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Questions and Answers
What is a primary challenge in interpreting EEG changes related to medications?
What is a primary challenge in interpreting EEG changes related to medications?
- The lack of experienced EEG technicians.
- The limited availability of EEG technology.
- EEG recordings are not sensitive enough to detect medication effects.
- Changes in EEG recordings are typically not specific to a particular drug. (correct)
What is a characteristic EEG finding associated with barbiturates and benzodiazepines?
What is a characteristic EEG finding associated with barbiturates and benzodiazepines?
- Suppression of all brain activity
- Excess fast frequencies (beta) (correct)
- Focal slowing
- Increased alpha activity
When analyzing the effects of medication on an EEG, what information is MOST critical for the reader to know?
When analyzing the effects of medication on an EEG, what information is MOST critical for the reader to know?
- The patient's age and sex
- What medications the patient was taking (correct)
- The patient's blood pressure and heart rate
- The patient's past medical history
Which of the following EEG patterns is LEAST likely to be specific to medication effects?
Which of the following EEG patterns is LEAST likely to be specific to medication effects?
What is the typical frequency range associated with excess fast activity (beta) on EEG due to medication effects?
What is the typical frequency range associated with excess fast activity (beta) on EEG due to medication effects?
How do medications generally affect epileptiform patterns on EEG?
How do medications generally affect epileptiform patterns on EEG?
What is a key consideration when interpreting periodic patterns observed on an EEG in relation to medication effects?
What is a key consideration when interpreting periodic patterns observed on an EEG in relation to medication effects?
What is the initial effect of most anesthetic medications on EEG?
What is the initial effect of most anesthetic medications on EEG?
What is the effect of halogenated inhalational anesthetics on EEG?
What is the effect of halogenated inhalational anesthetics on EEG?
What is a common effect of antiseizure medications (ASMs) on EEG, especially in quantitative studies?
What is a common effect of antiseizure medications (ASMs) on EEG, especially in quantitative studies?
In which frequency range do benzodiazepines typically create faster rhythmic activity on EEG?
In which frequency range do benzodiazepines typically create faster rhythmic activity on EEG?
What effect does phenytoin have on EEG at therapeutic doses?
What effect does phenytoin have on EEG at therapeutic doses?
How does lamotrigine typically affect the background activity of the EEG?
How does lamotrigine typically affect the background activity of the EEG?
Which of the following intravenous barbiturates has a briefer duration of action and less sedation, leading to a quicker return to EEG baseline?
Which of the following intravenous barbiturates has a briefer duration of action and less sedation, leading to a quicker return to EEG baseline?
Which of the following is LEAST likely to cause excess slow activity on an EEG?
Which of the following is LEAST likely to cause excess slow activity on an EEG?
A patient on an EEG shows generalized periodic discharges (GPDs) after being administered an anesthetic. What should be considered?
A patient on an EEG shows generalized periodic discharges (GPDs) after being administered an anesthetic. What should be considered?
A patient is administered benzodiazepines during an EEG. The recording shows rhythmic fast activity in the 10 to 16 Hz range. What might this suggest?
A patient is administered benzodiazepines during an EEG. The recording shows rhythmic fast activity in the 10 to 16 Hz range. What might this suggest?
A researcher aims to study the effect of a novel antiseizure medication (ASM) on EEG using quantitative methods. Given the information, what would be the MOST challenging aspect of this study?
A researcher aims to study the effect of a novel antiseizure medication (ASM) on EEG using quantitative methods. Given the information, what would be the MOST challenging aspect of this study?
Which medication effect on EEG would be MOST difficult to differentiate from nonconvulsive status epilepticus (NCSE)?
Which medication effect on EEG would be MOST difficult to differentiate from nonconvulsive status epilepticus (NCSE)?
What is a significant consideration when evaluating EEG changes in patients on multiple medications?
What is a significant consideration when evaluating EEG changes in patients on multiple medications?
What is the primary focus of the chapter regarding the effects of medications on EEG?
What is the primary focus of the chapter regarding the effects of medications on EEG?
When analyzing EEG results, what historical context regarding the patient is MOST important?
When analyzing EEG results, what historical context regarding the patient is MOST important?
What is a significant challenge in interpreting EEG findings related to medications?
What is a significant challenge in interpreting EEG findings related to medications?
Which of the following is commonly observed on EEG as a result of medication effects?
Which of the following is commonly observed on EEG as a result of medication effects?
What is a critical piece of information needed when analyzing the effects of medication on an EEG?
What is a critical piece of information needed when analyzing the effects of medication on an EEG?
How do anesthetics generally affect EEG patterns as dosages are increased?
How do anesthetics generally affect EEG patterns as dosages are increased?
What effect do benzodiazepines typically have on EEG at therapeutic doses?
