NEUROLOGY

Welcome to the pediatric neurology service! During your PGY-1 year, you will spend about 4 weeks with us and will learn much about epilepsy and childhood neurological conditions. We are constantly striving to provide an excellent learning experience while balancing your education with service obligations, so please let us know if you have thoughts, suggestions, or concerns about how the rotation is functioning.

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Please click on the links above for more information.

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EEG GUIDELINE

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Why these guidelines?

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• They have never been provided in the past.

• Some of you may go into the community (or even other academic centers) where EEG is not available after hours, or there is no continuous EEG capability.

• There are a growing number of studies and growing demand from other services for EEG reads which may or may not be appropriate.

 

Reasons to get a ROUTINE EEG:

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To give you a snapshot in time. Examples:

• Patient in ER/admitted who just had a seizure and is not returning to baseline:*STAT.

• Altered mental status in a patient with known toxic-metabolic disturbance (ie. ESLD, ESRD): *Decide if clinically indicated to be STAT or not.

• Altered mental status with subtle neurologic findings (nystagmus, positive Babinski, speech arrest): *STAT.

• New onset seizure in a patient already admitted (ie. liver patient, heme-onc patient): *Can wait until morning, as you are only looking for interictal findings.

• New onset seizure in ER: *Can be done as outpatient, although if admitted can get routine, as yield is highest in first 48 hours.

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Reasons to get CONTINUOUS EEG:

 

To capture and characterize events. Examples:

 

• Patient with convulsive status now treated but persistently altered: *Hook up ASAP.

• Vital sign changes in a comatose patient: *Can wait depending on clinical scenario.

• Patients with previous history of seizures, status, or post-cardiac arrest who are going to be on paralytics: *Can wait depending on clinical scenario.

• Convulsive status starting a drip or titrating to burst suppression: *Hook up ASAP.

• New onset stereotyped movements: *Can wait depending on clinical scenario.

• Cool Cap (hook-up within 6 hours): *Initial EEG read determines course of therapy, remainder of read waits until morning.

• Cooling Blanket: *No EEG read until morning.

• ECMO (hook-up within 6 hours): *No EEG read until morning.

• TBI (traumatic brain injury): *No EEG read until morning, unless concerning events or altered mental status.

 

Who to call? When are studies read?

 

If you are considering ordering an EEG, please inform/discuss with the on call pediatric neurology fellow first

 

• Routine EEG: Call the page operator and ask for EEG fellow on call.

• If STAT, the polite thing to do is to discuss the patient with them first.

• Stat EEG: Will be read by EEG fellow on call and a preliminary note will be submitted into Care Connect. Unless the patient is in active status epilepticus do not expect a page from the fellow.

• Continuous EEG: If there is any question about whether or not a patient needs to be on tele, or whether it is emergent, ask the on-service fellow or attending first. For urgent reasons to check the telemetry, if the EEG fellow on call is the peds EEG fellow, call the peds EEG fellow. Otherwise, call the EEG attending. If this is a new patient, please provide clinical information.

• Telemetry reads are provided on weekdays once a day for routine differential/presurgical patients and twice a day for ICU patients.

• Telemetry reads are provided on weekends once a day when convenient for the EEG reader.

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Reasons to call for an EEG read after hours (after 5pm and on weekends):

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• Something that sounds like seizures but is not clear, and findings will significantly alter clinical management (i.e. you are already treating and you are planning to escalate care with Dilantin, PHB, burst suppression, etc.).

• Suspicion for non-convulsive status (treated status or persistent AMS after seizure).

• Confirming pharmacologic burst suppression IF you and PICU fellow/resident are unsure.

 

What an EEG reader cannot provide for you after hours:

 

Reading from home is somewhat limited due to the excessive amount of time it takes to read remotely

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• Seizure counts.

• Check background.

• Checking burst suppression intervals.

• Reads on non-networked patients (in the ER, in certain rooms on 3F).

 

Final thoughts/conclusions:

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• Use your clinical judgment, it's the best tool you have.

• Treat the patient first, don't wait for the EEG.

• When in doubt, ask your on-service attending. Contact information:

• EEG fellow on-call (routine studies): Call page operator (310-206-6766).

• EEG telemetry fellow/attending on-call (cvEEG): Ask the peds neuro fellow.

• Pediatric EEG lab: 310-267-9457.

• Pediatric continuous video EEG tech on-call: p35525, 310-267-6999 when in-house.

• Adult/routine EEG tech on-call: p95921.

• Pediatric neurology fellow phone: 310-267-8221.

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HOW TO ORDER EEGs

 

For 20min EEG:

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• Routine, during 8am-5pm M-F: Order EEG awake and asleep in care connect. Page EEG technologist at p95921 to inform them the order. If it is ordered after hours, or on weekends, it will not be done until the next business day. Check CareConnect for official read.

 

• Stat: Same as for routine, page EEG tech and tell them it is STAT. The on-call epilepsy fellow will read the EEG within 2 hours and page the ordering MD so make sure to put your pager in the CareConnect order

 

Note: The Pediatric Neurology Team is not notified of these EEGs, and therefore cannot communicate reads. If recommendations are needed, a formal consult needs to be called.

 

For continuous video EEG monitoring, which includes an automatic Peds Neuro consult:

 

• During regular hours (8am-5pm M-F): Page the on-service Pediatric Neurology Fellow. Discuss the case and the Fellow will decide if continuous monitoring is appropriate. If so, the Fellow will contact our pediatric EEG techs and arrange the hook-up. A prelim read will be given to the primary team the following morning. At the Fellow's discretion, an urgent read may be given sooner.

 

• After hours: Page Pediatric Neurology on-call. The remainder of the procedure is the same.

• Note: No form needs to be completed/faxed for continuous vEEG monitoring.

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Cooling blanket, ECMO, and TBI kids warrant automatic Peds Neuro consultation & continuous vEEG monitoring. Please still page the Pediatric Neurology resident or fellow on-call - they will contact our EEG techs to arrange hook-up.

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Click HERE for UCLA Box with Neuro Resources