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For Referring Doctors - EEG Referral Guidelines

Indications for an EEG – guidelines for a referral


1. Questionable seizure activity. Is this a seizure or not?
  • Most diagnostic when the event occurs during a video EEG.
  • Activation by sleep deprivation, photic stimulation and hyperventilation increases the ability to detect abnormalities during a single recording.
2. First definite non-febrile seizure.
  • An EEG within hours or days of a first definite non-febrile seizure is reported to show a higher incidence of abnormality.
3. What type of seizure is it?
  • Certain seizure types are associated with specific EEG patterns.
  • The history of the seizure could be that of a generalized tonic clonic seizure; however, it could have been a focal seizure which secondarily generalized or a focal complex partial seizure.
  • Focal abnormalities may point to a diagnosis and type of anticonvulsant treatment.
4. What epilepsy syndrome could this be?
  • Certain EEG abnormalities and patterns are associated with specific epilepsy syndromes.
  • Please indicate what your differential syndrome diagnosis may be as we want to ensure the appropriate states and activation procedures are recorded.
5. Follow-up after treatment to assess seizure frequency.
  • Once treatment has begun and clinical seizures have stopped, a repeat EEG may indicate that subclinical seizures are still occurring.
  • This is common with infantile spasms, absence epilepsy and neonatal seizures.
6. To assess the effect of a change in medication (new, increasing or decreasing).
  • To assess the effect of changes in medication on the EEG, specifically in terms of the presence, absence or frequency of interictal discharges.
7. New or change in seizure type.

  • Children already diagnosed and treated may present with new seizure types that may impact the management of their medication.
8. Progressive neurological deterioration or degenerative disease.
  • The EEG may reflect a clinical deterioration that is due to a progressive degenerative process.
  • However, neurological deterioration can also be due to non-convulsive status which should be treated immediately.
  • An EEG can help to differentiate these.
Other conditions where an EEG may be helpful:
  • Atypical febrile convulsions
  • Acquired Aphasia of Childhood (Landau-Kleffner)
  • Autism (Sleep is very important so please order a sedated EEG)
When an EEG is less useful:
  • Typical febrile convulsions
  • Headaches
  • Tics
  • Breath-holding (Infantile syncope)
  • Learning disabilities
  • Behaviour problems

Indications for an Emergency EEG


1. Decreased level of consciousness of unknown etiology. The differential diagnosis could be any of the following:
  • Non-convulsive status
  • Encephalopathy
  • Postictal
  • Psychiatric
2. Questionable infantile spasms
  • babies 3-12 months
  • clusters of events
3. Subclinical seizures including evaluation of patients with recent seizures who are in drug-induced coma or paralysis.



How to get fast electronic EEG Reports


  • Your office can obtain faster EEG results by receiving a faxed report.
  • Physicians’ offices can contact us for more information by calling 604-875-2124.

Requisitions


You will be asked to give the reason for the EEG on our EEG Requisition (PDF). You may check as many as apply.

To Determine

To Evaluate

Other

• If event(s) are seizures

• Seizure type

• Epilepsy syndrome

• Subclinical seizures

• Non-convulsive status

• New seizure type

• Seizure control follow-up

• Change in medication

• Recurrence or increase in seizures

• Repeat EEG for sleep

• To capture an event

• Decreased LOC – undetermined cause

• Encephalopathic

• Other


If you have any questions regarding an EEG referral on a specific patient, please do not hesitate to call us at 604-875-2124 or email us at eeg_bcch@cw.bc.ca.

You can also print an EMG Requisition (PDF) or an EP Requisition (PDF).


Website updated March 2010.