EEG With Limited Source, Suryani Gunadharma

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EEG EXAMINATION WITHLIMITED SOURCES

EXPERIENCE IN INDONESIA

Suryani Gunadharma


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Electroencephalography (EEG)provides valuable insight into brainfunction

Advances in technology, most notablythe development of digital video-EEG,have significantly expanded the utility of

EEG


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In addition to the routine EEG, long-term monitoring studies including video-EEG, ambulatory EEG, and continuous

EEG monitoring play important roles invarious aspects of the diagnosis andtreatment of epilepsy


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IN DEVELOPING COUNTRIES

EEG is luxurious

High expenses

Lack of educated EEGer Lack of trained technicians


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IN INDONESIA

EEG equipments are only provided in limitedhospitals

Almost all private hospitals have at least one

EEG, either analog or digital Data from the Ministry of Health showed that

only 112 hospitals in Indonesia had thisfacility

Since this year, the Ministry of Health plans togive an EEG machine to almost all tertiaryhospitals


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COMMON DIAGNOSTIC

INDICATIONS FOR EEG

Clinical seizures

Definite epilepsy

Headache

Syncope

Learning disabilities

Movement disorders

Patients with altered mental status and coma

Attention-deficit hyperactivity disorder(ADHD)


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EEG RECORDING

IN INDONESIA


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EQUIPMENT

The cost of one digital EEG machine isaround Rp 200.000.000,- 600.000.000,- (US$25,000- 75,000)

Cost of analog EEG is cheaper: aroundRp 150.000.000,- 175.000.000,- (US$18.000 - 21.000 )


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CONSUMABLE ITEMS

Recording paper (Rp 250.000,-(US $30)) can be used for 12-13 pts with 20-minute recording time

Electrode gel: Rp 250.000,- (US$ 30),used for 150 pts

Electrical conducting paste:Rp340.000,- (US$ 40), used for 150 pts


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FEE CHARGED FOR EEG

Vary from Rp 80.000,- - Rp 300.000,-(US$ 9 35)

The EEG fee charged for civil servant inthe government hospital is subsidizedand much less than what private clinicscharge


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OTHER FACTORS

Other factors should be identified ashigher costs of the EEG recording, suchas:

Hospital staff fee

Maintenance cost of the EEG machine


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RECORDING TECHNIQUE

Most of the hospitals in Indonesia stilluse 8- or 10-channel analog-EEG

Duration of recording varies from 10-30

minutes in one patients due to theexpenses for each EEG recording

The activation procedures are

hyperventilation and photicstimulation In children, recording is almost done

with 100% sleep


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MANPOWER

Lack of educated electroencephalographer

Lack of trained technicians

Lack of trained EEG mechanics


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CAN WE DO MORE

WITH LESS

SOURCES?


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MINIMAL REQUIREMENT

A good EEG equipment (not necessaryexpensive) with at least 21 channels

Comfortable room (lack of noise)

20-30-minute recording time

A trained EEGer

A trained technician


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DO MORE IN LESS

For analog EEG

recording can be done in 20 minutes using2 faces of paper, each face for 10 minutes

For digital EEG

recording can be done for 20-30 minutes,but only 2-5 pages to be printed when

necessary20-30 EEG data can be stored in one CD

(available at US$ 0.4 /piece)


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DO MORE IN LESS

Minimal electrodes used for double bananamontages without T1-T2 and A1-A2 are 18channels with 1 ECG channel, 1 groundelectrode (at least 20 electrodes)

To minimize electrode paste use, use pasteonly on one side (either on the scalp or on theelectrode)

Scrubbing gel can be replaced by washingthe scalp thoroughly before recording; oilyscalp can be scrubbed with small piece ofcotton using a small amount of 70% ethanol


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DO MORE IN LESS

A high-school-graduate technician canbe paid less than a nurse

The technician should be trained in

doing good EEG recording, being awareof EEG seizure and soothing troublesduring recording

Anyone can read EEG as long ashe/she is well trained in EEG, but aneurophysiologist is preferable


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If a video recording is needed, one canused of-the-shelf video recorder whichrun together with the EEG recording


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VIDEO
http://localhost/var/Suryani/Video/Dadan%20.mpghttp://localhost/var/Suryani/Video/Dadan%20.mpg


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THANK YOU

Documents

EEG With Limited Source, Suryani Gunadharma