Special Interest Section: February 2021


A Simple Change Can Positively Impact Our Mindset

Greetings our dedicated readers,

I hope this edition finds you safe, healthy and content overall. It’s no doubt life has been rough this year, but we are now into 2021 and that alone feels so much better. Anyone else feel like they’ve just slid out of their mucky shoes and into their bedroom slippers? Mr. Fred Rogers would change his sweater and shoes upon entering his little house on Mr. Rogers’ Neighborhood. A simple change can positively impact our mindset.

Books often help open our minds to a new place, a new time and offer refreshment to our weary selves. Recently I finished reading Greenlights, by Matthew McConaughey. Admittedly, I chose it because I adore him. However, the engaging stories kept me reading and the insightful manner in which he views circumstances in his life helped provide me with a reframing of situations in my own life.  I am finding more than ever that those green lights and red lights are either move forward or slow down a bit, not necessarily stop. McConaughey’s book provides me with the humor, intellect, drama and quotable stories I just love to share and use in my daily life.

What books are you reading? I typically have at least 3 going at any given time. I have a fun crime thriller, a business book and an insightful, thought provoking philosophical book going all at the same time.  If my kids have one to offer at any moment, I am also most likely reading a manga along with them.

What are you reading? How is it changing you? We all want to know what you’re reading besides our amazing newsletter. Our Special Interest Section Leaders have prepared very special, insightful, and engaging articles for you in this edition of ASET News. I hope you all enjoy reading them as much as I did.

Stay healthy, well and safe! Read up but don’t keep it to yourself. Send a letter, a book review or better yet—send a book! We would love to hear what you are reading! Now on to my newest Patricia Cornwell non-fiction!

“If all that I would want to do, would be to sit and talk with you… would you listen”, Matthew McConaughey, age 12, “Greenlights”

Author: Petra Davidson, R. EEG/EP T., CLTM, FASET

Clinical EEG

The book that I have been reading is called Make it Stick, The Science of Successful Learning by Peter C. Brown, Henry L. Roediger III, and Mark A. McDaniel. In this book, the authors take many current teaching methods and draw upon recent discoveries in cognitive psychology and other areas to offer proven techniques that will allow learners to be more productive.

What I found interesting about this book is the different theories and ideas on how we learn. The book discusses several topics from Retrieval Practice, Elaboration, Reflection, Interleaving and Spaced Practice. What is most interesting is how all of these learning theories intersect with each other.

What intrigued me the most was the ability of the book to bring in real word examples from healthcare, education and sports to help keep the reader grounded and engaged in the material. Each concept helped the reader be able to learn about the theory and how to apply it in a multitude of places, from the workplace to the classroom.

Whether you are an educator or not, this book with help you understand your learning and others.

“We make the effort because the effort itself extends the boundaries of our abilities. Learning is deeper and more durable when it’s effortful. Learning that’s easy is like writing in sand, here today and gone tomorrow”. ― Peter C. Brown, Make It Stick: The Science of Successful Learning

Author: Emily Scanlan, BA, R. EEG T.

Epilepsy Monitoring

Reading has been my favorite activity since childhood. I read to relax and unwind, or to learn and draw inspiration. I usually read several books from different genres at the same time, this way (depending on my mood and preference for the day) the right book is always available: a novel or biography, book about science, business or self-help.

Like many other technologists, I am drawn to books which have some relation to medicine, ideally neurology or neurodiagnostics. One of my favorite books in this category is “Patient H. M: A Story of Memory, Madness and Family Secrets” by Luke Dittrich.  It is a fascinating true story about Henry Molaison, an epilepsy patient who underwent a ground-breaking epilepsy surgery in 1953. During the surgery, both of his temporal lobes were removed including the hippocampus and amygdala, with intention to cure him from intractable seizures. Instead of curing seizures, Henry’s surgery resulted in loss of ability to form new memories. He quickly became subject of countless research studies, scientists and researchers continued to compete for access to Henry for the rest of his life. After his death in 2008, scientists fought for the custody of his brain which was consequently cut into 2,401 razor-thin slices at the University of California San Diego. It was later moved to M.I.N.D Institute of the University of California Davis where it is studied to this day.

