EEG EXAMINATION WITH LIMITED SOURCES

EXPERIENCE IN INDONESIA

Suryani Gunadharma

 Electroencephalography (EEG) provides valuable insight into brain function Advances in technology, most notably the development of digital video-EEG, have significantly expanded the utility of EEG

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 In addition to the routine EEG, longterm monitoring studies including videoEEG, ambulatory EEG, and continuous EEG monitoring play important roles in various aspects of the diagnosis and treatment 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 limited hospitals 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 this facility Since this year, the Ministry of Health plans to give an EEG machine to almost all tertiary hospitals
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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

EQUIPMENT
The cost of one digital EEG machine is around Rp 200.000.000,- 600.000.000,- (US$25,000- 75,000) Cost of analog EEG is cheaper: around Rp 150.000.000,- 175.000.000,- (US$ 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 20minute 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 in the government hospital is subsidized and much less than what private clinics charge

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OTHER FACTORS
Other factors should be identified as higher costs of the EEG recording, such as:
Hospital staff fee Maintenance cost of the EEG machine

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RECORDING TECHNIQUE
Most of the hospitals in Indonesia still use 8- or 10-channel analog-EEG Duration of recording varies from 10-30 minutes in one patients due to the expenses for each EEG recording The activation procedures are hyperventilation and photic stimulation 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?

MINIMAL REQUIREMENT
A good EEG equipment (not necessary expensive) 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 using 2 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 necessary 20-30 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 banana montages without T1-T2 and A1-A2 are 18 channels with 1 ECG channel, 1 ground electrode (at least 20 electrodes) To minimize electrode paste use, use paste only on one side (either on the scalp or on the electrode) Scrubbing gel can be replaced by washing the scalp thoroughly before recording; oily scalp can be scrubbed with small piece of cotton using a small amount of 70% ethanol
SG/Dec/03

DO MORE IN LESS
A high-school-graduate technician can be paid less than a nurse The technician should be trained in doing good EEG recording, being aware of EEG seizure and soothing troubles during recording Anyone can read EEG as long as he/she is well trained in EEG, but a neurophysiologist is preferable
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 If a video recording is needed, one can used of-the-shelf video recorder which run together with the EEG recording

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VIDEO

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THANK YOU