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Activation Procedure
2
| Question | Answer |
|---|---|
| Physiology of Hv | Decreases in Co2 blood level that causes vasoconstriction of the cerebral arteries and changes the brain metabolism. Causes cerbroischemic anoxia. |
| What patients can benefit from HV? | Severe brain trauma, brain swelling, ventilator. |
| If a patient has lack of glucose in blood, what will 2 minutes of HV look like? | High amplitude. |
| If you give a deprived patient glucose at 2 minutes of HV, what will the EEG look like? | Decreased or low amplitude. |
| What determines HV effectiveness? | 1. Good over-breathing 2. Glucose level 3. Pt age |
| What is most important in HV? | Exhaling. |
| HV in Children: | May occur abruptly and with higher voltage. High voltage delta should occur. If not, most likely due to not blowing hard enough. |
| In HV, age has an effect on: | PCO2. |
| After HV ends, how long should the effect last for? | 60 Seconds. |
| In adults, where is HV effect maximal? | Frontal. |
| In children, where is HV effect maximal? | Occipital. |
| Photoparoxysmal Response (Photoconvulsive Response) | Spike and wave and multiple spike and wave complexes or bursts that don't necessary coincide with the flash frequency, which are bilaterally synchronous. |
| Photomyoclonic Response | Brief repetitive muscle spikes over the anterior regions of the head during PS. |
| What is a normal HV EEG finding? | Slowing of background rhythms, followed by a rhythmic 2-4 Hz high voltage activity (up to 500 uV). Slowing should be bifrontal. |
| What is HV secondarily used for? | Dramatically producing normal changes. |
| What is HV routinely used for? | Reproducing Absence szs. |
| What types of Photoparoxysmal Responses are there? | Generalized and poly spike and wave that outlasts the photic stimulus (including Absence), A self-limiting response that is a paroxysmal spike or spike and wave that ends before the flash stimulus, and spikes limited to the occipital head region. |
| Photic can induce... | Absence. |
| Can photoparoxysmal bursts be seen without a sz disorder? | Yes, it can be hereditary. |
| 1/5 of pts with photoparoxysmal sensitivities also demonstrate abnormalities with what? | Certain patterns, especially stripes. |
| Photoparoxysmal responses usually consist of what? | Generalized activity or occipital spikes. |
| In photic driving, what does 'Pace' mean? | To follow. |
| CJD can produce what during PS? | Pace Complexes. |
| Electroretinogram (ERG) | A retinal response to light. Can be seen in an ECS recording due to increased sensitivitu and sometimes in routines if amplitude is high enough. Seen in the leads nearest the, and follow the flash rate with EO or EC and disappears with eyes covered. |
| Photomyogenic Response (EMG) | Muscle twitches in response to the light stimulus, maximal in the frontal leads, and are at the same rate as the flash. Most commonly seen in pts of drug or alcohol withdraw, but normal in any. |
| Photoelectric | Artifact that occurs at the frontal leads and coincides with the flash at the same frequency. Indicates bad electrode or high impeadence. Cover with cloth and fix electrode after PS. |
| What response can photic produce in young children with late Infantile Lipidosis (Beilschowsky-Jansky type)? | Occipital spikes at low flash frequencies. |
| If a pt has a hx of photoparoxysmal response, what simple procedure can also produce a spike/wave response? | EO & EC. |
| What variant is the Photoelectric Response? | Normal. |
| What should you do if you have to stop photic due to a Photoparoxysmal Response? | Repeat the same frequency to check for frequency induced abnormality. |
| How do you eliminate Photoelectric activity? | Covering the leads with a cloth. |
| How often should the light flash in PS? | 10 seconds with a 5 - 10 second resting period between. |
| Asymmetrical PS recruitment is... | Abnormal. |
| Photic Response - Photic Driving: | Photic recruitment (may be harmonic or subharmonic). |
| Photic Response - Subharmonic: | Posterior activity is responding at 1/2 of the FPS as the photic light. |
| Photic Response - Normal: | No changes (No driving, harmonic, or subharmonic). |
| How far should the photic lamp be from the pt's eyes? | 6-18 inches. |
| How long should a PS flash last for safety such as protecting eyes from damage? | About 10 ms. |
| What is the Second Per Flash (SPF) range for PS? | 1-30. |
| PS Contraindication | Discontinue after abnormal activity presents, especially generalized polyspike and wave bursts. |
| What common wave form is produced by a visual scanning effect? | Lamda Waves. |
| Reflex Epilepsy | Rate and has a specific trigger that induces szs, such as musicogenic, audiogenic, reading epilepsy, and others. |
| Reading Epilepsy | 10-20 minutes to induce and begins with twitching around the mouth, which may progress to myoclonic jerks or generalized szs. |
| Musicogenic and Audiogenic | Often require very specific songs or tones to produce symptoms or szs and often lead to partial complex szs. |
| How is sleep deprivation/fatigue an activation procedure? | It stresses the CNS. |
| What is the most useful activator for generalized epileptiform abnormalities? | Sleep deprivation. |
| What is most important in activating abnormal discharges? | Light drowsiness and sleep. |
| 82% of CP pts will have interictal activity when? | During sleep. |
| What stage of sleep tends to activate the most epileptiform activity? | Stage II. |
| What changes morphology of a waveform? | Sleep. |
| What morphology does Typical Absence take during sleep? | Atypical or poly spike/wave. |
| Why is a Photoparoxysmal Response seen more in children than in adults? | There is an increased incidence of PGE in this group. |
| When is HV most effective? | In the young. |
| When is HV least effective? | In the elderly. |
| What does a long return to baseline mean after performing HV? | Usually indicates hypoglycemia. |
| Photic can produce a normal variant of... | Visual EP responses. |
| Photosensitivity is often maximal at what frequencies? | 14-16 Hz. |
| 30% of pts with epilepsy have increased activity with this activation procedure: | Sleep deprivation. |
| Sleep deprivation is a powerful activator in this situation: | EEGs are normal and epilepsy is suspected. |
| In sleep deprivation, is sleep or deprivation, itself the sz activator? | Deprivation. |
| Does falling asleep change the response to sleep deprivation? | No. |
| Insomnia | Difficulty initiating and maintaining sleep with early awakening. |
| Hypersomnia | Excessive sleepiness, usually daytime or inappropriate times. This problem is most often a result of poor sleep at night even though pt may believe they are sleeping well. |
| Parasomnias | Unusual behaviors during sleep. Ex: Nightmares, sleep talking, sleepwalking, REM sleep behavior disorder, nocturnal confusion. Usually experienced by the elderly. |
| Nocturnal Movement Disorders | Restless leg and nocturnal myoclonus. |
| Sleep Apnea | Abnormal pauses in breathing or instances of abnormally low breathing, during sleep. Ex: Loud snoring with transient, brief, intermittent breathing cessation lasting greater than ten seconds. Often associated with obesity. |
| Types of Hypersomnia | Obstructive sleep apnea, Central sleep apnea, Narcolepsy, Medication effects, Recent viral infection. |
| Sleep/Wake Cycle Distrubances | Irregular patterns, Delayed sleep phase syndrome, Advanced sleep phase syndrome. |
| Common causes of Insomnia | Non-prescription medications/drugs (alcohol, caffeine, decongestants, nicotine, antihistamines, stimulants), rebound from sedatives, depressants, medical problems (pain, gastric, etc.), Psychological (anxiety, etc.), behavior (sleep habits, etc.). |
Created by:
kmburg5840
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