Complex EEG Recording and Clinical Reporting

Details

Title

Complex EEG Recording and Clinical Reporting

Type

Stage Two

Module code

HPS253

Requirement

Compulsory

Module objective

By the end of this module the Clinical Scientist in HSST will be able to apply their expert knowledge of electroencephalography (EEG) and cortical function to analyse, interpret and provide comprehensive diagnostic reports across the full range of neurological and non-neurological conditions in adults and patients of paediatric age (including neonates) within the individual’s scope of practice.

They will perform, master and adapt a range of complex EEG recording techniques including sleep EEG, ambulatory EEG and long-term monitoring. They will be able to analyse the electrographic data in conjunction with the clinical history and seizure semiology to provide clinically relevant reports. The Consultant Clinical Scientist will make informed decisions in the best interest of the patient, will involve the patient in decision making, and will be mindful of all potential safety issues. In conjunction with medical colleagues, the Clinical Scientist in HSST will also formulate an appropriate plan for investigation and management, being aware of the need to expedite investigation in suspected serious disease. They will be aware of developments in technology that may be translated to and enhance the diagnostic capabilities of neurological conditions. The Clinical Scientist in HSST will also consistently demonstrate the attitudes and behaviours necessary to undertake the role of a Consultant Clinical Scientist.

Stage 2 HSST education and training is designed to ensure the Clinical Scientist in HSST is learning and working at the cutting edge of science. Where necessary, given the speed at which science and technology develops, those delivering training and the Clinical Scientist in HSST together are expected to identify emerging developments that may be outside those specifically detailed in the Stage 2 modules and gain the knowledge and skills to take them forward.

Knowledge and understanding

By the end of this module the Clinical Scientist in HSST will be able to analyse, synthesise, evaluate and critically apply their expert knowledge to a range of complex EEG recordings, including:

Anatomy, physiology, pathology and pharmacology:

• the prevalence of epilepsy and its relevance to the patient population referred;
• identification of typical anatomy and common variants;
• neurologic and metabolic conditions affecting cortical function, including infectious, inflammatory and inherited causes;
• pharmacology relevant to EEG recording of cortical function, including aggressive treatment regimens used in intensive care setting.

Clinical history, examination and management options:

• protecting patients of paediatric age and vulnerable adults from maltreatment, abuse, neglect or exploitation (safeguarding);
• consent in adults and paediatric patients;
• presenting signs and symptoms and identify possible alternative diagnoses;
• clinical seizure semiology, including clinically localising and lateralising manifestations;
• International League Against Epilepsy (ILAE) seizure classification;
• the range of medical, interventional and surgical management options;
• recognition of how diagnosis affects management pathway.

Diagnostic techniques

• the importance of performing all electrophysiological tests in accordance with current international standards and guidance;
• sources of artefact and errors in measurements and the appropriate action to take;
• how to recognise normal variants and relevance to interpretation in the clinical context;
• differential diagnoses relevant to the clinical context;
• the role of complex EEG in the diagnosis of the full range of neurological conditions that effect cortical function;
• uses and benefits of prolonged or serial EEG recordings for the diagnosis and management of patients in dedicated and non-dedicate environments;
• post acquisition analysis techniques to improve sensitivity of recording (such as jerk-locked back averaging, spectral density array, cortical mapping, etc.).

Clinical reporting:

• the importance of technical considerations and manipulation of data;
• age-related normal findings, including the elderly, paediatric and neonatal recordings;
• the relevance of a ‘normal’ EEG recording in the clinical context of epilepsy and the role of EEG in its diagnosis and treatment monitoring;
• abnormal generalised and focal abnormalities and their relevance to age and clinical conditions;
• electrographic correlate of other neurologic and metabolic conditions affecting cortical function, including infectious, inflammatory and inherited causes;
• how the results of other investigations influence diagnosis (e.g. clinical chemistry, genetics, imaging, etc.);
• how to recognise the clinical sequelae of the diagnosis;
• how the diagnosis affects the management pathway
• when to ‘treat the EEG’.

Clinical presentation, investigation and management of epilepsy (adult and paediatric)

• invasive EEG correlates of different seizure types;
• the uses, interpretation and limitations of electrocorticography;
• use of functional brain mapping in pre-surgical assessment;
• strategies of epilepsy surgery and multidisciplinary pre-surgical assessment;
• risks and benefits of epilepsy surgery and its associated procedures;
• procedure, uses and interpretation of carotid amytal test and simultaneous EEG recording;
• supportive care;
• long-term treatment and prognosis;
• how pharmacological treatment affects the EEG, including the effects of sedation/anaesthetic agents on the interpretation of EEG in the intensive care setting and their use in the management of complex epilepsy;use of functional brain mapping in pre-surgical assessment;
• use of advanced neuroimaging to identify eloquent cortex and epileptogenic zone.

Technical and clinical skills

By the end of this module the Clinical Scientist in HSST will have a critical understanding of current evidence and its application to the full range of complex EEG investigations. They will be able to perform and master each technique, adapting their response to meet the varying and complex challenges that will arise reliably:

• sleep EEG;
• ambulatory EEG;
• long-term monitoring (LTM) in dedicated and non-dedicated environments;
• pattern recognition in a range of idiopathic/genetic and metabolic conditions effecting neurological function;
• activation procedures, including suggestion for non-epileptic attack disorder (NEAD);
• design, develop and critically evaluate new investigations according to need and clinical condition;
• critically assess the evidence when there are competing priorities, e.g. cost, performance, to choose best solution;
• critically evaluate current guidelines and work with the multiprofessional team to develop and implement guidelines in the clinical setting, recognising the need to ensure the safety of the patient;
• critically evaluate ideas, innovations and inventions for their potential to have a positive impact on patient care, service delivery, education and training, and the organisation, etc.;
• critically evaluate new technology, set up and optimise equipment;critically apply their understanding of the clinical use of complex EEG recordings to compare and contrast the relative scientific merits of each technique for specific clinical situations, including risk, benefit and diagnostic accuracy;
• lead clinical audits to assess the effectiveness and accuracy of diagnostic procedures, implement changes and assess the effectiveness of any change made in response to findings.

