Real Time Tele-Epilepsy Consultants - RTTC

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Real Time Tele-Epilepsy Consultants - RTTC

Real Time Tele-Epilepsy Consultants (RTTC) is a physician-led organization delivering expert, high qu

05/25/2026

Today we pause to honor our fallen heroes. Their courage and sacrifice will always be remembered.

05/20/2026

EEG plays a critical role in post-stroke care by helping detect both convulsive and nonconvulsive seizures, assess the risk of post-stroke epilepsy, and guide anti-seizure medication management.

Commonly Observed EEG Patterns in Post-Stroke Patients:
🧠 Periodic Discharges (PDs/LPDs) - strong indicators of elevated risk for seizure recurrence.
🧠 Focal Slow Wave Activity (FSWA) - linked to worse functional outcomes and higher risk of seizure.
🧠 Ictal Epileptiform Abnormalities - direct evidence of seizure activity, often necessitating immediate treatment.

05/13/2026

🚨 MAY IS STROKE AWARENESS MONTH 🚨
Every 40 seconds, someone in the US has a stroke.

Do you know the signs? B.E. F.A.S.T.
⚖️ Balance
👁️ Eyes
😃 Face
💪 Arms
🗣️ Speech
⏰Time to call 911

05/07/2026

⚙️ EEG: Pitfalls in Reactivity Testing
EEG reactivity is a cornerstone of coma prognostication, but misinterpretation is common, especially in sedated or critically ill patients. Distinguishing true non-reactivity from technical or pharmacologic suppression is essential for accurate reporting.

🧠 Why it matters: False “non-reactive” readings can lead to inaccurate prognoses. Sedatives, metabolic factors, or poor testing technique can mask cortical responsiveness without implying irreversible injury.

💡 Tech Tip – Avoid These Common Pitfalls:
1. Sedation Confounders – Agents like propofol, midazolam, or barbiturates can profoundly blunt reactivity. Always note the timing, dose, and weaning status when testing.
2. Artifact Misinterpretation – Movement, ventilator, or ECG artifacts can mimic “reactivity.” Confirm cortical origin across derivations.
3. Weak or Inconsistent Stimuli – Use firm, reproducible auditory, tactile, and noxious stimulation.
4. Single-Modality Testing – A patient may react to touch but not sound. Use multimodal testing for accuracy.
5. State Variability – Repeat testing during lighter background states; reactivity may emerge later.
6. Technical Oversights – Check filters, impedance, and montage setup before labeling “non-reactive.”

04/30/2026

⚙️ EEG: The Subtleties of Reactivity
EEG reactivity reflects the brain’s ability to respond to external stimuli — a key marker of cortical integrity and prognosis, especially in comatose or post–cardiac arrest patients.

🧠 Why it matters: Reactivity isn’t simply “present” or “absent” – it’s about pattern-specific modulation. A reactive shows consistent, repeatable changes in frequency or amplitude after auditory, tactile, or noxious stimulation.
• Preserved reactivity implies intact thalamocortical pathways and better neurologic outcomes.
• Absent reactivity, confirmed across modalities, may reflect severe cortical/subcortical dysfunction – but always consider sedation confounders.
• Reactivity can appear as desynchronization, amplitude attenuation, or beta activation, depending on state.

💡 Tech Tip:
✅ Test multiple stimulus types: auditory (clap, name call), tactile (touch, nail bed pressure), and noxious (sternal rub, suction).
✅ Repeat each stimulus to confirm reproducibility.
✅ Describe the EEG change.
✅ Note state context – reactivity may appear only during certain background patterns or transitions.
✅ Avoid false negatives by verifying EEG settings and artifacts.

Clear, structured reactivity documentation helps physicians interpret cortical responsiveness and guide prognostic discussions with confidence.

04/22/2026

If you could name a montage, what would it be called?

04/20/2026

We wish every technologist and other healthcare professional a Happy and invite you to join us in celebrating!

04/14/2026

🎛️ Think of EEG montages like playlists – the right one changes the whole vibe.

🧠 Why it matters: Some rhythms only show up when viewed through the right montage (hello, temporal spikes).

💡 Tech Tip: When in doubt, switch it up – bipolar for localization, referential for confirmation. The more you remix, the clearer the signal.

04/08/2026

🧠 Case Summary:
A 64-year-old left-handed man experienced frequent focal sensorimotor seizures for about a year, described as electric shock–like sensations in the right thumb and forefinger, often triggered by hand movements.

🎥 Video-EEG Findings:
Seizures were reproducibly evoked by right-hand tapping, with ictal discharges localized to the left central and parietal regions — correlating with the sensorimotor symptoms.

🩻 Imaging:
MRI and CT revealed a metal splinter embedded in the left postcentral gyrus, near the hand k**b region, from a scalp injury sustained in infancy during a wartime air raid.

💊 Treatment & Outcome:
After multiple failed antiseizure medications, seizure control was finally achieved with levetiracetam and perampanel, maintaining near-complete remission for four years.

🔑 Key Point:
This case illustrates reflex epilepsy triggered by somatosensory input—in this instance, hand movement stimulating an epileptogenic zone within the contralateral perirolandic cortex.

📚 Reference: https://doi.org/10.1212/WNL.0000000000213704

🧠 Figure: Brain MRI (A, B, C) and Brain CT (D)

04/01/2026

⚙️ Remember electrodes have feelings, too! 🎧 Poor contact = poor data.

🧠 Why it matters: Loose electrodes can mimic focal slowing or create phantom spikes.

💡 Tech Tip: If one channel looks suspicious, check the electrode, not the patient. Even the best amplifier can’t fix a flaky connection.

03/25/2026

⚙️ When Asymmetry Speaks Volumes
Subtle amplitude asymmetry can reveal early hemispheric dysfunction – even before rhythmic or periodic activity appears.

🧠 Why it matters: Persistent voltage asymmetry, even without clear slowing, can indicate evolving structural or vascular pathology (e.g., acute ischemia, subdural hematoma, or focal edema). When amplitude reduction localizes consistently across montage types, it’s rarely benign.

💡 When evaluating asymmetry:
✔️ Confirm across multiple montages to rule out technical artifact.
✔️ Note whether asymmetry is persistent vs. state-dependent (e.g., appearing only during sleep or stimulation).
✔️ Document relative amplitude ratio (e.g., “right hemisphere voltage 40% lower than left”).
✔️ Correlate with reactivity – loss of reactivity on one side strengthens concern for focal dysfunction.

Even before periodic discharges appear, a consistent amplitude asymmetry trend may be the first sign that neuroimaging or clinical correlation is warranted.

Address

336 22nd Avenue North
Nashville, TN
37203

Telephone

+16153468182

Website

http://rttconsultants.com/

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