How not to read an EEG : Concluding statements

William O. Tatum Neurology 2013;80;S52 DOI 10.1212/WNL.0b013e318279754f This information is current as of January 14, 2013

The online version of this article, along with updated information and services, is located on the World Wide Web at: http://www.neurology.org/content/80/1_Supplement_1/S52.full.html

Neurology is the official journal of the American Academy of Neurology. Published continuously since 1951, it is now a weekly with 48 issues per year. Copyright 2013 by AAN Enterprises, Inc. All rights reserved. Print ISSN: 0028-3878. Online ISSN: 1526-632X.

How not to read an EEG

Concluding statements

William O. Tatum, DO, FAAN

Correspondence to Dr. Tatum: Tatum.william@mayo.edu Neurology 2013;80 (Suppl 1): S52S53

A neurologist undergoes 4 years of postgraduate education after medical school to specialize in the clinical practice of disorders of the nervous system. Seizures are an inextricable component to that education based on the sheer prevalence of encounters. In contrast, the time spent on EEG interpretation is typically 0 to 3 months. The exposure and experiences acquired during training establishes our knowledge base of clinical neurophysiology. Most practicing neurologists are required to utilize EEG in clinical practice. Limited exposure or experience in EEG interpretation during training translates to persistent inexperience in clinical practice. Our specialty has set some standards for EEG recording and reporting, but interpretation has not yet been standardized. The American Society of Electroneurodiagnostic Technologists, Inc. in conjunction with the American Board of Registration for Electroencephalographic and Evoked Potential Technologists has set standards (http://www.aset.org/files/public/ EEG_National_Competency_Skill_Standards_Approved_2011.pdf; accessed June 17, 2012) for performing EEG recordings. The American Clinical Neurophysiology Society in conjunction with the American Board of Clinical Neurophysiology has established some guidelines (http://www.acns.org/guidelines.cfm; accessed June 17, 2012) to govern EEG performance and use by physicians but they do not include the essentials of interpretation by virtue of the tests inherent subjectivity. How we interpret routine EEG is based on our background, and the quality of interpretation can affect patient care. Furthermore, each EEG interpretation may be biased by the reason for referral. It is therefore difficult to craft a clinically meaningful report. Waveform identification should not be based solely on pattern recognition, but confusing reports based on an overinterpreted EEG can result in inappropriate and sometimes harmful therapeutic recommendations. Finding a method by which we should interpret EEGs can be reached in part by outlining how we ought not to interpret EEGs, as illustrated in this supplement. Training during residency is key to developing a basis for orderly interpretation of the EEG. Failed or borderline interpretations are unfortunately common. We have outlined some of the pitfalls of EEG misinterpretation. Insight from our conference survey supports the necessity of continued medical education. Potential solutions include an independent second interpretation for EEG (low technology), made possible with existing remote access technology. Computer-assisted feature matching (high technology) is evolving and may become clinically useful in EEG interpretation. The survey results at our symposium overwhelmingly support the need for minimal training standards for neurologists (see figure in the Introductory Statements). Although this debate goes beyond the scope of this supplement, the need for education and the need for a critical reanalysis of our ability of how to read EEGs, as contrasted with How Not to Read an EEG, seems to be supported by clinicians and academicians alike. Future maintenance of certification for practicing neurologists will include measures of clinical quality and should extend to our ancillary practices that may influence patient care, including EEG. The quality indicators of epilepsy management have recommendations that include

From the Department of Neurology, Mayo Clinic, Jacksonville, FL. Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the author, if any, are provided at the end of the article. S52 2012 American Academy of Neurology

2012 American Academy of Neurology. Unauthorized reproduction of this article is prohibited.

obtaining an EEG.1 The next step is to crystallize methods of interpretation so as to raise the quality of EEG and thereby its contribution to optimal patient care.
AUTHOR CONTRIBUTIONS
W.O. Tatum: drafting/revising the manuscript.

Received June 5, 2012. Accepted in final form June 26, 2012. REFERENCE 1. Fountain NB, Van Ness PC, Bever CT, et al; for the American Academy of Neurology Epilepsy Measure Development Panel and the American Medical Association-Convened Physician Consortium for Performance Improvement Independent Measure Development Process. Quality improvement in neurology: AAN epilepsy quality measures. Report of the Quality Measurement and Reporting Subcommittee of the American Academy of Neurology. Neurology 2011;76: 9499.

DISCLOSURE
The author reports no disclosures relevant to the manuscript. Go to Neurology. org for full disclosures.

Neurology 80 (Suppl 1) January 1, 2013

S53

2012 American Academy of Neurology. Unauthorized reproduction of this article is prohibited.

How not to read an EEG : Concluding statements William O. Tatum Neurology 2013;80;S52 DOI 10.1212/WNL.0b013e318279754f This information is current as of January 14, 2013
Updated Information & Services References including high resolution figures, can be found at: http://www.neurology.org/content/80/1_Supplement_1/S52.full .html This article cites 1 articles, 1 of which can be accessed free at: http://www.neurology.org/content/80/1_Supplement_1/S52.full .html#ref-list-1 This article, along with others on similar topics, appears in the following collection(s): All Epilepsy/Seizures http://www.neurology.org/cgi/collection/all_epilepsy_seizures Clinical neurology history http://www.neurology.org/cgi/collection/clinical_neurology_his tory EEG http://www.neurology.org/cgi/collection/eeg_ Error in medicine http://www.neurology.org/cgi/collection/error_in_medicine Information about reproducing this article in parts (figures, tables) or in its entirety can be found online at: http://www.neurology.org/misc/about.xhtml#permissions Information about ordering reprints can be found online: http://www.neurology.org/misc/addir.xhtml#reprintsus

Subspecialty Collections

Permissions & Licensing

Reprints