References

Exam References: English

1. Abou-Khalil, B., Misulis, K.E., Atlas of EEG and Seizure Semiology. Butterworth-
Heinemann, 2005.

2. Aminoff, M.J. (ed.) Electrodiagnosis in Clinical Neurology, 5th ed. Churchill Livingstone,
2005.

3. Altman, C. “Infection Control: 2000 Review and Update for Electroneurodiagnostic
Technologists.” American Journal of Electroneurodiagnostic Technology. 40(2) pp 73 –
97, 2000.

4. Blume, WT., Kalibara., M., Young.,GB. Atlas of Adult Electroencephalography, 2nd
Edition. Lippincott, Williams & Wilkins, 2002.

5. Canadian Association of Electroneurophysiology Technologists Inc. Code of Ethics.
CAET, 1994.

6. Canadian Association of Electroneurophysiology Technologists Minimal Technical
Standards. CAET, 2016.

7. Canada’s National Occupations health and Safety Website. www.canoshweb.org

8. Canadian Centre for Occupational Health and Safety. www.ccohs.ca

9. Ebersole, J.S. and Pedley, T.A. (eds.) Current Practice of Clinical Electroencephalography,
3rd Edition. Lippincott Williams & Wilkins. 2003.

10. Fisch, B.J. Fisch & Spehlmann’s EEG Primer: Basic Principles of Digital and Analog
EEG, 3rd Revised and Enlarged Edition. Elsevier. 1999.

11. Goldensohn E.S. (ed) et al Goldensohn’s EEG Interpretation: Problems of Overreading
and Underreading, 2nd Edition. Futura. 1999.

12. Health Canada Infection Control Guidelines (July 1999, Volume 25 S4). Routine Practices
and Additional Precautions for Preventing the Transmission of Infection in health Care.

13. Krass, G.L. and Fisher. R.S. The Johns Hopkins Atlas of Digital EEG: An Interactive
Guide. Johns Hopkins Press, 2007.

14. Misulis, K.E., Essentials of Clinical Neurophysiology, 2nd Edition. Butterworth-
Heinemann. 1997.

15. Mizrahi, E.M., Hrachovy, R.A., Kellaway, P. Atlas of Neonatal Electronencephalography,
5th ed. Urban and Schwarzenberg, 2004.

16. Donald L. Schomer and Fernando H. Lopes Da Silva,. Neidermeyer’s Electroencephalography: Basic Principles, Clinical Applications and Related Fields, 6th edition. Lippincott, Williams & Wilkins. 2011.

17. Noachtar, S., Wyllie, E. Electroencephalographic Atlas of Epileptiform Abnormalities in the
Treatment of Epilepsy: Practice & Principles. 4th Edition., 2006: 183-214.

18. Office of the Privacy Commission of Canada www.privcom.ca

19. Purtilo, Ruth. Ethical Dimensions in the Health Professions. 3rd edition. 1999.

20. Purtilo, R., and Haddad, A. Health Professional and Patient Interaction. 5th edition. 1996.

21. Stern, JM., Engel, J. Jr. Atlas of EEG Patterns. Lippincott, Williams & Wilkins, 2004

22. Tatum, W.O., Husain, A.M. Benbadis, S.R., Kaplan, P.W., Handbook of EEG
Interpretation. Demos, 2007.

23. Wyllie, E., Gupta, A., Lachhwani, D.K. (eds.) The Treatment of Epilepsy: Principles and
Practice, 4th Ed. Lippincott Williams & Wilkins, 2006.

24. Guidelines for Visual-Sensitive EEG Testing Prepared by a Task Force* of the Canadian
Society of Clinical Neurophysiologists Can. J. Neurol. Sci. 2008; 35: 133-135

25. American Clinical Neurophysiology Society Guidelines in Electroencephalography,
Evoked Potentials, and Polysomnography. www.acns.org. 2006.

Exam Content

TECHNOLOGY
Electrode application: 10-20 measuring system technique and theoretical basis. Extra electrode positions. Measuring technique for asymmetrical heads and surgical scars. Properties of electrodes, polarized and non-polarized metals. Nasopharyngeal and sphenoidal electrodes. Measuring electrode impedance. Desirable electrode impedance values.

EEG Machine: Functions of the preamplifier, differential amplifier, effects of input impedance, Digital EEG concepts and instrumentation, including Analog-to-Digital Converter (ADC), sample rate, Sample skew, ADC precision (vertical resolution), aliasing, digital calibration, system reference electrode, digital filters, reformatting montages and screen display. Basic computer components (i.e. CPU, RAM, networking etc.) and their function(s). Archiving, retrieval and printing. Understanding of common mode rejection and factors that affect it. High and Low frequency filters and their response curves, calculation of sensitivity values. Indication for varied time scales.

Polarity: EEG convention. Cancellation. Localization on referential and bipolar montages. Advantages and disadvantages of bipolar and referential montages.

Artifacts: Environmental, mechanical, and physiological causes. Recognition, localization and elimination of artifacts. Placement of electrodes and indications for monitoring of respiration, eye movements, and muscle jerks or twitches. Types of transducers (e.g. thermistors, electrical crystal, and impedance pneumography).

Electronics: Ohm’s Law. Calculation of resistance, voltage and current in series or parallel circuits. Properties of individual electronic components (e.g. Resistor, capacitor, voltage sources, transistors). Capacitance, electromagnetism, and induction. Properties of a good conductor.
Electrical Safety: Understanding of the ground electrode, ground loops and leakage current. CSA acceptable levels of leakage current. Recognition of electrically susceptible patients, and prevention of electrocution.

