Module information
Module details
- Title
- Sleep and Long-term EEG monitoring
- Type
- Specialist
- Module code
- S-N-S5
- Credits
- 10
- Phase
- 3
- Requirement
- Compulsory
Aim of this module
This module will provide the trainees with a theoretical and practical background in the neurophysiological science of long-term EEG monitoring. Trainees will be exposed and participate in ambulatory EEG at home and on the ward.
They will also have the opportunity to develop a detailed knowledge and understanding of the physiology of sleep and the clinical uses of sleep investigations. Trainees will have the opportunity to gain the practical skills required to record sleep parameters during polysomnography and multiple sleep latency recordings.
Work-based content
Training activities
| # | Learning outcome | Training activity | Type | Action |
|---|---|---|---|---|
| # 1 | Learning outcome 1, 2 |
Training activities
Plan and prepare to conduct long term monitoring for:
|
Type ETA | Action View |
| # 2 | Learning outcome 2 |
Training activities
Adapt and explain long term monitoring to a patient/carer with additional communication needs to ensure co-operation with the diagnostic testing |
Type ETA | Action View |
| # 3 | Learning outcome 1, 2 |
Training activities
Prepare patients and perform a long-term diagnostic test for patients in the:
|
Type ETA | Action View |
| # 4 | Learning outcome 2, 3, 4 |
Training activities
Interpret, annotate and produce a full factual report for long term monitoring of:
|
Type ETA | Action View |
| # 5 | Learning outcome 5 |
Training activities
Plan and prepare to conduct the following sleep diagnostic tests on a patient:
|
Type DTA | Action View |
| # 6 | Learning outcome 5, 6, 9 |
Training activities
Adapt and explain the sleep procedure to the patient/parent/carer to ensure co-operation with the diagnostic testing |
Type ETA | Action View |
| # 7 | Learning outcome 5,6 |
Training activities
Prepare patients and perform PSG |
Type DTA | Action View |
| # 8 | Learning outcome 5, 6 |
Training activities
Prepare patients and perform an MSLT following the previous night’s PSG |
Type DTA | Action View |
| # 9 | Learning outcome 7, 8 |
Training activities
Interpret and annotate sleep tests, and produce a draft sleep reports based on:
|
Type DTA | Action View |
| # 10 | Learning outcome 10 |
Training activities
Present a patient pathway to the multidisciplinary team /colleagues for a patient you have seen with one of the following conditions:
|
Type DTA | Action View |
Assessments
Complete 2 Case-Based Discussions
Complete 2 DOPS or OCEs
Direct Observation of Practical Skills Titles
- Measure head in accordance with a recognised system.
- Apply electrode/transducers according to local procedures for a LT-EEG study.
- Apply electrode/transducers according to local procedures for a sleep study.
- Record PSG on a patient suspected of sleep disorder (starting, live monitoring and stopping).
- Record an MSLT on a patient suspected of a sleep disorder (starting, live monitoring and stopping).
- Accurately annotate clinical and EEG features on a patient reported clinical event.
- Annotate a patient’s sleep stages during sleep test.
Observed Communication Event Titles
- Obtain a detailed patient history for LT-EEG.
- Gain appropriate consent for long term monitoring and video recording in the home.
- Gain appropriate consent for long term monitoring and video recording in the hospital setting.
- Obtain a detailed patient history for a sleep study.
- Explain MSLT to the patient/carer and obtain appropriate consent.
Learning outcomes
| # | Learning outcome |
|---|---|
| 1 | Plan, prepare and perform long term EEG recordings in home-based settings and on the ward. |
| 2 | Practice according to relevant guidelines and protocols. |
| 3 | Analyse and interpret long-term monitoring studies, identifying normal and abnormal wave forms and clinical events. |
| 4 | Prepare reports of ambulatory and video telemetry studies recorded from patients undergoing monitoring for epilepsy investigation. |
| 5 | Prepare, and plan for the following sleep investigations polysomnography (PSG) and multiple sleep latency tests (MSLT). |
| 6 | Perform PSG and MSLT with guidance from a sleep physiologist. |
| 7 | Analyse and interpret PSG and identify sleep stage features, sleep-related EEG patterns and sleep stage transitions. |
| 8 | Prepare reports from the results from PSG and MSLT. |
| 9 | Demonstrate effective and compassionate communication skills with all stakeholder including patients and the multidisciplinary team. |
| 10 | Describe sleep related patient pathways. |
Clinical experiences
Clinical experiences help you to develop insight into your practice and a greater understanding of your specialty's impact on patient care. Clinical experiences should be included in your training plan and you may be asked to help organise your experiences. Reflections and observations from your experiences may help you to advance your practice and can be used to develop evidence to demonstrate your awareness and appreciation of your specialty.
