Psychiatric Bulletin (2003) 27: 437. doi: 10.1192/pb.27.11.437-c
© 2003 The Royal College of Psychiatrists
Psychiatric Bulletin (2003) 27: 437
© 2003 The Royal College of Psychiatrists
Author's reply
Jon Stone
Research Fellow in Neurology, Dept Clinical Neurosciences, University of
Edinburgh, Western General Hospital, Crewe Rd, Edinburgh EH4 2XU.
Correspondence:
E-mail:
jstone{at}skull.dcn.ed.ac.uk
We agree with Dr Hambridge that trainees can have of a tendency to order
more unnecessary investigations than consultants, although for an expensive
investigation such as an EEG, one would hope that the consultant in charge
would approve the request. Unfortunately, we did not collect data on this. We
also agree that sometimes investigations must be carried out even if the
expected yield is low. An EEG looking for evidence of diffuse slowing that
might indicate an organic brain disorder is a particularly useful
indication.
We were not advocating that psychiatrists must never request an EEG, but
that they should be aware of its considerable limitations, particularly in the
diagnosis of epilepsy. The fact that 29 of the 187 EEGs demonstrated temporal
lobe dysfunction is of little help in the diagnosis of temporal lobe epilepsy,
first, because the diagnosis of temporal lobe epilepsy depends primarily on a
good history and witness account and second, because of the frequency of
temporal lobe dysfunction, both in the population and in a number of
psychiatric disorders.
