EEG reading is frustrating

[IonClaws]

Hey everyone-

I'm a second year Neuro resident trying to learn to read EEGs...it's pretty frustrating. When I think an EEG is either stone cold normal or diffusely abnormal my attending will say there's focal slowing...I review the EEG again and see nothing of the sort....any tips? Or are EEGs just subjective to an extent?

Thanks.

---

Members don't see this ad.

 

[Telamir]

To an extent, yes. That being said, I personally believe in "undercalling". I.E., if you crank up your sensitivity to 100 and start reading abnormalities that are either subtle or could be a normal variant for age (intermittent temporal slowing in the elderly, FIRDA in the elderly, etc) you will make life much harder for everyone else as now the patient may get tests or interventions secondary to what you read. EEG is just as much about interpretation of abnormal as it is about normal variants and artifact. That being said, focal slowing is one of the harder abnormalities to find. Sometimes "crunching" the page down to 15 instead of the usual 30 might make some slowing pop up more.

It's also worth mentioning that your montage plays a big role. Find one you're comfortable with. Personally I do my first pass in an AP longitudinal bipolar montage L over R. So L parasagital over R parasagital on top, midline leads in the middle, and L temporal/R temporal on the bottom.

Hope it helps.

 

[FalconSlice]

Not an expert, but I know my way around different EEG protocols... and in my experience, when "there's some slowing" is all someone has to say, a lot of times, they're just filling the void of silence. In other words, I disregard it if that's literally all someone has to say (of course matching with clinical correlate. ie is pt newly encephalopathic, etc.)

 

[deathmerchant]

Hey everyone-

I'm a second year Neuro resident trying to learn to read EEGs...it's pretty frustrating. When I think an EEG is either stone cold normal or diffusely abnormal my attending will say there's focal slowing...I review the EEG again and see nothing of the sort....any tips? Or are EEGs just subjective to an extent?

Thanks.

There is definitely subjectivity to EEGs. I felt the same way in the first few years. Your eyes and mind get used to picking up stuff over time.
I would recommend focussing mostly on normal variants and artifacts in the second year.

 

[neurologist]

Hey everyone-

I'm a second year Neuro resident trying to learn to read EEGs...it's pretty frustrating. When I think an EEG is either stone cold normal or diffusely abnormal my attending will say there's focal slowing...I review the EEG again and see nothing of the sort....any tips? Or are EEGs just subjective to an extent?

Thanks.

Ahh, don’t worry about it. You’re an R2. Typical EEG exposure in residency is limited. You’ve read maybe a hundred EEGs. Your attending is an attending, quite possibly with EEG/neurophys/epilepsy fellowship training. He/she’s read thousands upon thousands of EEGs. It’s all pattern recognition. You’ll get better with time and repetition. I thought I was pretty good at EEG reading as an R4, but when I did fellowship and read dozens of EEGs a day every day, that was when I really “got it.” As a resident just understand how eeg works and the classic abnormal patterns (3 hz spike/wave, centrotemporal spikes, burst suppression, etc) that will be on the boards.

Your post reminds me of when I did my neuro rotation as a med student and saw my first EEGs. I was like “Damn. Someone can make sense of this random squiggly ****? I wanna do this!”

 

[fleshwound]

Correct me if I am wrong. There was a time when it was more common for attendings who had not received post-residency EEG training to read and bill for EEGs. Some certainly still do today. However the sense I get from recent grads and current trainees without neurophys or epi fellowship is that they don't feel comfortable with the liability without having the additional training. I'm doing a NM fellowship and while I can answer multiple choice questions about EEGs, I'm not sure that I'll ever read and bill for one. Or is this the wrong attitude? I still plan on looking at some squiggles (time permitting) but then deferring to the final verdict signed by the epileptologist.

 

[Sushirolls]

Huh. As a psychiatrist who might refer to Neurology to round off the work up in some one who has some possible symptoms of concern, I'd just assumed all general Neurologists did and had no problem ordering/reading a routine 'bedside' 'one hour' EEG.

 

[Postictal Raiden]

I feel that every neurologist should be able to look at an EEG and recognize abnormalities. However being able to characterize these abnormalities and differentiate between various types of seizures may require an EEG/epilepsy fellowship or extra exposure to this stuff during residency.