Activities
- Attend an epilepsy surgery multidisciplinary team meeting.
- Attend an epilepsy ward round.
- Attend radiology department to observe brain MRI acquisition/reporting.
- Observe invasive EEG procedures such as EcoEEG, Stereo EEG, depth or grid and reflect on the differences and similarities with scalp EEG.
- Attend a sleep multidisciplinary team meeting and reflect on the role of the clinical physiologist within the team.
- Attend an ENT or respiratory long-term ventilation clinic to see the impact of a non-neurological sleep disorder on night-time sleep and reflect on a multi system approach to assessment.
- Attend a sleep workshop, CBT session or narcolepsy group and reflect on patients’ experience.
- Visit a community setting e.g., elderly care, neurorehabilitation facility, neuro-disability, or a community clinic to explore the impact of sleep deprivation on carers and families and reflect on holistic care and the role of other agencies.
Academic content (MSc in Clinical Science)
Important information
The academic parts of this module will be detailed and communicated to you by your university. Please contact them if you have questions regarding this module and its assessments. The module titles in your MSc may not be exactly identical to the work-based modules shown in the e-portfolio. Your modules will be aligned, however, to ensure that your academic and work-based learning are complimentary.
Learning outcomes
On successful completion of this module the trainee will be able to:
- Critically appraise the pathophysiology, clinical presentation and EEG findings in paediatric epileptic syndromes and paediatric metabolic manifestations on the central nervous system.
- Criticaly evaluate the clinical applications of ambulatory recordings and video-telemetry in adult and childhood seisure disorders.
- Compare non-invasive and invasive EEG recordings (i.e. electrocorticography, stereo-EEG) describing the pathway followed by a patient with refractory epilepsy from non-invasive telemetry evaluation to surgery monitoring.
- Apply integrative understanding of normal and abnormal sleep and its assessment.
- Critically evaluate the clinical applications of ambulatory recordings in adult and childhood seisure disorders and sleep disorders.
Indicative content
- The EEG in epilepsy, and seizure disorders in children and adults
- Seizure classification
- Differentiation between epileptic and non-epileptic attacks
- Evaluating clinical symptoms
- Seizure classification by clinical criteria
- Hard to recognise seizures
- Transitory cognitive impairment
- Evaluating the frequency of events and detection of precipitating factors
- Evaluation of episodes of altered awareness or behaviour
- Clinical use of video-telemetry and ambulatory recording: Electrode types and montages
- The importance of video recording. Common artefacts (brushing teeth, chewing, eye movement, blinking, scratching, picking at electrodes and sweat)
- Recording of other physiological variables – ECG, EMG, tremor, eye movement, pulse oximetry
- Difference between irritative zone, symptomatogenic zone and seizure onset-zone
- Determination of seizure-onset zone.
- Drugs used in the management of epilepsy
- Protocol for drug withdrawal and management of status epilepticus in video telemetry patients.
- Use of invasive EEG recording in the evaluation and treatment of the refractory epileptic patient: electrocardiography and stereo EEG during invasive telemetry and surgery. Eloquent areas’ mapping
- Physiology and chronobiology of sleep
- Function of sleep
- Circadian biology
- Sleep regulation
- Neurotransmitters
- Melatonin production and effects
- Characteristics of the normal awake EEG in adults and paediatrics including normal variants
- Vertex sharp waves, sleep spindles, K complexes, delta waves and positive occipital sharp transients of sleep (POSTs)
- Sleep staging – AASM guidelines
- Wakefulness
- Stage I Non –rapid eye movement (NREM I)
- Stage II Non –rapid eye movement (NREM II)
- Stage III Non –rapid eye movement (NREM III)
- Rapid eye movement (REM)
- Sleep related events
- Respiratory events
- Motor events
- Cardiac events
- Other events
- Normal sleep architecture and hypnogram
- Polysomnography (PSG)
- Clinical use of PSG
- Electrodes and sensors placement EEG
- Electrooculogram (EOG)
- Electromyography (EMG) – Submental muscle, limbs
- Respiratory effort and movement
- Snoring
- Flow
- Oxygen saturation and carbon dioxide levels
- Protocol and overnight monitoring
- PSG analysis and reporting
- Multiple sleep Latency Test (MSLT following an overnight PSG
- Clinical use of MSLT
- Electrodes and sensors placement
- Protocol and live monitoring
- MSLT reporting
- Other sleep assessments and subjective assessment of excessive daytime sleepiness
- Classification of sleep disorders:
- Insomnia
- Sleep related breathing disorders
- Central disorders of hypersomnolence
- Circadian rhythm sleep-wake disorders
- Parasomnias
- Sleep related movement disorders
- Other sleep disorders
- Abnormal PSG and MSLT findings in the different sleep disorders
- Differential diagnosis