EEG history taking skills

1. EEG History taking Skills
Mohibullah Kakar
FMIC, Kabul Afghanistan
October 2019
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2. History
 Derived from Hisotria a greek word
 Hisotria means: Inquiry, Knowledge acquired by investigation.
 Collection and presentation of information about past event
 History is a written record of current and past event.
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3. History Taking
 The medical history of a patient is information gained by asking specific
question, either from the patient or other people who know the person and
can give suitable and relevant informationwith the aim of obtaining
information useful in formulation a diagnosis and providing medical care to
the patient.
 Take history directly from patient if he/she can.
 A person who is direct connection with the patient.
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4. Medical Terminology useful in history
taking
 Symptoms: problems that patient notices or feels
 Signs: a physician objectively detect sign and symptoms during patient
history.
 Sign and symptoms: Jerking, Stiffness, Stretchiness, Twitching, Numbness,
Abnormal sensation.
 Seizure: episodes of sudden disturbance of mental, motor, sensory or
autonomic activity caused by a paroxysmal cerebral malfunction.
 A seizure is defined as an abnormal, excessive, paroxysmal of the cerebral neurons.
 Epilepsy: the recurrence of seizures is known as epilepsy.
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5. Medical Terminology useful in history
taking
 Status Epilepticus: recurrent event of seizure that followed by another event
before patient regains conscious level completely.
 If such episode occurs only electrographically then the term is used as,
subclinical status epilepticus.
 Aura: feeling of the patient signaling the start of seizure
 Currently it known as simple partial seizure or it could be initial part of a seizure
like secondary generalized seizure.
 Vertigo, Hallucinations, Blackout, Abdominal Sensation, Nausea, Or Vomiting,
Headache, Twitching, Stretchiness, etc of limbs, Odd sensation, Smelling or change
in taste, Mood, Flashes of light etc….
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6. Medical Terminology useful in history
taking
 Ictal: It is a synonym of the word seizure.
 Ictal Phase: the state or phase in which patient had seizures
 Type of ictal phase:
1. Focal: Remain on one side or part of body like one limb or facial twitching.
2. Jacksonian March: starting from one part of the body and spreading to whole
body. Which parts was involved and where it spread.
3. Secondary Generalization: Starting from focal onset and then involving the whole
the whole body. Form where it get started.
4. Generalized: Involve the whole body or all four limbs strat from the beginning.
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7. Medical Terminology useful in history
taking
 Ictal Phase
 Any Associated Voices
 Grunting voice, shrill cry, difficulty in breath
 Body jerking, shivering, stiffness
 Eyes up roll, eyes deviation, staring, blinking
 Salivation, frothing
 Mouth bleeding due tongue bite
 Head/neck deviation or not, if yes to which side??
 Urine, fecal incontinence characteristic of generalized seizures.
 Automatism: mechanical seemingly aimless behavior in complex partial seizure
 Lip smacking, buttoning, picking at clothes
 Autonomic changes: Raised in heart rate, blood pressure, respiration..
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8. Medical Terminology useful in history
taking
 Post Ictal: It is a period after seizure, usually lasting longer than the seizure
itself.
 Patient physical/psychological state after seizure
 Lethargy, confusion, weakness, body ache, headache, joint dislocation..
 Regaining of conscious level
 Normal as before event, drowsy, or fell asleep
 Retrieving the memory after the seizure, by the patient.
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9. Medical Terminology useful in history
taking
 Interictal Seizure: The between the termination of post ictal period and the
onset of another seizure. In ex: minutes, hours, days, month..
 Convulsions: convulsions are violent involuntary contractions of the body
musculature.
 In neurology the term usually limited to contractions produced by cerebral seizure
activity.
 Sub-Clinical Seizures: subclinical seizure are the long lasting
electrographically epileptic discharges which may last in min to hours and
may or may not be associated with clinical manifestations.
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10. Medical Terminology useful in history
taking
Epileptic Prodrome: Abnormal symptoms, feeling or behavioral changes hours
before the onset of seizure.
Migraine, excitenss, disorientation, aphasia or photo sensitivity…
Diplopia: Double Vision
Dysphagia: Difficulty in swallowing
Stoke: Sudden loss of neurological function caused by a blockage or rupture of
a blood vessel to the brain or spinal cord; includes infraction and hemorrhage
subtypes
Hemiplegia: Paralysis on one side of the body.
Stupor: Condition of unresponsive from which the patient can only be
aroused by vigorous and repeated stimuli
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11. Medical Terminology useful in history
taking
 Hypoxia: Reduction in the supply of oxygen to the tissue
 Dysarthria: In ability to pronounce or articulate words due to disorder of vocal
apparatus
 Lips, tongue, larynx
 Dysphonia: Voice disorder, often related to weakness of laryngeal muscles, in
which sound production is impaired.
 Plegia: Inability to activate any motor neurons, paralysis
 Myoclonus: Sudden, shock-like, jerking
 Amnosmia: loss of sense of smell
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12. Medical Terminology useful in history
taking
 Infraction: Permanent tissue damage and death of all cellular elements due to
prolonged or severe ischemia…
 Aphonia: Complete loss of voice
 Hyponatremia: low blood sodium
 Paroxysmal: an abrupt onset, rapid attainment of a maximum and a sudden
termination.