Besides the story of Henry, the book reveals the truth about questionable ethics in medical practices in the early nineteen-fifties describing experimental procedures conducted on patients in mental institutions, and extreme forms of treatments these patients were subjected to. The book is written by grandson of Dr. William Scoville, a neurosurgeon who performed lobotomies on Henry Molaison and many other patients, including his own family members. The author shows the early days of epilepsy surgery and the evolution of neurosurgery, neuroscience, and psychiatry over the years, leading us to realize how far scientific discoveries have advanced medical knowledge in the last 70 years. This book had a lasting impact on me. So much of what we know about how the brain works, specifically how memories are formed and recalled, are thanks to Henry Molaison.

Author: Magdalena Warzecha, R. EEG/EP T., CLTM

Nerve Conduction Studies

Hi, everyone – Thankfully 2020 is in our rearview mirror and 2021 will bring us some semblance of normalcy and freedom from this Covid virus that has turned our country and our world upside down. Here at my hospital in Louisiana, Covid inpatients are screened by our medical director before any EEG, EMG/NCV, or EP studies are allowed to be done. For outpatients with Covid, usually those tests are deferred until after they are over the virus. Louisiana has gone through several outbreaks and recessions since the disease started last year. Hopefully this year the recessions and low numbers will be longer time wise than the outbreaks….To those of you on the front lines seeing these patients daily, my gratitude, prayers, thoughts and admiration are with you daily. You are truly the HEROES in this fight against this dreaded disease.

When I get home, there are several things I like to do to put the day’s problems and issues behind me. If it’s nice outside, I like to be out and about. When it gets late, I like to work on EMG/NCV lectures and projects. And in the last few months, I‘ve gotten back into reading somewhat. If Debby and I are planning a trip somewhere, I like to read the travel guides and such for the area where we’re going (hopefully, San Diego and Denver this year, later in the summer and fall). Otherwise, I would highly recommend 2 books that you may want to check into. I am not a mystery, science fiction, or any fiction type of reader. I used to be but in the last few years I’ve started reading biographies. One of them is NEVER LOOK AT THE EMPTY SEATS by the late Charlie Daniels. I picked it up after his death in July 2020. He has always been one of my favorite singers and story tellers throughout his career. This book chronicles his journey in country music and is an easy read as well. I remember seeing him live in concert, in the 80’s I think, opening for the band, Alabama, and almost stealing the spotlight from them with his opening set. And I followed his career ever since…

Last year, after the Kansas City Chiefs won the Super Bowl, I remembered a book that I had that was about the mascot of the Chiefs, Dan Meers, aka KC Wolf.  In 2019, when ASET celebrated its 60th anniversary in KC, Dan gave the plenary keynote address on Thursday morning. What an honor to hear him, speak with him and even get a few pictures with him. And to get his book, WOLVES CAN’T FL, you’ll have to read the book to see where the title comes from. The book is as inspirational and uplifting as his speech, and in this day and time we really need inspiration and positive input with what is going on in our world. And for a sports fanatic like me, it has some really cool pictures as well….

Please have a safe spring and summer. I’m hoping and praying that we will be able to meet TOGETHER IN PERSON this year in San Diego. If not, ASET will put a on a tremendous and well thought out virtual meeting as they did in 2020. If you ever have any questions about anything NCS, please call me or email me at any time (Jmorris09@suddenlink.net, 318-617-0970).

Author: Jerry Morris, MS, R.NCS.T., CNCT, FASET

Innovative Technologies & Practices

Personal research and sources

Many technologists have an interest in expanding their knowledge base, whether this is due to career development and depth of knowledge, or a desire to expand the breadth of knowledge over other modalities and interests.  For example, a graduate from an EEG program might have a good comfort level with performing routine EEG, but they may decide to expand their expertise into ICU cEEG or EMU from a personal interest or because their facility is expanding services.  This would be an example of advancing one’s range of EEG knowledge.  In a different example, the same EEG tech might decide they want to learn intraoperative neuromonitoring, or magnetoencephalography.  This would be an example of pushing toward expanding the breadth of knowledge within clinical neurophysiology.

