Technical tips: Performing EEGs and polysomnograms on children with neurodevelopmental disabilities

Kennedy Krieger Institute, Baltimore, Maryland, USA.
The Neurodiagnostic journal 12/2012; 52(4):333-48.
Source: PubMed


Electroencephalograms (EEGs) and polysomnograms (PSGs) are critical and frequently ordered tests in the care of children with neurodevelopmental disabilities (NDD). Performing studies with this population can be very intimidating, given that the referral reasons and seizure types can be unique, and children with NDD may have any combination of behavioral or sensory challenges that can make it difficult to successfully complete a study. This article presents a variety of strategies that can be used to overcome these challenges through good preparation, patience, caregiver involvement, effective behavioral management techniques, and education about the medical aspects of EEG/ PSG in NDD. This Technical Tips article features ideas and experiences from an EEG/PSG technologist, two board-certified child neurologists (one who is further certified in Clinical Neurophysiology, while the other is further certified in Sleep Medicine), and two behaviorally trained pediatric psychologists.

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    • "Either a patient's favorite movie or one provided by the lab TV or monitor, DVD player, DVDs (supplied by staff or have patient bring their favorite) Dickson-Gardiner 2006 Sewkarran 2010 Lee et al. 2012 Paasch et al. 2012 Lim et al. 2013 Sleep deprivation Age specifi c sleep deprivation guidelines Instructions to caregivers only Brown et al. 1997 Sweeney et al. 1997 Ong et al. 2004 Music CD/Radio/Live music Either a CD player, MP3 player, or a live musician Loewy et al. 2005 Dickson-Gardiner 2006 O'Callaghan et al. 2012 Paasch et al. 2012 Favorite comfort item Toy/pillow/blanket/doll Brought with patient Paasch et al. 2012 Pretend or show & tell Show patient materials used, explain them and allow patient to touch items None needed Dickson-Gardiner 2006 Webb and Moore 2002 Paasch et al. 2012 Melatonin Natural sleep inducer Prescription for melatonin and pharmacy Wassmer et al. 2001a, 2001b Caregiver assistance "
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    ABSTRACT: "The need for sedation can be decreased greatly by adequate preparation and by creating a less threatening, child friendly environment in which to perform the study" (Olson et al. 2001). In 2006, Bild encouraged the avoidance of sedation during EEG and provided several helpful ideas in his ASET News article "Alternatives to Sedation in the EEG Lab" (Bild 2006). In this article Bild states, "We recently discontinued the use of sedation in our lab and we were probably one of the last holdouts using chloral hydrate" (Bild 2006). Several years later chloral hydrate is still a common method of sedating children for EEG studies. This article will encourage exploration and utilization of sedation alternatives, and discourage the use of sedatives for neurophysiological testing. This article is based on a review of EEG lab websites, a literature review, and over a decade of experience as a neurophysiology technologist at multiple institutions.
    The Neurodiagnostic journal 06/2014; 54(2):110-24.

  • Developmental Medicine & Child Neurology 04/2013; 55(7). DOI:10.1111/dmcn.12165 · 3.51 Impact Factor
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    ABSTRACT: Aim: Sleep is important for underlying neural plasticity, and children with developmental disabilities suffer behavioural, emotional, cognitive, and sensory-motor issues that affect their wake and sleep states. Problematic sleeping can be hypothesized to have adverse effects on both of these areas in children with developmental disabilities. With this review, we aim to provide a benchmark in managing problematic sleeping in children with developmental disabilities. Method: A literature search was conducted and data on the study descriptives, patient characteristics, study design, study-related factors, criteria applied to operationalize sleep and developmental disability, and sleep 'management' were collected. Each management strategy was tabulated and analysed. Results: We identified 90 studies involving 1460 children with developmental disabilities, of whom 61.6% were male. The highest proportion of studies, almost half, were in children with syndromes (44.4%), followed by studies in children with intellectual disabilities (18.9%). Non-pharmacological sleep management was primarily aimed at improving sleep quality (86.7%), followed by sleep-wake schedules and, to a certain extent, sleep regularity (42.2%). About 56.7% of the studies reported more than one approach. Studies mostly focused on disorders of initiating and maintaining sleep through a diversity of strategies and relied heavily on subjective measures to identify and monitor problematic sleeping. Sleep management approaches were primarily delivered at the level of the individual in the home setting. The number of management approaches per study was unrelated to the number of sleep problems discussed. Interpretation: Modifying sleep management strategies to meet the specific needs of children with developmental disabilities is encouraged, and studies that look beyond sleep quality or sleep quantity are required. It is also advocated that modifications to sleep hygiene, sleep regularity, and sleep ecology in a population with developmental disabilities are rigorously investigated. Finally, daytime somnolence should not be overlooked when aiming to optimize sleep in children with developmental disabilities across the ages and stages of their lives. There were several limitations in the research findings of problematic sleep in children with developmental disabilities. In general, the sleep problems and the developmental disabilities investigated were multicomponent in nature. It is likely that management approaches impacted those problems on multiple levels or through diverse 'therapeutic' pathways. There is a need for randomized controlled trials and more objective measures that quantify improved sleep or wake states.
    Developmental Medicine & Child Neurology 11/2014; 57(2). DOI:10.1111/dmcn.12623 · 3.51 Impact Factor
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