MCCCD Official Course Competencies:

EEG205  2009 Fall – 2009 Fall

Applied Evoked Potentials

1.

Relate the development of the study of evoked potentials (evoked responses, EP) from research to a clinical modality and compare EP to clinical electroneurodiagnostic technology (EEG). (I)

2.

Describe the current uses of evoked potentials in a clinical setting. (II)

3.

Diagram the concept of signal averaging. (III)

4.

Prepare a ratio problem illustrating the concept of the signal to noise ration (S/N). (III)

5.

Describe the concept of common mode rejection. (III)

6.

List the parameters used in selecting the specific evoked potential tests for diagnosis of a particular clinical problem. (IV)

7.

Demonstrate the selection of recording sites appropriate for these tests: Brain Auditory Evoked Response (BAER), Visual Evoked Response (VER), Somatosensory Evoked Potential (SSEP), and Electrical Retirial Evoked Response (ERG). (V)

8.

Describe the location of the neurological "generators" of the BAER including their waveforms. (VI)

9.

Describe the various stimuli used in these EP tests: BAER, VER, and SSEP. (VII, VIII)

10.

Identify commonly encountered sources of artifacts and possible means of their rejection from data used for analysis. (IX, X)

11.

List specific diseases that may be identified by these EP tests: BAER, VER, SSEP, and ERG, and state why each test is appropriate for that disease. (XI)

12.

Review all literature provided. (XII)

13.

Prepare, perform and complete BAER, VER, and SSEP tests on a volunteer patient. (XIII)

MCCCD Official Course Outline:

EEG205  2009 Fall – 2009 Fall

Applied Evoked Potentials

I. Use of evoked potentials (evoked responses, EP)

A. Comparison of clinical EEG and EP

1. Clinical EEG - resting status of nervous system

2. Clinical EP - dynamic analysis of nervous system

B. Development of EP as clinical testing procedure

II. Current clinical uses of evoked potential (EP) tests

A. Evaluation of sensory function

B. Evaluation of brain maturization

C. Localization of brain lesions

D. Evaluation of higher nervous functions

III. Essential concepts of EP data collection

A. Signal averaging

1. Single response size

2. Control of trigger timing

3. Selection of signal of interest

4. Repetition of trigger (stimulus)

B. Signal to noise ratio

1. Small amplitude (nanovolt range)

2. S/N ratio

a. 1:1

b. 1:10

c. 5:1

3. Selected sources of noise

a. Preamplifers

b. Atmospheric

c. Muscle

C. Common mode rejection

1. Recognition of wave frequencies

2. Selection with instrumentation

IV. Parameters for EP testing

A. BAER

B. VER

C. SSEP

V. Accurate identification of EP recording sites

A. BAER

B. VER

C. SSEP

D. ERG

VI. BAER

A. Generators of signal

B. Typical waveforms

VII. Stimulus for EP testing

A. Modality and intensity

B. Characteristics of stimulus onset

C. Stimulus influence on size and morphology of EP

1. Intensity

2. Location

3. Quality

VIII. Specific stimuli for BAER, VER and SSEP

A. BAER testing

1. Earphones

2. Clicks

3. Tone pips and bursts

B. VER testing

1. Light source

2. Screens and goggles

C. SSEP testing

1. Vibration

2. Electromechanical taps

3. Light electrical shock

IX. Common EP artifacts

A. Stimulus artifact

B. 60 Hz noise

C. Muscle potentials

D. Eyeblink and eye movements

E. Skin potentials

F. Noncerebral potentials

X. Artifact rejection

A. Theory of rejection

B. Alternation of stimulus polarity

C. Variation of stimulus interval

D. Prestimulus muscle contraction

E. Record and average eye movements

F. Skin preparation under electrodes

G. Patient movement

XI. Relationship of specific EP tests to specific diseases

A. BAER

1. Hearing function in infants

2. Childhood autism

3. Mutiple sclerosis

B. SSEP

1. Mutiple sclerosis

2. Peripheral neuropathies

C. VER

1. Retinal degeneration

2. Retrobulbar neuritis

3. Multiple sclerosis

D. ERG

1. Hydroencephaly

2. Lesions of primary visual cortex

3. Loss of primary visual cortex

XII. Literature review

XIII. BAER, VER, and SSEP testing demonstrations

A. Preparation of equipment

B. Explanation of procedure to volunteer patient

C. Preparation of volunteer patient

D. Conduct supervised testing

E. Clean up patient, area and equipment after testing

F. Preparation of data

G. Presentation of data

E. Clean up patient, area, and equipment after testing