Ideal, formal advanced training in these areas is, of course, the way to maximize impact.  However, sometimes this is not feasible, or there is an interest to expand into an area where there isn’t availability for targeted formal education. Additionally, as lifelong learners, there might a desire to continue the expansion of knowledge naturally along a person’s career.  In any of these cases, self-study is then a possibility that many technologists will have an interest in at some point. 

In the modern world, there is also the possibility that pandemic related factors either free up time to pursue interests, prompt consideration of different modalities to explore, or simply provide an escape from everyday tedium. This newsletter article is focused on the self-study learner.  In it, we will explore some ways to formulate your self-study path forward to maximize impact, as well as some resources to consider along that path.  While the “why” of the self-learner could take up its own article of focus, here we will look at the more practical aspect of “how”.  There are three main considerations we will examine: 1) networking and mentorship, 2) online research tools that focus on free access, and 3) critical thinking (essential and often overlooked).  Note, there are no conflicts of interest related to any of the tools, sites, or processes listed, nor should they be considered exhaustive but just simply examples.

One thing that has impressed me as well as distressed me over the years is the willingness of many to mentor (impressed) and the lack of many taking advantage of mentorship (distressed).  While it is not an across the board guarantee, I propose to you that many of the people who publish and have advanced knowledge are willing to share it with those motivated and serious to learn.  After you have decided the general area of interest you would like to pursue, take the time to find someone(s) to mentor you.  This involves evaluating local and online (smaller world than it used to be) potential candidates and then initiating contact and establishing the mentorship mentee relationship.  I will speak here at times about my personal feelings, to hopefully illuminate what others you find might also think.  One important thing to keep in mind about possible mentors, they probably do not share their knowledge to get rich, no one I know planned to get rich from publications, giving talks at conferences, or doing research.  They do it because they have a passion for the field and because they are invested in sharing knowledge and advancing the field.  They are likely willing to assist you, as long as you are serious and invested in learning.

Decide the area of interest and explore who the knowledge resources might be.  Start with a general framework or outline of what you want to learn, IOM, MEG, ICU cEEG, etc.  Use online tools to find some candidates for mentorship.  You can do this in different ways, but I will present three here: 1) credentialing sites, 2) social media sites, and 3) formal publication sites.  ABRET, LinkedIn and neurophysiology Facebook groups are some examples of places to look for those with specific credentials or who have interest in different areas.  You can also identify those who have given talks or published in an area.  PUBMED and Google Scholar have tools for searching, for example.  Using a search term for something representative of what you want to learn will bring up various publications.  Evaluate the titles, look for ones that more closely match your interests or that seem to resonate with you.  Look at the authors (and affiliations for where they are located) of that publication.  Are they local?  Do they know someone you know (networking)? Is their email address listed?  Develop a prioritized list of possible people to contact.

Prepare communication in a thoughtful way.  Those who convey the seriousness of their interest will probably get more traction than those who are more casual and vague.  Include the generalities of what you are wanting to learn, why you are wanting to learn it, examples of your past that support serious pursuit of knowledge, and a clean description of what level of involvement and time you are looking for in a mentor.  Don’t write a book, but “Hey, you wanna help me learn stuff?” is probably not going to get many willing to assist.  Contact them and find the ones that are most willing to mentor and most closely align with your interests. 

Expect that while they will be willing to assist, the work falls on you.  They can help you network, and give areas of focus, as well as help with navigating the path of learning (you can’t jump in the deep end off the bat).  Expect they will ask you to develop a learning plan, and they will help refine it.

For example, when people ask me for mentorship, a common request is to develop a plan of progressing topics (which I assist with refinement of) and then per subject area, find publications (at least three with different views), and prepare what you have learned with the understanding from integrated knowledge of different views and thoughts what your thoughts are, not just rote regurgitation of other peoples’ thoughts.

Two examples of places to look for publications are PUBMED and Google Scholar.  In my experience, if you have access to journals through your work, PUBMED will fit better, while if you need them to be free sources, Google Scholar often lends itself to free sources.  While abstracts are almost always available, they are an overview, and true depth of evaluation really requires access to the full manuscript.  Pay attention to areas where facts are presented that surprise you.  Look for the references related to those facts (usually listed in the publication).  Expand your knowledge base by including a review of those referenced sources.

