NDT 232 - EEG Procedures and Pathology IV

Module 1:  Objectives

• Explain the elements of age-appropriate pediatric care.
• Identify the ages/stages of development and suggested best practices for technologists:
  • Infant: Birth to 1 year “Trust vs. Mistrust”
  • Toddler 1-3 years “Autonomy vs. Shame and Doubt”
  • Pre-school 4-7 years “Initiative vs. Guilt”
  • School age 8-12 years “Industry vs. Inferiority”
  • Adolescence 13 to 18 years “Identity vs. Role Confusion”
• Describe measures that add to patient comfort and gain cooperation during the EEG procedure. 
• Explain ways to incorporate behavior techniques that add to patient comfort and gain cooperation during the EEG procedure. 

Module 1:  Assignments

• Complete Links:

• ACNS Guideline 5
• ASET Presentation:  Pediatric Age Appropriate Care
• ASET Slides Lesson 1
• Poster:  Pediatric EEG w/o Sedation
• ASET Article: Pediatric Sedation vs Music Therapy
• ASET Position Statement
• Technical Tips
• Complete Quiz 1
• Complete Assignment 1

Module 2:  Objectives

• Describe normal awake patterns in children 3 months to 18 years.
• Explain passive eye closure and it’s usefulness to view background activity.
• Recognize Posterior Slow Waves of Youth.
• Chart the development of normal awake posterior dominant rhythms.
• Describe activation procedures such as sleep, photic stimulation and hyperventilation
• Identify Photic driving in infants.
• Recognize HV Buildup in children.
• Identify normal variants commonly seen in children such as: Lambda & Mu Rhythm.

Module 2:  Assignments

• Complete Links:

• Reading Material Lesson 2
• ASET Article:  What is Normal?
• ASET Article:  EEG Maturation
• Part 1 Neonatal EEG
• Part 2 Infant, Pediatric and Adult EEG
• Part 3 Normal Age Related Development
• Complete Quiz 2

Module 3:  Objectives

• Recognize sleep patterns in normal pediatric EEG recordings.
• Describe age appropriate appearance of patterns such as sleep spindles, POSTS, Vertex waves and K Complexes and Hypnagogic and Hypnopompic Hypersynchrony.
• Define the following sleep stages according to the American Association of Sleep Medicine
  • W = Wakefulness, Stage N1 (NREM 1), Stage N2 (NREM 2), Stage N3 (NREM 3/slow wave sleep)
    Stage R (REM Sleep) 
• Describe children’s sleep habits at various ages, according to the National Sleep Foundation.

Module 3:  Assignments

• Reading Material Lesson 3
• ASET Article:  Childhood Sleep Wake Disorders
• Sleep Stages & Definitions
• National Sleep Foundation

• Complete Quiz 3

Module 4:  Objectives

• Recognize and describe the abnormal pediatric EEG associated with:
  • Infantile Spasms
  • West’s Syndrome
  • Lennox-Gastaut Syndrome
  • Benign Juvenile Myoclonic Epilepsy
  • Benign Rolandic Epilepsy
  • Benign Occipital Epilepsy
  • Absence Seizures

• Describe EEG patterns associated with 
  • Generalized and focal spikes/polyspikes  
  • 3 Hz spike and wave and Slow spike and wave
  • Hypsarrhythmia and Electrodecremental events
• List the benefits of activation procedures such as hyperventilation and sleep deprivation for certain seizure types.

Module 4:  Assignments

• Read “Practical Approach…” text Pgs 218-257

• Complete Links:

• Reading Material 4
• Video Presentation-Goodman
• 2^nd Video Presentation-Goodman
• ASET Article:  First Sz in a Child
• ASET Article:  JME
• Compare and Contrast Doose Syndrome & Dravet
• Epileptic Syndromes

• Complete Assignment 2
• Complete Quiz 4

Module 5:  Objectives

• Describe normal awake patterns in children 3 months to 18 years.

• Recognize the abnormal pediatric EEG in patients with neurological disorders such as:
  • Cerebrovascular, Traumatic, Infectious, Metabolic, Neoplastic
• Identify symptoms and patterns seen in the following:
  • Moya Moya Disease
  • Alternating Hemiplegia
  • Syncope
  • Traumatic Brain Injury
  • Meningitis and Encephalitis
  • Congenital Herpes Encephalitis
  • Cytomegalic Virus
  • Rasmussen’s Encephalitis
  • MELAS
  • Agenesis of the Corpus Callosum
  • Tuberous Sclerosis
• Identify Pediatric Sleep Disorders that resemble seizures
  • Parasomnias & sleep walking

Module 5:  Assignments

• Complete Links:

• Lesson 5 Reading Material
• Brain Injury Facts
• Video:  Moya Moya Disease
• Language and Behavior Disorders
• Periodic Patterns in Pediatric Patients
• Complete Quiz 5

