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Biondi A, Dursun E, Viana PF, Laiou P, Richardson MP. New wearable and portable EEG modalities in epilepsy: The views of hospital-based healthcare professionals. Epilepsy Behav 2024; 159:109990. [PMID: 39181111 DOI: 10.1016/j.yebeh.2024.109990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 08/06/2024] [Accepted: 08/06/2024] [Indexed: 08/27/2024]
Abstract
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.
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Affiliation(s)
- Andrea Biondi
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Eren Dursun
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Pedro F Viana
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Petroula Laiou
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mark P Richardson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Chiarello D, Perrone A, Ricci E, Ferrera G, Duranti F, Bonetti S, Marchiani V, Fetta A, Lanari M, Cordelli DM. The Role of Electroencephalography in Children with Acute Altered Mental Status of Unknown Etiology: A Prospective Study. Neuropediatrics 2024. [PMID: 39106957 DOI: 10.1055/a-2380-6743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/09/2024]
Abstract
INTRODUCTION Acute altered mental status (AAMS) is often a challenge for clinicians, since the underlying etiologies cannot always easily be inferred based on the patient's clinical presentation, medical history, or early examinations. The aim of this study is to evaluate the role of electroencephalogram (EEG) as a diagnostic tool in AAMS of unknown etiology in children. MATERIALS AND METHODS We conducted a prospective study involving EEG assessments on children presenting with AAMS between May 2017 and October 2019. Inclusion criteria were age 1 month to 18 years and acute (<1 week) and persistent (>5 minutes) altered mental status. Patients with a known etiology of AAMS were excluded. A literature review was also performed. RESULTS Twenty patients (median age: 7.7 years, range: 0.5-15.4) were enrolled. EEG contributed to the diagnosis in 14/20 cases, and was classified as diagnostic in 9/20 and informative in 5/20. Specifically, EEG was able to identify nonconvulsive status epilepticus (NCSE) in five children and psychogenic events in four. EEG proved to be a poorly informative diagnostic tool at AAMS onset in six children; however, in five of them, it proved useful during follow-up. CONCLUSIONS Limited data exist regarding the role of EEG in children with AAMS of unknown etiology. In our population, EEG proved to be valuable tool, and was especially useful in the prompt identification of NCSE and psychogenic events.
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Affiliation(s)
- Daniela Chiarello
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Policlinico di Sant'Orsola, Università di Bologna, Bologna, Italy
- Department of Neuroscience, Neurology of Epilepsy and Movement Disorder Unit, Bambino Gesù Children's Hospital - Member of the European Reference Network EpiCARE, Roma, Italy
| | - Annalisa Perrone
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Policlinico di Sant'Orsola, Università di Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell'Età Pediatrica, Bologna, Italy
| | - Emilia Ricci
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Policlinico di Sant'Orsola, Università di Bologna, Bologna, Italy
- Department of Health Sciences, Child Neuropsychiatry Unit, Epilepsy Center, San Paolo Hospital, University of Milan, Milan, Italy
| | - Giulia Ferrera
- Department of Health Sciences, Child Neuropsychiatry Unit, Epilepsy Center, San Paolo Hospital, University of Milan, Milan, Italy
| | - Francesca Duranti
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Policlinico di Sant'Orsola, Università di Bologna, Bologna, Italy
- Child and Adolescent Neuropsychiatry Unit, AUSL Romagna - Infermi Hospital, Rimini, Italy
| | - Silvia Bonetti
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell'Età Pediatrica, Bologna, Italy
| | - Valentina Marchiani
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell'Età Pediatrica, Bologna, Italy
| | - Anna Fetta
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Policlinico di Sant'Orsola, Università di Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell'Età Pediatrica, Bologna, Italy
| | - Marcello Lanari
- Pediatric Emergency Unit, Scientific Institute for Research and Healthcare (IRCCS), Sant'Orsola University Hospital, Bologna, Italy
| | - Duccio Maria Cordelli
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Policlinico di Sant'Orsola, Università di Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell'Età Pediatrica, Bologna, Italy
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Biondi A, Santoro V, Viana PF, Laiou P, Pal DK, Bruno E, Richardson MP. Noninvasive mobile EEG as a tool for seizure monitoring and management: A systematic review. Epilepsia 2022; 63:1041-1063. [PMID: 35271736 PMCID: PMC9311406 DOI: 10.1111/epi.17220] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/07/2022] [Accepted: 03/07/2022] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Andrea Biondi
- Department of Basic and Clinical NeuroscienceInstitute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Viviana Santoro
- Department of Basic and Clinical NeuroscienceInstitute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Pedro F. Viana
- Department of Basic and Clinical NeuroscienceInstitute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK,Faculty of MedicineUniversity of LisbonLisbonPortugal
| | - Petroula Laiou
- Department of Biostatistics and Health InformaticsInstitute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Deb K. Pal
- Department of Basic and Clinical NeuroscienceInstitute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Elisa Bruno
- Department of Basic and Clinical NeuroscienceInstitute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Mark P. Richardson
- Department of Basic and Clinical NeuroscienceInstitute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
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Abstract
Purpose of this review This review presents current therapy for seizures in the intensive care unit. The reader is provided with recent evidence regarding the use of EEG in determining treatment for acute seizures. Proposed treatment approaches for seizures and status epilepticus are provided. Controversies and complexity of selecting treatments are discussed. Recent findings Critical Care EEG Monitoring Research Consortium analyzed the association of periodic and rhythmic electroencephalographic patterns with seizures and found that lateralized and generalized periodic discharges and lateralized rhythmic delta were associated with increased seizure risk. Applications using modified EEG techniques have demonstrated more rapid feedback to the ICU than was previously possible. Summary Accurate diagnosis and efficient treatment of seizures in the ICU is challenging due to patient factors, complexities of antiepileptic drug therapy, and the required expertise for EEG interpretation. Selection of optimally effective therapy for seizures or status epilepticus depends on multiple factors, making collaboration between neurophysiologists and the ICU team of paramount importance.
