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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.mpg7/30/2019 EEG With Limited Source, Suryani Gunadharma
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THANK YOU