Meriem Bensalem-Owen

Education Research: Evaluating the use of podcasting for residents during EEG instruction A pilot study

Objective: Educational methods for residents are shifting toward greater learner independence aided by technological advances. A Web-based program using a podcast was created for resident EEG instruction, replacing conventional didactics. The EEG curriculum also consisted of EEG interpretations under the tutelage of a neurophysiologist. This pilot study aimed to objectively evaluate the effectiveness of the podcast as a new teaching tool. Methods: A podcast for resident EEG instruction was implemented on the Web, replacing the traditional lecture. After Institutional Review Board approval, consent was obtained from the participating residents. Using 25-question evaluation tools, participants were assessed at baseline before any EEG instruction, and reassessed after podcasting and after 10 clinical EEG exposures. Each 25-item evaluation tool contained tracings used for clinical EEG interpretations. Scores after podcast training were also compared to scores after traditional didactic training from a previous study among anesthesiology trainees. Results: Ten anesthesiology residents completed the study. The mean scores with standard deviations are 9.50 ± 2.92 at baseline, 13.40 ± 3.31 (p = 0.034) after the podcast, and 16.20 ± 1.87 (p = 0.019) after interpreting 10 EEGs. No differences were noted between the mean educational tool scores for those who underwent podcasting training compared to those who had undergone traditional didactic training. Conclusion: In this pilot study, podcast training was as effective as the prior conventional lecture in meeting the curricular goals of increasing EEG knowledge after 10 EEG interpretations as measured by assessment tools. Neurology® 2011;77:e42–e44

Sporadic Creutzfeldt-Jakob disease presenting as nonconvulsive status epilepticus case report and review of the literature

Creutzfeldt-Jakob disease (CJD) is the most common transmissible human spongiform encephalopathy. Seizures and status epilepticus (SE) are an uncommon finding in CJD. We report a 64-year-old woman with rapid cognitive decline who had electroencephalographic (EEG) changes suggestive of nonconvulsive status epilepticus (NCSE). She was later diagnosed with sporadic CJD (sCJD). We also reviewed the literature for published cases on this topic. MEDLINE was employed to identify all published reports of CJD and SE. We identified 8 references with a total of 12 cases with CJD and NCSE. sCJD should be considered in the differential diagnosis of any patient who presents with rapid cognitive decline and EEG changes consistent with status epilepticus.

Induction of Progressive Profound Hypocitraturia with Increasing Doses of Topiramate

OBJECTIVES To provide prospective, longitudinal evidence of the effects of topiramate, an antiepileptic medication prescribed for migraine headaches, on stone-risk factors, specifically as pertaining to dosing and rapidity of onset. METHODS Patients scheduled to begin topiramate therapy were recruited to participate in the study. Enrolled subjects collected a pretreatment 24-hour urine specimen with subsequent 24-hour urine specimens collected 5 days after beginning topiramate and after each dose escalation. RESULTS Six subjects enrolled in the study, 4 of whom completed two additional urine collections after initiating topiramate therapy. The pretreatment urine collections of the 4 subjects with additional samples revealed the following mean (range) values: urine volume 1550 (1300 to 1900) mL, pH 6.75 (6 to 7), creatinine 1436.3 (1196 to 1590) mg/day, calcium 305.8 (209 to 423) mg/day, and citrate 606.8 (290 to 860) mg/day. Five days after initiation of topiramate, mean calcium decreased to 211.5 mg/day (31% decrease), and mean citrate decreased to 398 (99 to 804) mg/day, an average decrease of 39.8% (6.5% to 65.9%) per patient. After a dose escalation, calcium increased to 286.8 mg/day, but citrate decreased further to 209 (119 to 353) mg/day, an average decrease of 65.1% (57.9% to 71.7%) per patient from pretreatment levels. CONCLUSIONS Topiramate therapy induces a profound decrease in urinary citrate levels, equivalent to the levels seen in distal renal tubular acidosis. Citrate levels decrease quickly after the start of topiramate therapy and continue to decrease with escalating doses.

Tonic glutamate in CA1 of aging rats correlates with phasic glutamate dysregulation during seizure

Characterize glutamate neurotransmission in the hippocampus of awake‐behaving rodents during focal seizures in a model of aging.

Prior Podcast Experience Moderates Improvement in Electroencephalography Evaluation After Educational Podcast Module.

BACKGROUND:There is continued interest in using technology to enhance medical education and the variables that may affect its success. METHODS:Anesthesiology residents and fourth-year medical students participated in an electroencephalography (EEG) educational video podcast module. A 25-item evaluation tool was administered before any EEG education was provided (baseline), and the podcast was then viewed. Another 25-item evaluation tool was administered after podcast viewing (after podcast). Ten EEG interpretations were completed with a neurophysiologist with an additional 25-item evaluation tool administered after the interpretations (after 10 EEG interpretations). Participants were surveyed concerning technology and podcasting experience before the educational module and their responses to the podcast educational model. Multiple analyses were performed (1) to evaluate differences in improvement in EEG evaluation scores between the podcast module and the standard didactics (control group); and (2) to evaluate potential moderation by technology and the podcast experience on the change in mean EEG evaluation scores from after the podcast module to after 10 EEG interpretations. RESULTS:A total of 21 anesthesiology residents and 12 fourth-year medical students participated. Scores on the 25-item evaluation tool increased with each evaluation time (P ⩽ 0.001). Moderation analyses revealed that individuals with more podcast experience (≥4 previous podcasts) had greater increases in scores after a podcast and 10 EEG interpretations compared with individuals with less experience (⩽3 previous podcasts) (P = 0.027). Furthermore, compared with a control group with similar baseline characteristics that received only standard didactics without a podcast, those in the podcast group had greater increases in mean EEG evaluation scores between baseline and after 10 EEG interpretations. CONCLUSIONS:In reviewing the improvement in EEG evaluation after a podcast education module, those with more podcast experience achieved greater gains in EEG evaluation scores. For EEG education, those receiving the podcast education module showed greater increases in scores compared with those receiving didactic teaching without podcasting, as measured by change in a mean EEG evaluation scores.