By the end of this module the Clinical Scientist in HSST will be expected to critically reflect on their clinical practice. They will apply in practice a range of advanced clinical and communication skills to advise and communicate effectively with patients, relevant clinicians and the public, and other healthcare professionals, and will be able to:

History and investigation:

• take a comprehensive history, understanding the nature of the neurological complaint, triage and select the most appropriate electrophysiological investigations according to signs, symptoms, medical and family history;
• choose and provide expert opinion on the most appropriate technique/test for the clinical presentation;
• take a holistic approach to diagnosis and take electrophysiological recordings that provide an accurate and comprehensive assessment of the patient’s clinical problem;
• analyse all electrophysiological data;
• interpret the electrophysiological data and provide a clinical report, placing the results in the context of history, including evaluation of possible differential diagnoses;
• compare all data to justify and validate the conclusion;
• produce a clear and informative report with recommendations for further diagnostics and/or treatments;
• advise clinicians on the efficacy of treatment intervention in appropriate disorders and, if appropriate, advise on potential changes in therapeutic strategy.

Communication and team working:

• discuss, as appropriate and in conjunction with the lead clinician, the young person’s epilepsy with them so as to inform their decisions regarding their future care;
• communicate appropriately with the patient, placing the patient at the centre of care and prioritising the safety of the patient;
• advise and communicate effectively with the patient and the public as determined by the scope of practice;
• communicate with the multidisciplinary team and participate as an active member of the team;
• support and contribute to the development of multidisciplinary clinical team working and work with the team to determine scientific service priorities;
• recognise the importance of the multidisciplinary clinical team and take responsibility for ensuring appropriate and effective decision-making processes are in place;
• educate Clinical Neurophysiological Scientists, clinicians and other members of the healthcare team with respect to the principles behind new developments and innovation.

Professional practice:

• adapt current tests, and develop, validate and implement novel investigations to better to facilitate diagnosis and management within current ethical and governance frameworks;
• consistently work to high standards of clinical practice applying knowledge and evidence, making evidence-based decisions and evaluating the impact of those decisions;
• monitor, evaluate and maintain personal clinical practice standards and the standards of the service they lead;
• balance data confidentiality, security and protection, and the sharing of data with relevant stakeholders, including patients, to ensure high-quality patient- centred care;
• explain the principles and relevance of the novel procedures to patients at an appropriate level of complexity and involve patients in the development process appropriately;
• support conclusions draw from evidence with reasoned argument;
• appreciate the impact of new evidence on patients and carers;
• facilitate effective and empathic communication with respect to the evidence base underpinning vascular science;
• act in accordance with the principles and practice of patient-centred care, regularly reflecting on personal practice and revising judgements and changing behaviour in the light of new evidence;
• critically assess and evaluate personal and team-related performance in the context of evidence-based patient care, identify areas of good practice and make improvements where necessary;educate Clinical Neurophysiological Scientists, clinicians and other members of the healthcare team with respect to the principles behind new developments and innovation.
• seek feedback from patients on their own and the team’s performance and adapt practice accordingly.Advances in scientific and clinical practice:
• identify opportunities for innovative approaches to the development, delivery and evaluation of new clinical services;
• present these new developments in a concise and appropriate manner to the multidisciplinary team, including healthcare management, in order to influence and progress their implementation;
• keep up to date with scientific research in Neurophysiological Science;
• adopt a mindset that actively seeks creative solutions to problems through engagement with individual creativity, approaches and techniques;
• work with and encourage others to find creative solutions to problems through engagement with group creativity approaches and techniques;
• be positive and confident about developing ideas and putting them into action;
• actively seek out opportunities for collaborative discussions and research, being open to new developments, attending conferences and keeping up to date with the literature;
• adopt a forward-looking, progressive approach and be receptive to new ideas and looking out for emerging technologies;
• promote a sustainable, engrained culture of innovation in an individual, department and/or organisation;
• ensure clinical and scientist colleagues are kept up to date with novel techniques used within the service;
• ensure patients fully understand any procedure that is undertaken;
• continue to monitor any safety issues relating to a novel procedure introduced to the diagnostic or follow-up service.

Leading scientific services:

• critically review the literature and disseminate findings and scientific data, and make recommendations for future activity;
• ensure clinical and scientist colleagues are kept up to date with new and novel techniques used within the service;
• work with patients and parents to develop and update patient information materials appropriate to service requirements;
• share data on clinical practice standards with service users and managers to encourage dialogue and debate;
• be committed to, support and lead continuous improvement of neurophysiological scientific services, with particular reference to auditing practice, evidence-based practice, innovation, and the introduction and use of new and improved technologies;critically review the literature and disseminate findings and scientific data, and make recommendations for future activity;
• reflect on the challenges of applying research to practice in relation to these areas of practice and suggest improvements, building on a critique of available evidence.