Rethinking Seizure Care Blog

Introduction to In-home Video EEG Monitoring

Posted by RSC Diagnostics on Jul 23, 2019


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Pat Trudeau, Vice President of Clinical Services for RSC Diagnostic Services, a R. EEG T., CLTM and FASET, was the guest speaker on The Epilepsy Spectrum Podcast on June 30th. The host and producer of The Epilepsy Spectrum Podcast is Tiffany Webb. Episode: Introduction to EEG's with Pat Trudeau of RSC Diagnostic Services. Listen to learn more about how In-home Video EEG Monitoring can assist physicians in diagnosing patients with neurological events in the comfort of their own home or continue reading the transcript below. To listen to the podcast visit Apple Podcasts or click here.


 

Intro: Today we have Pat Trudeau on the show, she is the Vice President of Clinical Services for RSC Diagnostic Services. She has been involved with patient care for over 35 years and she's served on the Local Professional Advisory Board in Wisconsin and on the National Epilepsy Foundation Professional Advisory Board. She has served as the Board of Director for the National END Credentialing (ABRET) and has presented at national, regional and state conferences on epilepsy. Pat, welcome to the show.

Tiffany: "Tell me about your connection to epilepsy."

Pat: I actually don't have epilepsy. I was a history major in college, but knew I didn't want to teach. I became involved in the field of electroneurodiagnostics because my good friend was an EEG technologist and I job shadowed with her. It was such an interesting thing to be able to help physicians in diagnosing seizures for epilepsy. I thought it would be a very rewarding career.

I worked as a coordinator for the EMU in a large 600 bed hospital and clinic in a rural area in Wisconsin. I became very involved in epilepsy monitoring, Routine EEGs and surgical workup. I served on the Epilepsy Foundation Board and that's where I got to meet a lot of patients that have epilepsy. I was able to hear some of the struggles throughout there life and that's how I became really involved with epilepsy.

Tiffany: "I love that you are involved with epilepsy and you don't have it. We need more advocates like you out there helping us with raising awareness for the condition. [So] Thank you for that. Your company is RSC Diagnostic Services and that stands for Redefining Seizure Care."

Pat: Yes, RSC Diagnostic Services. We offer In-home Video EEG Monitoring. We are in 17 states and can do studies on a variety of ages, from as young as 1 month of age until 110 years old. We perform our services in the patients home for as short as 24 hours to as long as a 6-day study.

Tiffany: "For the patients that do find it to be scary and intimidating to be hooked up to wires in a hospital, that at home option makes you feel so much more secure in what you're dealing with."

Pat: That's right and especially with our pediatric patients. We know that it is really hard for parents to take off work, so we offer these studies over the weekend. Many times patients don't have the option for flexible scheduling in an epilepsy monitoring unit. Sometimes studies in an EMU are only performed Monday through Friday, whereas RSC offers the option to come into your home and do the study over the weekend. That is also great for patients who work Monday through Friday and can only take off a few days from work. RSC can certainly work around there schedule.

Tiffany: "Let's talk a little bit about what to expect when a patient is first introduced to an EEG as well. And Pat, for those listeners that don't know what an EEG is, can you explain that for them?"

Pat: A Routine EEG is generally from 20-30 minutes. If its a younger child, like a new born, sometimes the Routine EEG can be as long as 45 minutes. The patients head is measured according to the 10-20 system. The electrodes need to be on the head symmetrical, so that's why a technologist measures the head. There are 23 electrodes that go on the head along with EKG heart monitoring, which may applied with glue or paste. During the Routine EEG, sometimes patients are told to be kept awake the night before, so we can get some sleep. We also may do some activation. Activation means we try to bring out abnormal activity in the brain. We can do this by showing a strobe light and running that light at different frequencies. Also, we do hyperventilation. That can bring out Absence seizures, which is a starring spell. The patient starts hyperventilating and may have these Absence spells. The most common clinical feature of Absence seizures is starring, the patient will stop what they are doing until the seizure has ended and then continue on with what they were doing.

Tiffany: "Is it diagnosing the type of abnormal activity or just determining abnormal activity?"