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Affiliation(s)
- Jane G Boggs
- Comprehensive Epilepsy Center, Wake Forest University, Winston-Salem, NC USA
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Caricato A, Della Marca G, Ioannoni E, Silva S, Benzi Markushi T, Stival E, Biasucci DG, Montano N, Gelormini C, Melchionda I. Continuous EEG monitoring by a new simplified wireless headset in intensive care unit. BMC Anesthesiol 2020; 20:298. [PMID: 33287711 PMCID: PMC7720535 DOI: 10.1186/s12871-020-01213-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 11/25/2020] [Indexed: 01/03/2023] Open
Abstract
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.
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Affiliation(s)
- Anselmo Caricato
- Department of Anesthesia and Intensive Care, Catholic University School of Medicine, Largo F. Vito, 1, 00168, Rome, Italy. .,Neurosurgical Intensive Care, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.
| | - Giacomo Della Marca
- Stroke Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,Department of Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eleonora Ioannoni
- Neurosurgical Intensive Care, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Serena Silva
- Neurosurgical Intensive Care, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | | | - Eleonora Stival
- Neurosurgical Intensive Care, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Daniele Guerino Biasucci
- Neurosurgical Intensive Care, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Nicola Montano
- Department of Neurosurgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Camilla Gelormini
- Neurosurgical Intensive Care, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Isabella Melchionda
- Neurosurgical Intensive Care, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
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Meyer M, Fuest S, Krain D, Juenemann M, Braun T, Thal SC, Schramm P. Evaluation of a new wireless technique for continuous electroencephalography monitoring in neurological intensive care patients. J Clin Monit Comput 2020; 35:765-770. [PMID: 32488677 DOI: 10.1007/s10877-020-00533-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/19/2020] [Indexed: 10/24/2022]
Abstract
A novel wireless eight-channel electroencephalography (EEG) headset specially developed for ICUs was tested in regard of comparability with standard 10/20 EEG systems. The continuous EEG (cEEG) derivations via CerebAir EEG headset (Nihon Kohden Europe, Rosbach, Germany) and internationally standardized 10/20 reference EEGs as the diagnostic standard were performed in a mixed collective on a neurointensive care unit (neuro-ICU). The derivations were verified for comparability in detection of EEG background activity, epileptiform discharges, and seizure patterns. Fifty-two patients with vigilance reduction following serious neurological or metabolic diseases were included, and both methods were applied and further analyzed in 47. EEG background activity matched in 24 of 45 patients (53%; p = 0.126), epileptiform discharges matched in 32 (68%) patients (p = 0.162), and seizure activity matched in 98%. Overall, in 89% of the patients, cEEG detected the same or additional ICU-relevant EEG patterns. The tested wireless cEEG headset is a useful monitoring tool in patients with consciousness disorders. The present study indicates that long-term measurements with the wireless eight-channel cEEG lead to a higher seizure and epileptiform discharge detection compared to intermittent 10/20 EEG derivations in the ICU setting.
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Affiliation(s)
- Marco Meyer
- Department of Geriatrics, Jung-Stilling Hospital Siegen, Wichernstrasse 40, 57074, Siegen, Germany.
| | - Sven Fuest
- Department of Neurology, Universitaetsklinikum Giessen & Marburg Standort Marburg, Baldingerstrasse, 35033, Marburg, Germany
| | - Dominique Krain
- Department of Neurology, Universitaetsklinikum Giessen & Marburg Standort Giessen, Klinikstrasse 33, 35385, Giessen, Germany
| | - Martin Juenemann
- Department of Neurology, Universitaetsklinikum Giessen & Marburg Standort Giessen, Klinikstrasse 33, 35385, Giessen, Germany
| | - Tobias Braun
- Department of Neurology, Universitaetsklinikum Giessen & Marburg Standort Giessen, Klinikstrasse 33, 35385, Giessen, Germany
| | - Serge C Thal
- Department of Anesthesiology, Helios Universitaetsklinikum Wuppertal University Witten/Herdecke, Heusnerstraße 40, 42283, Wuppertal, Germany
| | - Patrick Schramm
- Department of Anesthesiology, Johannes Gutenberg Universitaet, Universitaetsmedizin Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
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