Evaluation of a new wireless technique for continuous electroencephalography monitoring in neurological intensive care patients

New wearable and portable EEG modalities in epilepsy: The views of hospital-based healthcare professionals

BACKGROUND

Novel mobile and portable EEG solutions, designed for short and long-term monitoring of individuals with epilepsy have been developed in recent years but, they are underutilized, lacking full integration into clinical routine. Exploring the opinions of hospital-based healthcare professionals regarding their potential application, technical requirements and value would be crucial for future device development and increase their clinical application.

PURPOSE

To evaluate professionals' opinions on novel EEG systems, focusing on their potential application in various clinical settings, professionals' interest in non-invasive solutions for ultra-long monitoring of people with epilepsy (PWE) and factors which could increase future use of novel EEG systems.

MATERIALS AND METHODS

We conducted an online survey where Hospital-based professionals shared opinions on potential advantages, clinical value, and key features of novel wearable EEG systems in five different clinical settings. Additionally, insights were gathered on the need for future research and, the need for additional information about devices from companies and researchers.

RESULTS

Respondents (n = 40) prioritized high performance, data quality, easy patient mobility, and comfort as crucial features for novel devices. Advantages were highlighted, including more natural settings, reduced application time, earlier epilepsy diagnosis, and decreased support requirements. Novel EEG devices were seen as valuable for epilepsy diagnosis, seizure monitoring, automatic seizure documentation, seizure alarms, and seizure forecasting. Interest in integrating these new systems into clinical practice was high, particularly for supervising drug-resistant epilepsy, reducing SUDEP, and detecting nocturnal seizures. Professionals emphasized the need for more research studies and highlighted the need for increased information from companies and researchers.

CONCLUSIONS

Professionals underscore specific technical and practical features, along with potential clinical advantages and value of novel EEG devices that could drive their development. While interest in integrating these solutions in clinical practice exists, further validation studies and enhanced communication between researchers, companies, and clinicians are crucial for overcoming potential scepticism and facilitating widespread adoption.

Automated Seizure Detection in Patients with Cardiac Arrest: A Retrospective Review of Ceribell™ Rapid-EEG Recordings

BACKGROUND

In patients with cardiac arrest who remain comatose after return of spontaneous circulation, seizures and other abnormalities on electroencephalogram (EEG) are common. Thus, guidelines recommend urgent initiation of EEG for the evaluation of seizures in this population. Point-of-care EEG systems, such as Ceribell™ Rapid Response EEG (Rapid-EEG), allow for prompt initiation of EEG monitoring, albeit through a reduced-channel montage. Rapid-EEG incorporates an automated seizure detection software (Clarity™) to measure seizure burden in real time and alert clinicians at the bedside when a high seizure burden, consistent with possible status epilepticus, is identified. External validation of Clarity is still needed. Our goal was to evaluate the real-world performance of Clarity for the detection of seizures and status epilepticus in a sample of patients with cardiac arrest.

METHODS

This study was a retrospective review of Rapid-EEG recordings from all the patients who were admitted to the medical intensive care unit at Kent Hospital (Warwick, RI) between 6/1/2021 and 3/18/2022 for management after cardiac arrest and who underwent Rapid-EEG monitoring as part of their routine clinical care (n = 21). Board-certified epileptologists identified events that met criteria for seizures or status epilepticus, as per the 2021 American Clinical Neurophysiology Society's Standardized Critical Care EEG Terminology, and evaluated any seizure burden detections generated by Clarity.

RESULTS

In this study, 4 of 21 patients with cardiac arrest (19.0%) who underwent Rapid-EEG monitoring had multiple electrographic seizures, and 2 of those patients (9.5%) had electrographic status epilepticus within the first 24 h of the study. None of these ictal abnormalities were detected by the Clarity seizure detection system. Clarity showed 0% seizure burden throughout the entirety of all four Rapid-EEG recordings, including the EEG pages that showed definite seizures or status epilepticus.

CONCLUSIONS

The presence of frequent electrographic seizures and/or status epilepticus can go undetected by Clarity. Timely and careful review of all raw Rapid-EEG recordings by a qualified human EEG reader is necessary to guide clinical care, regardless of Clarity seizure burden measurements.

Noninvasive mobile EEG as a tool for seizure monitoring and management: A systematic review

In the last two decades new noninvasive mobile electroencephalography (EEG) solutions have been developed to overcome limitations of conventional clinical EEG and to improve monitoring of patients with long-term conditions. Despite the availability of mobile innovations, their adoption is still very limited. The aim of this study is to review the current state-of-the-art and highlight the main advantages of adopting noninvasive mobile EEG solutions in clinical trials and research studies of people with epilepsy or suspected seizures. Device characteristics are described, and their evaluation is presented. Two authors independently performed a literature review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A combination of different digital libraries was used (Embase, MEDLINE, Global Health, PsycINFO and https://clinicaltrials.gov/). Twenty-three full-text, six conference abstracts, and eight webpages were included, where a total of 14 noninvasive mobile solutions were identified. Published studies demonstrated at different levels how EEG recorded via mobile EEG can be used for visual detection of EEG abnormalities and for the application of automatic-detection algorithms with acceptable specificity and sensitivity. When the quality of the signal was compared with scalp EEG, many similarities were found in the background activities and power spectrum. Several studies indicated that the experience of patients and health care providers using mobile EEG was positive in different settings. Ongoing trials are focused mostly on improving seizure-detection accuracy and also on testing and assessing feasibility and acceptability of noninvasive devices in the hospital and at home. This review supports the potential clinical value of noninvasive mobile EEG systems and their advantages in terms of time, technical support, cost, usability, and reliability when applied to seizure detection and management. On the other hand, the limitations of the studies confirmed that future research is needed to provide more evidence regarding feasibility and acceptability in different settings, as well as the data quality and detection accuracy of new noninvasive mobile EEG solutions.

Continuous EEG monitoring by a new simplified wireless headset in intensive care unit

Background

In critically ill patients continuous EEG (cEEG) is recommended in several conditions. Recently, a new wireless EEG headset (CerebAir®,Nihon-Kohden) is available. It has 8 electrodes, and its positioning seems to be easier than conventional systems.

Aim of this study was to evaluate the feasibility of this device for cEEG monitoring, if positioned by ICU physician.

Methods

Neurological patients were divided in two groups according with the admission to Neuro-ICU (Study-group:20 patients) or General-ICU (Control-group:20 patients). In Study group, cEEG was recorded by CerebAir® assembled by an ICU physician, while in Control group a simplified 8-electrodes-EEG recording positioned by an EEG technician was performed.

Results

Time for electrodes applying was shorter in Study-group than in Control-group: 6.2 ± 1.1′ vs 10.4 ± 2.3′; p < 0.0001. Thirty five interventions were necessary to correct artifacts in Study-group and 11 in Control-group. EEG abnormalities with or without epileptic meaning were respectively 7(35%) and 7(35%) in Study-group, and 5(25%) and 9(45%) in Control-group;p > 0.05. In Study-group, cEEG was interrupted for risk of skin lesions in 4 cases after 52 ± 4 h. cEEG was obtained without EEG technician in all cases in Study-group; quality of EEG was similar.

Conclusions

Although several limitations should be considered, this simplified EEG system could be feasible even if EEG technician was not present. It was faster to position if compared with standard techniques, and can be used for continuous EEG monitoring. It could be very useful as part of diagnostic process in an emergency setting.