Expect that you will find different views.  In fact, I would suggest you embrace those different views and findings.  “They are experts, and if they disagree, can they both be right?” you might ask.  Usually, the authors support their conclusions from information already published in the literature which helps to support why they arrived at that conclusion.  They can be right, but it’s more important you understand why they thought that, and then weighing the supporting evidence, you formulate you own opinion.  I will give an example here for illustration: scalp recording of high frequency oscillations.  Doing a PUBMED or Google Scholar search, you will find multiple publications.  Some say you absolutely can record high frequency oscillations using scalp recording and this is how/what it means, while others say you cannot, it’s just artifact.  Both views will give evidence to support their view.  Read it, weigh the strength and weakness of the presented views, decide if there are different cases where one applies versus the other, and in the end, make your own (educated) opinion.

Lastly, I will propose your next steps.  Keep in mind that while the preceding steps might seem like they are simple, expect them to take a while.  Once you have learned the area of interest for you, now what?  I propose you decide, and act based on the following:  Do you want to pursue formal education or credentialing?  If so, do it (your mentor will probably assist networking and may even write a letter of recommendation).  Are there new areas you want to focus on that you learned about (maybe to add depth of knowledge or breadth to new areas you were exposed to?  If so, repeat the process laid out earlier.  One thing to keep in mind, is that now you have the expertise, you have a responsibility to also foster others, share your knowledge, and yes, probably even mentor.  It’s all the circle of life in the end, isn’t it?  There really is no reason not to expand your knowledge.

If this article interested you, I am pleased.  If you think you want to go down this path, please do.  I, for one, am happy to mentor as are many others, so if you need more guidance on taking this path, reach out, but please, be serious and engaged in the process and except to work.

Happy learning!

Author: Andrew Ehrenberg, BS, R. EEG T., CNIM

Acute/Critical Care Neurodiagnostics

10 Books to Read – ICU Long-term Monitoring

When asked to share what books we are currently reading, I thought what better opportunity to put together a list of new books hitting the market for 2020, and why not go even further and share some of my favorite older ones that I consider must haves.  In my search, I additionally located a third edition of one of my favorites that is available for pre-order, possibly available by the time this article is published. All of the books listed below can be found on Amazon and prices listed were at the time of research and subject to change.

  1. Epilepsy and Intensive Care Monitoring: Principles and Practice, by Bruce Fisch – October 2009

Featuring practical procedures and applications from expert authors from major epilepsy monitoring centers, covering both adult and pediatric EMU and ICU monitoring.  This book also includes an Appendix with guidelines for essential services, personnel and facilities needed for developing and organizing a specialized epilepsy monitoring care in the EMU.  Currently available on Amazon for Kindle $132 and Hardcover $157.

  1. Atlas of EEG in Critical Care, by Lawrence Hirsch and Richard Brenner – February 2010

Features basic EEG patterns seen in the critical care setting, as well as confusing artifacts and controversial patterns on the ictal-interictal spectrum that are commonly seen in the long-term monitoring of ICU patients. Currently available on Amazon Hardcover $193.

  1. The NeuroICU Book, by Kiwon Lee – September 2017

Features comprehensive coverage of neurocritical care diseases like hemorrhage, stroke, brain tumors, cardiac arrest and anoxic brain injuries, hepatic failure, status epileptics, encephalopathy and delirium.  Neurocritical care monitoring for the management of intracranial pressure, temperature and multimodality neuromonitoring of EEG and Evoked Potentials is discussed.  Section covering Neurosurgery discusses external ventricular drains, ventriculoperitoneal shunts, endovascular neuroradiology, brain aneurysms, AVMs and bypass surgery, postcraniotomy complications, as well as pediatric neurosurgery.  Cardiovascular section covers detailed information about the role of ECMO in cardiopulmonary failure and rhythm disturbances in critically ill patients. Currently available on Amazon for Kindle $88 and Paperback $99.