Module 6:  Objectives

• Define Gestational age, Legal/Chronological age and Conceptional Age
• Describe the implications of the Apgar Score, apnea, bradycardia and reflux in the high risk infant.
• Describe the technique and parameters used for recording neonatal EEG.
• List the physiologic variables needed to differentiate sleep stages in the neonatal recording including EEG, EKG, EMG, EOG and Respiration.
• Recognize and describe the age dependent (CA 29 weeks to 48 weeks) EEG associated with:
  • Common background patterns (continuity, symmetry, synchrony)
  • Active & Quiet Sleep
  • Trace Alternant
  • Trace Discontinua
  • Active Moyenne
  • Sleep Spindles
  • Delta Brushes
  • Encoches frontales

Module 6:  Assignments

• Complete Links:

• Lesson 6 Reading Material
• Required Reading ASET Article Neonatal EEG
• APGAR Scoring
• Skin Safety
• Video Presentation Neonatal Technique
• Pain in the Human Neonate
• Complete Quiz 6
• Complete Assignment 3

Module 7:  Objectives

• Recognize abnormal patterns in neonates such as:

Burst-suppression

Excessive discontinuity

Abnormal asymmetry or asynchrony

Abnormal sharp waves and spikes

Neonatal Seizures

• Recognize the clinical manifestations of neonatal seizures
• List the various etiology of neonatal seizure disorders such as:

Asphyxia, Hycocalcemia, Hypoglycemia/Hypernatermia

Intracranial hemorrhages. Infection, congenital malformations, inborn errors of metabolism, drug withdrawl and anesthetic intoxication

• Identify neonatal epilepsy syndromes
• Identify the usefulness of electroencephalography in identifying:

Interictal and ictal abnormalities

Prognostic implications and treatments

Module 7:  Assignments

• Read “Practial Approach…” Pgs 315-327
• Complete Links:

• Video Presentation Pediatric Seizure Disorders
• Presentation Handout for Pediatric Seizure Disorders

• Complete Quiz 7

Module 8:  Objectives

• Define seizures, epilepsy and epilepsy syndromes.
• Explain why seizure classification is important.
• Explain the clinical utility of imaging studies and how they correlate with EEG findings.

• Identify focal and generalized abnormalities and EEG patterns that suggest specific syndromes

• Complete Links:

• Video Presentation Pediatric Classification
• ASET Article:  Pediatric Video Monitoring
• Pediatric Case Studies
• Complete Quiz 8

Grading Scale

91-100%     =  4.0   Excellent

86-90.9%    =  3.5

81-85.9%    =  3.0   Good

76-80.9%    =  2.5   Satisfactory and Passing

71-75.9%    =  2.0   Not Passing

66-70.9%    =  1.5

60-65.9%    =  1.0

0-59.9%      =  0.0 

Points Possible

Module Assignments

Due Date

70

Module 1:  Objectives

• Explain the elements of age-appropriate pediatric care.
• Identify the ages/stages of development and suggested best practices for technologists:
  • Infant: Birth to 1 year “Trust vs. Mistrust”
  • Toddler 1-3 years “Autonomy vs. Shame and Doubt”
  • Pre-school 4-7 years “Initiative vs. Guilt”
  • School age 8-12 years “Industry vs. Inferiority”
  • Adolescence 13 to 18 years “Identity vs. Role Confusion”
• Describe measures that add to patient comfort and gain cooperation during the EEG procedure. 
• Explain ways to incorporate behavior techniques that add to patient comfort and gain cooperation during the EEG procedure. 

Module 1:  Assignments

• Complete Links:

• ACNS Guideline 5
• ASET Presentation:  Pediatric Age Appropriate Care
• ASET Slides Lesson 1
• Poster:  Pediatric EEG w/o Sedation
• ASET Article: Pediatric Sedation vs Music Therapy
• ASET Position Statement
• Technical Tips
• Complete Quiz 1
• Complete Assignment 1

10

Module 2:  Objectives

• Describe normal awake patterns in children 3 months to 18 years.
• Explain passive eye closure and it’s usefulness to view background activity.
• Recognize Posterior Slow Waves of Youth.
• Chart the development of normal awake posterior dominant rhythms.
• Describe activation procedures such as sleep, photic stimulation and hyperventilation
• Identify Photic driving in infants.
• Recognize HV Buildup in children.
• Identify normal variants commonly seen in children such as: Lambda & Mu Rhythm.

Module 2:  Assignments

• Complete Links:

• Reading Material Lesson 2
• ASET Article:  What is Normal?
• ASET Article:  EEG Maturation
• Part 1 Neonatal EEG
• Part 2 Infant, Pediatric and Adult EEG
• Part 3 Normal Age Related Development
• Complete Quiz 2

10

Module 3:  Objectives

• Recognize sleep patterns in normal pediatric EEG recordings.
• Describe age appropriate appearance of patterns such as sleep spindles, POSTS, Vertex waves and K Complexes and Hypnagogic and Hypnopompic Hypersynchrony.
• Define the following sleep stages according to the American Association of Sleep Medicine
  • W = Wakefulness, Stage N1 (NREM 1), Stage N2 (NREM 2), Stage N3 (NREM 3/slow wave sleep)
    Stage R (REM Sleep) 
• Describe children’s sleep habits at various ages, according to the National Sleep Foundation.