 Ataxial: Incoordination of movement usually due to disease of cerebellar or
sensory pathways.
 Aphasia: Lack of speech cause by brain disease of injury
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13. Medical Terminology useful in history
taking
Clonus: a series of involuntary muscular contraction due to sudden stretching
of the muscle
Flaccidity: Severe form of hypotonicity
Atonia: Loss of muscle tone
Craniotomy: Surgical removal of a section of bone from the skull for the
purpose of operating on the underling tissues.
Nystagmus: Involuntary, rhythmic oscillation of trembling of the eye balls.
Phonophobia: Abnormal intolerance to sound that commonly occurs in
migraine and other headaches.
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14. Medical Terminology useful in history
taking
 Diffuse/Generalized: Occurring over large areas of one or both sides of the
head.
 Hypothermia: Low body temperature
 Hyperthermia: Increased in body temperature.
 Hypercapnia: more that the normal level of carbo dioxide in the blood
 Hypocapnia: less that the normal level of carbon dioxide in the blood.
 Syncope: Temporary loss of consciousness due to a lack of blood flow to the
braine
 Alexia: Inability to read, usually due to a lesion of dominant
occipitiotemporal.
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15. Medical Terminology useful in history
taking
 Ipsilateral: Located on the same side of the body (brain).
 Contralateral: Located on the opposite side of the body.
 Photophobia: Abnormal intolerance to light, which associated with eye pain…
 Unilateral: confined to one side of the head
 Scar: a mark left on the skin or within body tissue where a wound, burn, or
sore has not healed completely and fibrous connective tissue has developed
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16. Describing History
 Don’t use jargon words (Profession related terminologies)
 Use simple language to describe history
 If patient had an event describe it
 Safe the patient
 Appearance of patient
 Duration of event
 Automatisms
 Check conscious level of patient during event
 If Describe what he/she saw/heard
 Fi patient complains of head turning or eyes movement, describe to which side
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17. Seizure Triggering Factor
 Missed Medication
 Sleep Deprivation
 Photo Sensitivity
 Alcohol Withdrawal
 Fever in children
 Certain Medication
 Hormonal Changes (menstrual cycle
 Stress, Anxiety
 Dehydration
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18. Birth History
 Birth history from birth up to 14-15 years
 Normal (full term 36-38 weeks)
 Preterm or post term
 Birth Hypoxia
 Febrile seizures
 Developmental History:
 Neck Holding 3-4 months
 Sitting with support 6-7 months
 Independent sitting 8-9 months
 Walking 12-15 months
 Vision
 Hearing 3 months
 Speech 1 year
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19. History related to age
 Infants:
 some seizures are age related
 Infantile spasm at the age 3 months up to 12 months
 Flexion, extension or nodding of head and limbs
 School age and young age:
 Absence seizure
 JME
 School performance
 Attention in class
 Adults and Olds:
 Amnesia in Dementia
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20. Medication History
 Antiepileptic drugs
 Sedative or hypnotics
 Antidepressant
 Anticonvulsant drugs
 Benzodiazepines
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21. Preparation
 Introduce yourself and your surrounding people.
 Ask the patients name and identify correct patient by using the two main
identifiers ( Name & Medical Record#)
 Take verbal consent for taking history, if patient fell safely continue otherwise
stop.
 Relax the patient
 Give full attention to the patient.
 Assure patient's that information is confidential
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22. History should contain information about
 Onset of event
 Acute onset seizure or event
 Chronic seizure
 Timing and duration of event
 Last for sec, min, hours
 Associated symptoms
 Aura
 Difference from previous ones
 Apparent patient condition
 Oriented
 Disoriented
 Take observation of the patient during procedure/event
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23. History should contain information about
 Number on episodes until now
 Firs Episodes and last episodes
 Activities before the seizure
 Sleep derived
 Medication missing
 Duration of seizure and duration of each episodes
 Frequency of seizures
 Day
 Week
 Month
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24. History should contain information about
 Variation in duration, frequency and timing of progressive increasing, same or
decreaseing
 Occurrence of seizure during
 Sleep
 Awake
 Anytime
 Age of onset of seizure and last attack
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25. Current History
 Ask the patient to describe the complaints
 Listen all the complaints of patient
 Present complains
 Past Complains
 Focus on the complains with which the patient is presented or referred for
procedure
 Ask open ended questions and avoid guided questions
 Take history of the presenting illness
 Time of onset of symptom
 Aggravating and relieving factors of the symptoms.
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26. Past History
 Have the patient had any similar episodes in the past
 Are previous are same of different in type, duration, frequency?
 Asthma
 Cerebral vascular accident (CVA)
 Cardiac Problems
 Kidney, Hepatic failure of infections
 Head injury
 Vision problem
 Photo sensitivity
 Bullet injury
 Road traffic accident (RTA)
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27. Family History
 Same complaints:
 Seizure
 epilepsy
 Migraine
 Other complaints which can correlate with present patient history
 Consanguinity in parents.
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