CLINICAL EEG AND ACTIVATION PROCEDURES
The Normal EEG: Descriptive features and identification of waveforms in the normal waking and sleep EEG of adults and children. Normal Variants. Basic Neonatal EEG. Maturation of the EEG from infancy to old age.

Hyperventilation: Method and mechanism. Metabolic changes. Normal and abnormal responses at all ages. Indications and contraindications.
Photic Stimulation: Normal and abnormal responses. Photoparoxysmal and photomyogenic response. Indications. Type of disease process activated by photic stimulation.

Sleep: Sleep stages. The use of sleep as an activator. The normal sleep cycle. Narcolepsy, sleep apnea, and night terrors. Neonatal sleep stages.
Clinical EEG: The use of and EEG findings in the investigation of epilepsy, tumors, infections, head injuries, coma, encephalopathy’s, cerebrovascular disease, psychiatry, dementia, anoxia, metabolic and toxic conditions. Alpha coma, burst suppression, triphasic waves, and PLEDS.

Electrocerebral Silence: Definition, minimum technical requirements, identification and elimination of artifacts. Causes of transient ECS.

CLINICAL EPILEPSY, NEUROLOGY, ANATOMY, MEDICATIONS
Seizures: Knowledge of the International Classification of Seizures. Clinical expression of all generalized, partial and secondarily generalized seizures. Anatomical localization of seizure symptoms. Activation procedures indicated for common seizure types. Care of the patient during a seizure. Aura’s, Todd’s paralysis, Non-epileptic seizures, Epilepsia Partialis Continua, Status Epilepticus.

Basic neurology: Clinical and EEG features of the following conditions: migraine headaches; vascular disease such as stroke, and transient ischemic attacks. Degenerative diseases including Alzheimers, Jacob Creutzfeldt, white and grey matter degeneration. Coma, Drug Overdose; Faints; Hydrocephalus; Tumors; Metastatic Disease; Brain Abscess; Encephalitis; Meningitis; Multiple Sclerosis; Reye’s Syndrome; S.S.P.E.; and Tuberous Sclerosis. Upper motor neuron vs lower motor neuron signs.

Neuroanatomy: Gross anatomy of the head and neck. Lobes and main fissures of the cerebral hemispheres and their relation to the skull and scalp. Anatomical correlates with the 10-20 system routine and extra electrode positions. The main subcortical structures including the cerebellum, brain stem and spinal cord. Cortical areas concerned with motor, sensory and speech functions. Arterial and venous supply of the brain. Knowledge of the location and function of the cranial nerves. The formation and circulation route of cerebro-spinal fluid. The meninges. Basic knowledge of the structure of the neuron, action potentials, synaptic potentials, inhibitory and excitatory potentials. Properties of the neuromuscular junction.

Medications: The indication, toxicity and effect on the EEG of anticonvulsant medications, barbiturates, tranquilizers, sedatives and hypnotics. Contraindications to sedation.

EEG Clinical Competency
Workplace Health and Safety
Patient-Centered Care
Professional Accountability and Responsibility
Infection Control

Sample Exam Questions: Exam Information

TECHNOLOGY

1.What is the voltage of a spike that measures 15mm peak to peak at sensitivity  10uV/mm?
a) 1.5 uV
b) 5 uV
c) 15 uV
d) 50 uV
e) 150 uV

2. Using the 10 – 20 International Measuring system, the distance transversely between
F7 and F8 is 22 cm. What will be the distance between F4 and F3?
a) 2.2 cm
b) 4.4 cm
c) 5.5 cm
d) 11 cm
e) 16.5 cm

3. Constant use of a High Frequency filter setting of 15 Hz during a normal wake and
sleep record other than reducing muscle artifact, would
a) Decrease the frequency of beta.
b) Decrease the frequency of alpha.
c) Cause no change in any activity of brain origin.
d) Decrease the amplitude of beta and sleep spindles.
e) Decrease the amplitude of drowsy theta and hyperventilation build-up.

CLINICAL EEG AND ACTIVATION PROCEDURES

4. The degree of EEG response to hyperventilation will NOT be influenced by
a) age
b) gender
c) posture
d) blood sugar
e) degree of gas exchange

5. A patient has seizures beginning with numbness of the left hand. The electrode positions
most likely to record its origin are
a) C4 and F4
b) C4 and T4
c) C4 and P4
d) Cz and P4
e) Cz and C4

6. Cerebral infarction can produce all of the following EEG abnormalities EXCEPT
a) PLEDs
b) Focal theta
c) Small sharp spikes
d) Depression of sleep spindles unilaterally
e) Focal diminution of voltage of cerebral activity

7 . The technologist arrives in ICU to record the EEG. He has been told Mr. D is in room 15. The patient does not respond when his name is called. To confirm the patient’s identity, the technologist should:
a) Ensure names on patient chart and requisition match.
b) Ensure names on patient wristband and requisition match.
c) Ask the attending nurse to confirm patient’s name.
d) Ensure the names on patient room and requisition match.

CLINICAL EPILEPSY, NEUROLOGY, ANATOMY, MEDICATIONS

8. A lesion in the right optic tract will result in a loss of vision in
a) the left eye
b) the right eye
c) both nasal fields
d) the left visual field
e) the right visual field

*The examination content and sample multiple choice questions are offered as reference material