Module 3:  Assignments

• Reading Material Lesson 3
• ASET Article:  Childhood Sleep Wake Disorders
• Sleep Stages & Definitions
• National Sleep Foundation

• Complete Quiz 3

70

Module 4:  Objectives

• Recognize and describe the abnormal pediatric EEG associated with:
  • Infantile Spasms
  • West’s Syndrome
  • Lennox-Gastaut Syndrome
  • Benign Juvenile Myoclonic Epilepsy
  • Benign Rolandic Epilepsy
  • Benign Occipital Epilepsy
  • Absence Seizures

• Describe EEG patterns associated with 
  • Generalized and focal spikes/polyspikes  
  • 3 Hz spike and wave and Slow spike and wave
  • Hypsarrhythmia and Electrodecremental events
• List the benefits of activation procedures such as hyperventilation and sleep deprivation for certain seizure types.

Module 4:  Assignments

• Read “Practical Approach…” text Pgs 218-257

• Complete Links:

• Reading Material 4
• Video Presentation-Goodman
• 2^nd Video Presentation-Goodman
• ASET Article:  First Sz in a Child
• ASET Article:  JME
• Compare and Contrast Doose Syndrome & Dravet
• Epileptic Syndromes

• Complete Assignment 2
• Complete Quiz 4

10

Module 5:  Objectives

• Describe normal awake patterns in children 3 months to 18 years.

• Recognize the abnormal pediatric EEG in patients with neurological disorders such as:
  • Cerebrovascular, Traumatic, Infectious, Metabolic, Neoplastic
• Identify symptoms and patterns seen in the following:
  • Moya Moya Disease
  • Alternating Hemiplegia
  • Syncope
  • Traumatic Brain Injury
  • Meningitis and Encephalitis
  • Congenital Herpes Encephalitis
  • Cytomegalic Virus
  • Rasmussen’s Encephalitis
  • MELAS
  • Agenesis of the Corpus Callosum
  • Tuberous Sclerosis
• Identify Pediatric Sleep Disorders that resemble seizures
  • Parasomnias & sleep walking

Module 5:  Assignments

• Complete Links:

• Lesson 5 Reading Material
• Brain Injury Facts
• Video:  Moya Moya Disease
• Language and Behavior Disorders
• Periodic Patterns in Pediatric Patients
• Complete Quiz 5

70

Module 6:  Objectives

• Define Gestational age, Legal/Chronological age and Conceptional Age
• Describe the implications of the Apgar Score, apnea, bradycardia and reflux in the high risk infant.
• Describe the technique and parameters used for recording neonatal EEG.
• List the physiologic variables needed to differentiate sleep stages in the neonatal recording including EEG, EKG, EMG, EOG and Respiration.
• Recognize and describe the age dependent (CA 29 weeks to 48 weeks) EEG associated with:
  • Common background patterns (continuity, symmetry, synchrony)
  • Active & Quiet Sleep
  • Trace Alternant
  • Trace Discontinua
  • Active Moyenne
  • Sleep Spindles
  • Delta Brushes
  • Encoches frontales

Module 6:  Assignments

• Complete Links:

• Lesson 6 Reading Material
• Required Reading ASET Article Neonatal EEG
• APGAR Scoring
• Skin Safety
• Video Presentation Neonatal Technique
• Pain in the Human Neonate
• Complete Quiz 6
• Complete Assignment 3

40

Module 7:  Objectives

• Recognize abnormal patterns in neonates such as:

Burst-suppression

Excessive discontinuity

Abnormal asymmetry or asynchrony

Abnormal sharp waves and spikes

Neonatal Seizures

• Recognize the clinical manifestations of neonatal seizures
• List the various etiology of neonatal seizure disorders such as:

Asphyxia, Hycocalcemia, Hypoglycemia/Hypernatermia

Intracranial hemorrhages. Infection, congenital malformations, inborn errors of metabolism, drug withdrawl and anesthetic intoxication

• Identify neonatal epilepsy syndromes
• Identify the usefulness of electroencephalography in identifying:

Interictal and ictal abnormalities

Prognostic implications and treatments

Module 7:  Assignments

• Read “Practial Approach…” Pgs 315-327
• Complete Links:

• Video Presentation Pediatric Seizure Disorders
• Presentation Handout for Pediatric Seizure Disorders

• Complete Quiz 7

25

Module 8:  Objectives

• Define seizures, epilepsy and epilepsy syndromes.
• Explain why seizure classification is important.
• Explain the clinical utility of imaging studies and how they correlate with EEG findings.

• Identify focal and generalized abnormalities and EEG patterns that suggest specific syndromes

• Complete Links:

• Video Presentation Pediatric Classification
• ASET Article:  Pediatric Video Monitoring
• Pediatric Case Studies
• Complete Quiz 8

195

Final Evaluation

500

Total Points