Reading the EEG in Children

What this deck covers

Reading the EEG in Children in twelve illustrated clinical cases with worked explanations – case presentations built around clinical images, radiology, teaching illustrations and real laboratory data, with the reference range beside every value a case quotes. This visual, data-interpretation style of practice suits candidates preparing for MRCPCH AKP in particular, alongside Saudi and Gulf licensing examinations such as the Arab Board, DHA and OMSB. Each case gives you a clinical vignette, four options, the correct answer, and an explanation of why each of the other three is wrong.

The twelve cases, in order

1. Staring, and the test that provokes it
2. Clusters on waking, and a baby who has stopped progressing
3. Twitching at night, and a normal child by day
4. A rising feeling, and then two lost minutes
5. A quiet baby after a difficult birth
6. One faint, and an EEG that was not needed
7. A normal EEG, and a seizure that certainly happened
8. After the first seizure, what is the EEG for
9. A second look, and how to make it count
10. Generalised or focal, and why the label chooses the drug
11. The convulsion stopped, and she has not woken up
12. Morning jerks, and a syndrome for life

What this deck teaches

• The EEG classifies. The history diagnoses.. A seizure is diagnosed on what happened. The EEG names the syndrome and estimates recurrence, and it does neither job well if the history is thin.
• A normal EEG does not exclude epilepsy. About half of children with epilepsy have a normal first interictal study. It lowers the recurrence estimate; it does not overturn a good history.
• The commonest harm is an over-read normal variant. Sharp transients occur in well children. An EEG ordered for a faint invites a wrong diagnosis, a restricted life and an unnecessary drug.
• Sleep is the most useful activator. Centrotemporal spikes may appear only in sleep. An awake-only study with a suggestive history is half a study – repeat it sleep-deprived, with sleep.
• Generalised or focal decides the drug. Carbamazepine, oxcarbazepine and phenytoin can worsen absence and myoclonic seizures. A focal ONSET is also what makes MRI necessary.
• In the newborn, read the background. Burst suppression is a severely abnormal background; tracé alternant is its normal mimic in quiet sleep, and the difference is the inter-burst voltage.

Exam pearls from this deck

• Three minutes of hyperventilation in clinic is the cheapest provocative test in paediatrics.
• Spasms plus regression plus hypsarrhythmia is West syndrome, and the clock matters.

The twelve worked cases in this deck, with the images and the full explanation of every option, are part of Pediatric Case Review membership. See what is included, or start with the free Pediatric Exam Review Sets.

More from this system: all neurology illustrated case decks · neurology board questions for bank-style drilling · the free Pediatric Exam Review Sets · pediatric reference values.