What effect do benzodiazepines typically have on EEG at therapeutic doses?
What is a key consideration when observing generalized periodic discharges (GPDs) on an EEG in relation to medication?
What is a key consideration when observing generalized periodic discharges (GPDs) on an EEG in relation to medication?
Which of the following best describes how antiseizure medications (ASMs) can affect epileptiform patterns on EEG?
Which of the following best describes how antiseizure medications (ASMs) can affect epileptiform patterns on EEG?
Which of the following must be known to accurately interpret the effects of medications on an EEG?
Which of the following must be known to accurately interpret the effects of medications on an EEG?
Which medication is known for having a briefer duration of action and quicker return to EEG baseline compared to amobarbital?
Which medication is known for having a briefer duration of action and quicker return to EEG baseline compared to amobarbital?
A patient on an EEG is administered a medication, and the recording shows diffuse slowing in the delta range. What should the interpreter consider?
A patient on an EEG is administered a medication, and the recording shows diffuse slowing in the delta range. What should the interpreter consider?
Which of the following is LEAST likely to be a direct effect of medication on EEG?
Which of the following is LEAST likely to be a direct effect of medication on EEG?
What is a significant challenge when trying to correlate specific ASMs with their qualitative effects on EEG?
What is a significant challenge when trying to correlate specific ASMs with their qualitative effects on EEG?
What EEG change is most commonly associated with excess beta activity on the EEG?
What EEG change is most commonly associated with excess beta activity on the EEG?
In a scenario where an awake patient on therapeutic medications presents with beta frequencies in the 20 to 25 Hz range, how should the EEG be interpreted?
In a scenario where an awake patient on therapeutic medications presents with beta frequencies in the 20 to 25 Hz range, how should the EEG be interpreted?
A patient is on lamotrigine and shows a reduction in interictal epileptiform discharges. What are the implications for clinical seizure frequency?
A patient is on lamotrigine and shows a reduction in interictal epileptiform discharges. What are the implications for clinical seizure frequency?
Why is considering the pharmacologic profile of a patient crucial in EEG interpretation?
Why is considering the pharmacologic profile of a patient crucial in EEG interpretation?
What is the MOST important reason to interpret EEG changes in clinical context?
What is the MOST important reason to interpret EEG changes in clinical context?
Why is differentiating between diffuse and focal EEG effects important?
Why is differentiating between diffuse and focal EEG effects important?
Excess slow activity (Theta/Delta) on an EEG is MOST likely associated with which condition?
Excess slow activity (Theta/Delta) on an EEG is MOST likely associated with which condition?
Excess fast activity (Beta) on an EEG is commonly associated with which class of medications?
Excess fast activity (Beta) on an EEG is commonly associated with which class of medications?
What should be strongly considered when periodic patterns are observed on an EEG?
What should be strongly considered when periodic patterns are observed on an EEG?
Benzodiazepines typically have what effect on frontal beta activity on EEG?
Benzodiazepines typically have what effect on frontal beta activity on EEG?
What EEG changes are associated with barbiturates?
What EEG changes are associated with barbiturates?
How does phenytoin toxicity typically manifest on EEG?
How does phenytoin toxicity typically manifest on EEG?
Which of the following is a noted effect of carbamazepine on EEG?
Which of the following is a noted effect of carbamazepine on EEG?
What effect does valproate toxicity have on EEG?
What effect does valproate toxicity have on EEG?
Which medication is associated with a minimal effect on EEG but may suppress spikes?
Which medication is associated with a minimal effect on EEG but may suppress spikes?
Which of the following is associated with a shorter-acting effect and faster EEG recovery?
Which of the following is associated with a shorter-acting effect and faster EEG recovery?
What should be considered when an alert patient displays diffuse delta activity on EEG?
What should be considered when an alert patient displays diffuse delta activity on EEG?
Why should focal findings observed on EEG prompt further investigation?
Why should focal findings observed on EEG prompt further investigation?
What is most likely the cause of the enhanced paroxysmal fast activity?
What is most likely the cause of the enhanced paroxysmal fast activity?
EEG changes as a result of taking Levetiracetam can be expected to show:
EEG changes as a result of taking Levetiracetam can be expected to show:
After sedative withdrawal, what activity can return on an EEG?
After sedative withdrawal, what activity can return on an EEG?
What EEG changes are associated with Propofol?
What EEG changes are associated with Propofol?
What EEG changes are associated with Etomidate?
What EEG changes are associated with Etomidate?
Flashcards
Electroencephalograph (EEG)
Electroencephalograph (EEG)
A recording of brain electrical activity using electrodes on the scalp or in the brain.
Quantitative EEG (qEEG)
Quantitative EEG (qEEG)
Advanced techniques used to evaluate medication effects on EEG recordings.