Evaluating the requirements of electroencephalograph instruction for anesthesiology residents.

BACKGROUND: During a 1-mo neurosurgical intensive care unit rotation, anesthesiology residents interpret electroencephalograms (EEGs) performed throughout the institution, including intraoperative EEGs. The curriculum goal is to increase familiarity with EEG use and interpretation with 20 EEG interpretations with a clinical neurophysiologist during this rotation. We aimed to determine whether the EEG curriculum goals could be achieved with fewer EEG interpretations. METHODS: Each anesthesiology resident who participated interpreted 20 EEGs throughout the rotation. Using a 25-question evaluation tool, anesthesiology residents were assessed before interpreting any EEGs with a clinical neurophysiologist and reassessed after 10, 15, and 20 EEG interpretations. Each 25-item evaluation tool was developed to assess the impact of this EEG curriculum to gain experience with EEG monitoring and anesthetic effects using EEG tracings, and clinical EEG interpretation. RESULTS: Eight residents completed the study. Mean scores improved from 8.00 ± 2.51 at baseline to 15.12 ± 3.00 (P < 0.001), 15.88 ± 3.18 (P < 0.001), and 18.12 ± 3.23 (P < 0.001) after 10, 15, and 20 EEG interpretations. DISCUSSION: This innovative, collaborative approach using the expertise of the clinical neurophysiologist met the curriculum goals after 10 supervised EEG interpretations, as measured by the study assessment tool.

Effectiveness of diazepam rectal gel in adults with acute repetitive seizures and prolonged seizures: a single-center experience.

Many adults with epilepsy have breakthrough seizures despite treatment with antiepileptic drugs (AEDs), requiring them to have a rescue medication as part of a comprehensive treatment plan. We evaluated the effectiveness and tolerability of rectal diazepam in the treatment of breakthrough seizures in adult patients with epilepsy. We identified 50 such patients who had used diazepam rectal gel for clusters of seizures defined as acute repetitive seizures, prolonged seizures, or both, in the previous 18 months. Information on diagnoses, dose, frequency of use, reasons for use, safety, and efficacy was collected. Diazepam rectal gel was effective in stopping seizures in 45 patients (90%). Somnolence was reported in most patients, but no other adverse events were reported. Diazepam rectal gel demonstrates efficacy and tolerability as a seizure rescue medication for adult patients with a variety of seizure types, and may help improve quality of life.

The effectiveness of an interdisciplinary approach to EEG instruction for residents(r).

Expanding EEG use calls for education during postgraduate training. We performed a study to see whether an innovative, interdisciplinary approach to EEG instruction for residents achieved curriculum goals of increasing knowledge of EEG use and interpretation. A 45-minute EEG educational module was developed by a clinical neurophysiologist and a neurocritical care anesthesiologist. After institutional review board approval and consent, neurologic surgery residents were evaluated using a 25-question assessment tool before and after the module to assess its impact. This tool included EEG tracing interpretations. Nine of 10 residents completed the study. Assessment tool scores increased from a mean of 12.00 ± 1.87 before the educational module to 19.67 ± 2.06 (P < 0.001) after the educational module. This innovative, collaborative approach for EEG instruction of residents using the expertise of a clinical neurophysiologist met the curriculum goals after a 45-minute educational module as measured by the study assessment tool.

The impact of an interdisciplinary electroencephalogram educational initiative for critical care trainees.

PURPOSE The purpose of this study is to evaluate the effectiveness of an interdisciplinary electroencephalogram (EEG) educational module for critical care training. Electroencephalogram is increasingly used for diagnosis, monitoring, and treatment decisions in critically ill patients with neurologic and nonneurologic disorders. Continuous EEG monitoring has an expanded role in the intensive care unit as an additional evaluation tool for critically ill patients with altered mental status. MATERIALS AND METHODS During a neurosurgical intensive care rotation, pulmonary critical care fellows participated in an EEG curriculum covering didactics, clinical exposure, and EEG interpretations. Using 25-question evaluation tools, including EEG interpretations, participants were assessed before EEG instruction and after curriculum completion. RESULTS Nine fellows completed the pilot study. Evaluation scores increased from 7.56±2.24 to 16.67±2.96 (P<.001). CONCLUSIONS An interdisciplinary approach was effective for increasing EEG knowledge in critical care fellows as measured by the assessment tools. As an added potential benefit, the pulmonary fellows also learned about sleep disorder-related EEG. This model can be replicated in other institutions for trainees of other specialties interested in critical care.

Continuous spikes and waves during slow sleep in an adult

Continuous spikes and waves during slow wave sleep (CSWS) is rare and is considered to be an age-related epileptic syndrome occurring only in children. We report the case of a 21-year-old patient diagnosed with this syndrome. The patient had a history of seizures since the age of 3 and was admitted for continuous video/EEG monitoring to evaluate seizure exacerbation and unprovoked outbursts of anger. During 3 days of monitoring, awake EEG recordings showed focal slow wave activity in the right temporal region. CSWS were observed. After a change in his antiepileptic drug regimen, subsequent EEG recordings showed resolution of CSWS. As shown in our patient, CSWS can be observed in adults. In addition, continuous video/EEG monitoring including sleep is important in the evaluation of patients with sudden deterioration of seizure control accompanied by behavioral changes.