A day in the life of an EEG tech

2015-10-15 10:26:05 by Kathy Johnson, as posted on the inside.akronchildrens.org blog.

Olga Lytvynova Olga Lytvynova

Olga Lytvynova and Jeanine Schuller both took what can only be described as circuitous routes to become registered EEG technologists at Akron Children’s.

For Olga the journey began halfway across the world when, at the age of 21, she moved to the United States by herself from eastern Ukraine.

Undeterred by what would seem like insurmountable odds, her tenacity helped her learn English and get accepted to Cuyahoga Community College, where she earned her EEG certification, followed by Cleveland State University, where she’s currently working on her healthcare compliance degree.

Jeanine Schuller putting little Aliah at ease before her EEG. Jeanine Schuller putting little Aliah at ease before her EEG.

Jeanine’s move from Seattle to Ohio was no less daunting.

“I had been living in Seattle for 17 years working as a teacher,” she said. “When I moved back home to northeast Ohio to be closer to my family there were no teaching jobs to be found. I had to completely reinvent myself.”

Jeanine had always wanted to work in healthcare so she went back to school at Cuyahoga Community College.

Now employed by Akron Children’s as EEG techs, both women perform electroencephalograms, a test used by neurologists to record electrical activity in the brain.

Through an EEG, doctors can look for abnormal patterns that indicate seizures and other problems. There are many different types of seizures, including those brought on by fever known as febrile; focal seizures, which remain in a limited area of the brain; and generalized seizures, which affect the whole brain.

Olga Lytvynova explains the windmill test to Makaila. Olga explains the windmill test to Makaila.

“Symptoms of seizures vary widely depending on the type of seizure and the patient,” Olga said. “Some patients have an abnormal muscle contraction in their finger that is hardly noticeable. Others experience grand mal seizures where they lose consciousness and experience violent muscle contractions.”

Being able to pinpoint the type of seizure is important in determining the treatment plan, which can include special diets, medications and surgery.

“Through our roles in diagnostic procedures we can help the doctors find out what’s wrong,” said Jeanine. “It’s rewarding to be a part of the process.”

Olga works on Akron Children’s inpatient epilepsy monitoring unit. She sits in front of 4 screens with live EEG and video feeds to monitor patients.

“My job is to observe the patients and try to catch them having a seizure,” Olga said. “I watch brain waves on the EEG and then break hours and hours of video down into smaller increments for the physicians to review.”

With lengths of stay that vary from 1 to 14 days, Olga and her co-workers get to know their patients – many of whom are repeat customers – quite well.

Down in Akron Children’s NeuroDevelopmental Science Center, Jeanine performs a routine outpatient EEG on 15-year-old Justice whose parents became concerned when he started experiencing staring episodes.

Jeanine Schuller watches the monitor while Justice undergoes his EEG. Jeanine watches the monitor while Justice undergoes his EEG.

“We’d be talking to him and then all of the sudden he’d pause and stare off into space,” said Justice’s dad, Dan. “It’s been happening a few times a week for the past 2 months. It’s very random.”

After meticulously affixing electrodes to Justice’s scalp – a time-consuming process that can take up to 45 minutes – Jeanine puts Justice through a battery of exercises called activation procedures – from flashing strobe lights at his eyes to having him blow on a pinwheel for 5 consecutive minutes. The goal is to provoke a seizure.

“We ask that patients come in sleep deprived because when their bodies are under stress it can help bring on a seizure,” Jeanine said. “Also, if they’re tired they may fall asleep during the EEG and sometimes abnormalities will appear during sleep. Ideally we want them to have a seizure while here because it helps us to identify the kind of seizure, where it’s coming from, and how to treat it.”

Dan explains that Justice has had trouble concentrating since third grade and had been on some ADHD medications that weren’t producing any results.

“It’s been a frustrating road,” he said.

Back in the EMU Olga has left the monitoring room to check on 9-year-old Makaila who had a few of her leads fall off. She heads into the room to reconnect them.

“Makaila began having seizures when she was in kindergarten,” said Olga. “She has been on 3 medications which have had their share of side effects over the years, and now she’s been having breakthrough seizures.”

Olga Lytvynova prepares Makaila for her EEG. Olga prepares Makaila for her EEG.

When medication no longer works to prevent seizures, patients may be surgical candidates – unless they have generalized seizures that affect the whole brain.

Downstairs, Justice’s test has wrapped up and Jeanine uses a baby shampoo solution to meticulously remove the residue left by the leads. She tells Justice’s parents to expect the test results in the next few days.

Her next patient, 20-month-old Aliah, has also been experiencing staring spells. Jeanine gets Aliah’s medical history and explains to mom and dad what to expect during the EEG. She asks mom to remain close by to offer distraction and comfort.

“I need Aliah to be really still during the test,” Jeanine said. “It’s more challenging when they’re young because they don’t understand what’s going on and they are scared. I’m basically a stranger and I’m trying to put electrodes on their head – not something they have done every day.”

According to a logbook in the department, Aliah marks the 1,206th routine outpatient EEG performed in 2015. Jeanine and her fellow techs also do bedside EEGs for patients who cannot be transported off their units.

Olga’s patient, Makaila, is on day 3 of a 12-day stay in the EMU to determine if she would make a good surgery candidate. Having been slowly weaned off her 3 seizure medications, Makaila suffered 3 seizures on day 1 but has been seizure-free since then.

Olga gets ready to put her through another activation procedure (hyperventilation and photic stimulation) to see if she can elicit a seizure.

Makaila is considered a Phase I patient. Doctors are trying to conclude if all of her seizures are coming from the same part of her brain. If they’re coming from an area that isn’t responsible for things like speech, vision, cognition and mobility, she may be a candidate for surgery to remove the part of her brain tissue causing the seizures.

During Phase II neurosurgeons place electrodes on the surface of the brain. This type of invasive electrode recording allows for accurate localization of the epileptogenic zone and mapping of functional cortical regions, since external scalp EEG is unable to adequately localize or lateralize this zone.

Mapping entails stimulating the electrodes with small electrical impulses to identify the functions of different areas of the brain.

“The idea is to remove the brain tissue causing the seizures without affecting quality of life,” said Olga. “Whether it’s through surgery or medication, the best part of my job is getting to see my patients improve. Sometimes they are completely different kids.”

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