Excess Fast Activity on EEG
Excess Fast Activity on EEG
Excess fast activity (15-25 Hz) often indicating a medication effect.
Epileptiform Activity on EEG
Epileptiform Activity on EEG
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Periodic Patterns on EEG
Periodic Patterns on EEG
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Anesthetics and EEG
Anesthetics and EEG
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Antiseizure Medications (ASMs) on EEG
Antiseizure Medications (ASMs) on EEG
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Benzodiazepines on EEG
Benzodiazepines on EEG
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Barbiturates on EEG
Barbiturates on EEG
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Phenytoin on EEG
Phenytoin on EEG
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Carbamazepine on EEG
Carbamazepine on EEG
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Lamotrigine on EEG
Lamotrigine on EEG
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Levetiracetam on EEG
Levetiracetam on EEG
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Anesthetic Medications on EEG
Anesthetic Medications on EEG
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Amobarbital and Methohexital on EEG
Amobarbital and Methohexital on EEG
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Valproate on EEG
Valproate on EEG
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Methohexital
Methohexital
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Medication Effects on EEG
Medication Effects on EEG
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Excess Beta Activity
Excess Beta Activity
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Excess Slow Activity
Excess Slow Activity
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Drug-Induced Seizures
Drug-Induced Seizures
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Sedative-Hypnotics on EEG
Sedative-Hypnotics on EEG
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Dose-Related EEG Suppression
Dose-Related EEG Suppression
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Teasing Out Medication Effects
Teasing Out Medication Effects
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EEG Interpretation
EEG Interpretation
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Clinical Approach to EEG
Clinical Approach to EEG
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Excess Slow Activity (Theta/Delta)
Excess Slow Activity (Theta/Delta)
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Propofol on EEG
Propofol on EEG
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Etomidate on EEG
Etomidate on EEG
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Pentobarbital on EEG
Pentobarbital on EEG
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Medication Effects vs. Underlying Conditions
Medication Effects vs. Underlying Conditions
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Study Notes
Why This Matters
- EEG interpretation should consider the patient's pharmacologic profile.
- Many CNS-active medications affect the EEG.
- These effects are often nonspecific, and recognizing them prevents misinterpretation.
- Changes in EEG must be interpreted in clinical context, including age, medication timing, and comorbidities.
Clinical Approach: EEG with Medications in Mind
- Know the patient's medications, including route and timing.
- Assess state-dependent patterns (awake/drowsy/sleep).
- Differentiate diffuse vs focal effects; focal findings usually indicate pathology.
- Correlate changes with known medication profiles.
- Use qEEG for spectral analysis when available.
Core EEG Changes by Pattern
- Excess Slow Activity (Theta/Delta): Diffuse slowing, seen with toxic ASM levels or metabolic encephalopathies.
- Excess Fast Activity (Beta): Associated with benzodiazepines, barbiturates, propofol; frontally predominant.
- Epileptiform Activity: May be suppressed or mimicked by drugs. Correlate with timing and response to withdrawal.
- Periodic Patterns: May resemble NCSE; differentiate by response to benzodiazepine challenge.
- Burst Suppression: Seen with anesthetic titration; may lead to ECI.
Specific Medication Effects
- Benzodiazepines: Increase frontal beta, suppress interictals.
- Barbiturates: Beta slowing, burst suppression, ECI.
- Phenytoin: Mild slowing in toxicity; no beta increase.
- Carbamazepine: Inconsistent slowing; may initially increase spikes.
- Valproate: Toxic slowing; Reduces generalized discharges.
- Primidone: Slowing, reduces spikes.
- Lamotrigine: Minimal effect, may suppress spikes.
- Levetiracetam: Reduces interictals in generalized epilepsy.
Anesthetics & Sedatives
- Propofol: Dose-dependent pattern: beta slowing, burst suppression, ECI.
- Etomidate: Increases amplitude, used in NIOM.
- Pentobarbital: GPDs on withdrawal; suppression pattern.
- Amobarbital: Used in Wada test; longer recovery.
- Methohexital: Shorter-acting; faster EEG recovery.
Clinical Pearls
- Don't confuse beta with generalized paroxysmal fast activity.
- Diffuse delta in alert patients suggests toxicity.
- Focal findings should prompt investigation.
- Epileptiforms may rebound after sedative withdrawal.
Summary Table
- Benzodiazepines: Frontal beta, suppress spikes.
- Barbiturates: Beta slowing, burst suppression.
- Valproate: Slows at toxic levels, suppresses generalized spikes.
- Carbamazepine: Diffuse slowing, possibly increases spikes.
- Phenytoin: Mild slowing in toxicity.
- Propofol: Beta ECI.
- Etomidate: Enhances amplitude/spikes.
- Levetiracetam: Suppresses interictals.
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