Guidelines for Qualifications of Neurodiagnostic Personnel: A Joint Position Statement of the American Clinical Neurophysiology Society, the American Association of Neuromuscular & Electrodiagnostic Medicine, the American Society of Neurophysiological Monitoring, and ASET The Neurodiagnostic Society.

The Guidelines for Qualifications of Neurodiagnostic Personnel (QNP) document has been created through the collaboration of the American Clinical Neurophysiology Society (ACNS), the American Society of Neurophysiological Monitoring (ASNM), the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM), and ASET The Neurodiagnostic Society (ASET). The quality of patient care is optimized when neurophysiological procedures are performed and interpreted by appropriately trained and qualified practitioners at every level. These societies recognize that neurodiagnostics is a large field with practitioners who have entered the field through a variety of training paths. This document suggests job titles, associated job responsibilities, and the recommended levels of education, certification, experience, and ongoing education appropriate for each job. This is important because of the growth and development of standardized training programs, board certifications, and continuing education in recent years. This document matches training, education, and credentials to the various tasks required for performing and interpreting neurodiagnostic procedures. This document does not intend to restrict the practice of those already working in neurodiagnostics. It represents recommendations of these societies with the understanding that federal, state, and local regulations, as well as individual hospital bylaws, supersede these recommendations. Because neurodiagnostics is a growing and dynamic field, the authors fully intend this document to change over time.

Guidelines for Qualifications of Neurodiagnostic Personnel: A Joint Position Statement of the American Clinical Neurophysiology Society, the American Association of Neuromuscular & Electrodiagnostic Medicine, the American Society of Neurophysiological Monitoring, and ASET-The Neurodiagnostic Society.

SUMMARY: The Guidelines for Qualifications of Neurodiagnostic Personnel (QNP) document has been created through the collaboration of the American Clinical Neurophysiology Society (ACNS), the American Society of Neurophysiological Monitoring (ASNM), the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM), and ASET-The Neurodiagnostic Society (ASET). The quality of patient care is optimized when neurophysiological procedures are performed and interpreted by appropriately trained and qualified practitioners at every level. These societies recognize that neurodiagnostics is a large field with practitioners who have entered the field through a variety of training paths. This document suggests job titles, associated job responsibilities, and the recommended levels of education, certification, experience, and ongoing education appropriate for each job. This is important because of the growth and development of standardized training programs, board certifications, and continuing education in recent years. This document matches training, education, and credentials to the various tasks required for performing and interpreting neurodiagnostic procedures. This document does not intend to restrict the practice of those already working in neurodiagnostics. It represents recommendations of these societies with the understanding that federal, state, and local regulations, as well as individual hospital bylaws, supersede these recommendations. Because neurodiagnostics is a growing and dynamic field, the authors fully intend this document to change over time.

Guidelines for Qualifications of Neurodiagnostic Personnel: A Joint Position Statement of the American Clinical Neurophysiology Society, the American Association of Neuromuscular & Electrodiagnostic Medicine, the American Society of Neurophysiological Monitoring, and ASET - The Neurodiagnostic Society.

The Guidelines for Qualifications of Neurodiagnostic Personnel (QNP) document has been created through the collaboration of the American Clinical Neurophysiology Society (ACNS), the American Society of Neurophysiological Monitoring (ASNM), the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM), and ASET - The Neurodiagnostic Society (ASET). The quality of patient care is optimized when neurophysiological procedures are performed and interpreted by appropriately trained and qualified practitioners at every level. These Societies recognize that Neurodiagnostics is a large field with practitioners who have entered the field through a variety of training paths. This document suggests job titles, associated job responsibilities, and the recommended levels of education, certification, experience, and ongoing education appropriate for each job. This is important because of the growth and development of standardized training programs, board certifications, and continuing education in recent years. This document matches training, education, and credentials to the various tasks required for performing and interpreting Neurodiagnostic procedures. This document does not intend to restrict the practice of those already working in Neurodiagnostics. It represents recommendations of these Societies with the understanding that federal, state, and local regulations, as well as individual hospital bylaws, supersede these recommendations. As Neurodiagnostics is a growing and dynamic field, we fully intend this document to change over time.

Emergency ("stat") EEG in the era of nonconvulsive status epilepticus.

The most widely accepted indication for a stat EEG (stEEG) is the suspicion of nonconvulsive status epilepticus (NCSE). NCSE has been reported with surprising frequency in a wide variety of acute structural and metabolic brain injuries and significantly increases the risk of permanent brain damage and death. This risk rises and the effectiveness of treatment decreases with delays in diagnosis and increased duration of NCSE. Recent evidence confirms that more than half of NCSE patients improve with anti-seizure treatment. The emergence of NCSE as a common, dangerous, time-urgent, and treatable problem has positioned it as a target for emergency therapeutic intervention. NCSE can only be diagnosed by EEG testing, and stEEG has demonstrated value in improving NCSE management. As a result, in the near future, EEG laboratories will see increasing demands for stEEG related to NCSE. The two main obstacles to an effective stEEG program are EEG technologist coverage and electroencephalographer availability after work hours. We recommend three simple but fundamental changes in the traditional approach to stEEGs in order to overcome these obstacles: the use of EEG set-up templates by onsite personnel, easy access to EEG instruments after hours, and remote stEEG connectivity for real-time, off-site electroencephalographer interpretation.

Subdermal needle electrodes: an option for emergency ("stat") EEGs.

Emergency or "stat" EEGs are ordered on patients who are suspected to have serious acute brain dysfunction (ABD). Often, these patients are comatose or have some altered level of consciousness (ALOC) from stroke, brain hemorrhage, head trauma, encephalopathy, seizures, or status epilepticus--which may be convulsive (SE) or non-convulsive (NCSE). As the number of stat EEGs increases, consider alternatives to traditional methods and tools, keeping overall patient care and outcome in mind.

Regional attenuation without delta (RAWOD): a distinctive EEG pattern that can aid in the diagnosis and management of severe acute ischemic stroke.

Acute thrombolysis with recombinant tissue plasminogen activator (tPA) is the only treatment of proven effectiveness in acute ischemic stroke (AIS). Cerebral edema (CE) is the most feared and fatal complication of AIS. For both of these conditions, patient selection for treatment and timing of intervention are crucial but controversial issues. Conventional diagnostic tools for AIS, including the neurological exam, computerized cerebral tomography (CT) Scan, and magnetic resonance imaging (MRI) have not as yet been able to determine which patients are the best risk-benefit candidates for thrombolysis, nor are they sensitive to the early detection of patients at risk for cerebral edema. This article suggests that the use of Emergency EEG (EmEEG) in AIS can reveal a distinctive EEG pattern that adds value to the selection of patients for thrombolytic and cerebral edema treatment. This pattern, called RAWOD (Regional Attenuation WithOut Delta) can identify patients with massive AIS earlier than CT or MRI. Patients with RAWOD are unlikely to benefit from thrombolysis but may be candidates for early surveillance and intervention for cerebral edema.