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The Structure and Philosophy of the EEG Report
The essential purpose of recording and interpreting an EEG is to communicate information to the clinicians that will help guide the patient’s care. When patients are referred for EEG testing, the referring physician often does not have the opportunity to review the EEG personally but usually relies completely on the report of the EEG to learn the findings and clinical implications of the test. Physical and time barriers and lack of EEG expertise may limit direct review of the record. Often, the EEG report becomes the de facto permanent record of the results of the study. For these reasons and others, considerable thought should be put into the content and wording of the EEG report, which is typically divided into a number of sections as described in this chapter.
IDENTIFYING INFORMATION
The EEG report generally starts with clinical identifiers, including the patient’s name and date of birth, the name and location of the laboratory performing the study, the date of the study, and the name of the referring physician. Next, a brief clinical history is given that includes the general indications for which the study was ordered. This brief summary may reflect a combination of the clinical information that has been provided by the referring physician and additional history that has been obtained from the patient or family by the EEG technologist. The medications taken by the patient and the date of the most recent seizure may also be given, if applicable. This history is usually recounted in a concise fashion:
This 60-year-old woman is referred because of episodes of confusion lasting 1 to 2 minutes that started approximately 1 month ago. There is a history of a left-sided stroke 3 years previously. The EEG is requested to rule out seizures.
This clinical description serves multiple purposes. First, it may alert the EEG technologist to the necessity of using specific recording techniques. For instance, absence seizures are suspected, the technologist may concentrate particularly on hyperventilation, perhaps even performing it twice. If temporal lobe epilepsy is suspected, the technologist may place extra electrodes over the temporal areas. Second, when the EEG report is completed, issues surrounding the clinical indications for the study are often addressed in the final “Clinical Correlation” paragraph at the end of the report. For example, if the referring physician suspected temporal lobe epilepsy, the EEG report may include additional pertinent negatives that directly address the clinical question posed, such as a comment that no epileptiform or slow-wave activity was noted in the temporal areas. Finally, the clinical history may also alert the technologist and the reader to special situations such as skull defects from previous surgeries, areas of the scalp that are inaccessible because of a bandage or other instrumentation on the head, or perhaps the fact that this is the fourth EEG in a sequence obtained on a patient in a coma.
TECHNICAL SUMMARY
Next, a technical description of the procedure used for the recording is provided. Because in any given laboratory most EEGs are recorded by a standard technique, this descriptive paragraph is usually standardized and only requires revisions when there are deviations from the laboratory’s routine procedure. Because the technologist is responsible for the recording procedure, this paragraph is typically produced by the technologist. An example of a procedure description for a routine EEG is as follows:
A 21-channel digital electroencephalogram was performed in the Clinical Neurophysiology Laboratory of The Particular Hospital at a sampling rate of 256 samples per second. The 10-20 international system of electrode placement was used and both bipolar, and referential electrode montages were monitored. Additional electrodes were placed at FT9 and FT10. The patient was sleep-deprived. No sedation was administered. The patient was recorded during the waking, drowsy, and sleep states. The total recording time was 41 minutes.
The next three sections represent the core of the EEG report and are produced by the interpreting electroencephalographer. These include a description of the appearance and findings of the EEG, a summary of the findings or interpretation of the EEG (which may include an “abnormality list”), and a clinical correlation paragraph discussing the clinical implications of the findings. Each of these sections is now discussed in more detail.
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