  1. Handbook of ICU EEG Monitoring, by Suzette LaRoche – March 2018

Features practical coverage of all aspects of ICU EEG monitoring with chapters on cardiac arrest, therapeutic hypothermia and quantitative EEG (qEEG).  Technical aspects, indications and procedural concerns are also covered.  You also receive access to downloadable ebook with purchase that holds additional EEG and qEEG examples and clinical cases for review.  Currently available on Amazon for Kindle $58 and Paperback $60.

  1. Atlas of Intensive Care Quantitative EEG, by Ng, Jing, and Westover – November 2019

Quantitative coverage of fundamental principles for qEEG, featuring pattern recognition principles for a broad range of signature patterns and artifacts typically seen in the ICU setting.  Contains more than 400 full-page vivid color qEEG samples paired with raw data for interpretation skill building. Currently available on Amazon for Kindle $112 and Hardcover $117.

  1. Wyllie’s Treatment of Epilepsy: Principles and Practice 7th Edition, by Elaine Wyllie – May 2020

Features a comprehensive, detailed overview of seizure disorders and available treatment options.  Additionally, provides more than 500 CME-eligible review questions online targeting key concepts for the ABPN subspecialty exam and clinical practice. Currently available on Amazon Hardcover $154.

  1. Reading EEGs: A Practical Approach, by Greenfield, Carney, Geyer – July 2020

Features an easy-to-use guide for waveform recognition.  Covers simple, intermediate and advanced topics, as well as separate chapters on subdural and stereotactic EEG recording. Currently available on Amazon for Kindle $80 and Paperback $82.

  1. Atlas of Pediatric and Neonatal ICU EEG, by Arnold Sansevere and Dana Harrar – December 2020

Features a comprehensive overview of EEG patterns seen in critically ill neonates and pediatric patients during epilepsy monitoring.  Purchase includes digital access.  Currently available on Amazon for Kindle $143 and Paperback $151.

  1. A Practical Approach to Stereo EEG, by Stephan Shuele – December 2020

A practical handbook written by leading experts in the field for the monitoring of complex cases with the use of stereoelectroencephalography (sEEG).  Purchase includes access to ebook and online chapter-based narrated cases.  Currently available on Amazon for Kindle $93 and Paperback $98.

  1. NeuroAnatomy Through Clinical Cases 3rd Edition, Hal Blumenfield – February 2021

Features over 100 interactive clinical cases and high-quality radiologic images for integrating the teachings of neuroanatomy brought you by award winning leader in neuroanatomy.  Pre-order on Amazon $106.

Author: Sabrina Faust, BS, R. EEG/EP T., CNIM, CLTM

Autonomic Testing

We’ve all heard it or maybe even said it ourselves, “I can’t wait to put this year behind me!!”  The year 2020 has been labeled as something awful, but I have a challenge for you.  Can you find something that you learned in 2020?  I have been taught that our hardships are where we learn the most.  In 2020, I learned to slow down, to appreciate the simple things in life and family-time.  My kids learned to appreciate their teachers and were excited about in-person school, which is actually a miracle.  Infection prevention policies were revised and implemented to protect ourselves, patients and coworkers. I would like to think 2021 will be better a year; but that does not mean the 2020 didn’t teach me a lot.  In 2021, I would like to continue to focus on enjoying the small things.  I want to make sure each of my patients are safe.  Most of all, I am thankful that 2020 took me back to the basics!

Author: Marcia Hawthorne, R. EEG T., CAP

Neurodiagnostic Education

“The feeling when you don’t want to put your book down because the characters might do something without you.”

This is a great way to explain my opinion on reading. For as long as I can remember, I have turned to fiction books to ‘escape’ and ‘travel.’ It seems that this last year has had me turning to books more than ever. 2020 changed so many things for all of us. We all know someone that or have experienced being home firsthand. During this last year, a friend of mine and I sort of challenged each other to read as many books as we could (since both of us were working from home). I am not sorry to say that I lost the challenge, but I read some wonderful books along the way. I even put off finishing one book because it was the end of a trilogy and I did not want it to be over. For me, letting a story absorb me helps me to ‘forget’ about what is going on around me, or the rough day I had. It has been said many times in the last 12 months, and I am sure it will be said many more; take time for you during all this chaos, lose yourself in a good book! And remember, audiobooks count as books too!

Author: Anna-Marie Beck, DBA, R. EEG T., FASET


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