “rou- tine” tracing, affects the diagnostic yield and burden ofthe test, as well as the chance that further recordings will be required. Many neurologisisdo not recognize the ex- tent oF effects of nonneurologists’ confu- sion surrounding these terms and, ther fore, do not make a point of educating them, Sleep means a tracing during sleep. Sleep deprivation denotes in the research literature a complete lack of sleep at least overnight and usually for 24 hours, and should be clearly distinguished from re- duced sleep designed to facilitate a sleep tracing, Arguably, no common test in neu- (aepnuyeD) ARCH NETROUNOUSP ATG TO (©2002 American Medical Association, All rights setwork.comy by a University College London User on 06/04/2016 Preliminary observations suggested that neurologists generally understand the srminology and procedures but, not sur- prisingly, are unaware of the specific evi dence basis for a fll sleep-

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