Pat: It is both. For example, perhaps the patient getting a Routine EEG had a seizure the day before, the chances of seeing abnormal activity are a little bit higher. However, the Routine EEGs are for a very short period of time, so many times you don't get sleep activity. Sleep activity can really bring out abnormal activity in patients with epilepsy. If a routine EEG is normal, many times a physician will say we need to get a longer study to try and capture an event. Whether the event be epilepsy or not. Patients can have a variety of different events that may not be epilepsy. That's why video EEG monitoring is very important to capture the events to help the physician determine what is the best course for this patient, medical wise or other treatment.

Tiffany: "Now, if I had a seizure on an EEG is there ever a case where it wont show up on the paperwork or the graph that you look at?"

Pat: That's a really good question. And yes, that can occur. Especially if a patient doesn't have an abnormal EEG, but had what is called a partial seizure without impairments. They may have just felt something, but didn't lose any impairment. Meaning they stayed aware the whole time. There may not be any EEG changes with that.

Tiffany: "Are there additional tools that you use with it that help to determine seizure activity?"

Pat: The video is so important. For instance, if a patient has a start of a seizure, where we begin to see rhythmic abnormal activity on the EEG, there still may not be anything clinically going on with the patient. Then, the video is able to provide vital information for the physician to help determine what type of epilepsy they may have and what type of medication they would use for that particular type of epilepsy.

Tiffany: "How does it work in transferring the information from your brain to the EEG that monitors what is going on?"

Pat: EEG stands for electroencephalogram. Basically, what we are recording is the electrical activity from the brain. Unlike an MRI or a CT scan, that shows a picture of what is going on in the brain, an EEG is the actual electrical activity happening. We have amplifiers that amplify that activity we recorded digitally, so we can look at it many different ways. But there is certain activity that is normal for younger children and normal for adults. We compare the left side of the brain next to the right side of the brain as they should look the same. There are all certain types of activity that are normal for adults or a child and then its different EEG activity when you fall asleep. 

Tiffany: "So, the regular [Routine] EEG like you said is less than an hour and in a hospital, but it doesn't capture everything that you want to sometimes?"

Pat: That is correct. Because it is for a short period of time.

Tiffany: "And the Ambulatory EEG, that just means that you are mobile?"

Pat: Correct.

Tiffany: "And with the video monitoring unit, how does that work with someone having that in their home?"

Pat: We tell our patients to try and have a base camp. A lot of patients will stay in their bedroom and then have a big lounge recliner next to them to watch TV, but we're able to record them while they're sleeping at night. And that's especially important to make sure that we're recording if they have nocturnal events. Otherwise, parents typically set-up little tents for there children. We've done kids for three days as young as 2 years of age and it has turned out really well by setting up a play area. The camera is on a tripod, so we can scam the area.

What we want is a really good study for the length of time that the physician has ordered. RSC strives to get a good study done and we accomplish this by putting on good application, informing the patient on what they need to do and asking if there is anything that my elicit an event. For example, maybe a particular song can cause an event or maybe eating certain food can bring out a certain event. Those are the things that we go over with the patient and patients family prior to the testing. This process helps to make sure that the family or the patient proceeds with trying those triggers, so we can capture the results. The patient is our number one priority and getting a diagnosis for them. We have a great team that works at scheduling patients and a patient advocate, so that the patients needs are matched. All in all, I think its a great tool for patients to have this video-EEG monitoring in an in-home environment.

Tiffany: "I just have one more question for you. One thing I know that people really struggle with and that is getting the glue [and gunk] off of your head once you've had an EEG. [So] That is the worst part of it [I think], in my experience. Do you have any advice for listeners that are trying to find new ways to get that off of their scalp when they are finished with their EEG experience?"

Pat: That really can be a challenge sometimes. What I have always told patients to do is to put conditioner in your hair and put a lot of it. Get a wide tooth comb and comb out some of that glue. Then, hit the shower and that will help get majority of the glue out of our your hair. Also, patients have told me they've used baby oil, especially with kids, to soften up any patches where the glue has dried and then again, using a wide tooth comb to try and get that out. What RSC uses is the non-acetone nail polish remover. That's basically what most labs use, so that works pretty good too.

Tiffany: "If listeners would like to learn more about an in-home EEG experience with your company, where should they go online?"

Pat: It's www.rscdiagnosticservices.com and we also have a blog that you're able to visit through the website.

Tiffany: "Wonderful. Well, Pat thank you so much for joining us and sharing a little more information about EEGs and about what your company does to help patients that have seizures and that have epilepsy."

Pat: Thank you for inviting me. It was my pleasure.

Topics: RSC Diagnostic Services, In-Home Video EEG