Hold the Smartphone! Tele-epilepsy in a Post-COVID-19 World

EEG as an indispensable tool during and after the COVID-19 pandemic: A review of tribulations and successes

During the coronavirus disease 2019 (COVID-19) pandemic, elective and non-emergent tests and procedures were delayed or suspended in lieu of diverting resources to more emergent treatment of critically ill patients and to avoid the spread and contraction of COVID-19. Further, the workforce was stretched thin, and healthcare facilities saw high turnover rates for full-time and contract employees, which strained the system and reduced the ability to provide clinical services. One of the casualties of these changes was electroencephalography (EEG) procedures, which have been performed less frequently throughout the world since the pandemic. Whether considered routine or emergent, the deferral of EEG studies can cause downstream effects, including a delay in diagnosis and initiation of treatment for epilepsy and non-epileptic seizures resulting in a higher risk of morbidity and mortality. Despite these limitations, the importance and utility of EEG and EEG technologists have been reinforced with the development of COVID-related neurological complications, including encephalopathy and seizures, which require EEG for diagnosis and treatment. Since the pandemic, reliance on remote telemonitoring has further highlighted the value and ease of using EEG. There has also been a heightened interest in rapid EEG devices that non-technologist professionals can attach quickly, allowing minimum patient contact to avoid exposure to COVID-19 and taking advantage of remote EEG monitoring. This review discusses the acute and potential long-term effects of the COVID-19 pandemic on the use and performance of EEG.

Evaluation of the Patient With Paroxysmal Spells Mimicking Epileptic Seizures

BACKGROUND

The diagnostic issue of paroxysmal spells, including epileptic seizure (ES) mimics, is one that neurologists frequently encounter. This review provides an up-to-date overview of the most common causes of ES mimics encountered in the outpatient setting.

REVIEW SUMMARY

Paroxysmal spells are characterized by changes in awareness, attention, perception, or abnormal movements. These can be broadly classified as ES and nonepileptic spells (NES). NES mimics ES but are distinguished by their symptomatology and lack of epileptiform activity on electroencephalography. NES may have psychological or physiological underpinnings. Psychogenic non-ES are the most common mimics of ES. Physiological causes of NES include syncope, cerebrovascular, movement, and sleep-related disorders.

CONCLUSIONS

Distinguishing NES from ES at times may be challenging even to the most experienced clinicians. However, detailed history with an emphasis on the clinical clues, including taking a moment-by-moment history of the event from the patient and observers and physical examination, helps create an appropriate differential diagnosis to guide further diagnostic testing. An accurate diagnosis of NES prevents iatrogenic harm, including unnecessary exposure to antiseizure medications and overuse of health care resources. It also allows for the correct specialist referral and appropriate treatment.

Pocketable Labs for Everyone: Synchronized Multi-Sensor Data Streaming and Recording on Smartphones with the Lab Streaming Layer

The streaming and recording of smartphone sensor signals is desirable for mHealth, telemedicine, environmental monitoring and other applications. Time series data gathered in these fields typically benefit from the time-synchronized integration of different sensor signals. However, solutions required for this synchronization are mostly available for stationary setups. We hope to contribute to the important emerging field of portable data acquisition by presenting open-source Android applications both for the synchronized streaming (Send-a) and recording (Record-a) of multiple sensor data streams. We validate the applications in terms of functionality, flexibility and precision in fully mobile setups and in hybrid setups combining mobile and desktop hardware. Our results show that the fully mobile solution is equivalent to well-established desktop versions. With the streaming application Send-a and the recording application Record-a, purely smartphone-based setups for mobile research and personal health settings can be realized on off-the-shelf Android devices.

Monitoring the frequency and duration of epileptic seizures: "A journey through time"

Seizure monitoring plays an undeniably important role in diagnosing and managing epileptic seizures. Establishing the frequency and duration of seizures is crucial for assessing the burden of this chronic neurological disease, selecting treatment methods, determining how frequently these methods are applied, and informing short and long-term therapeutic decisions. Over the years, seizure monitoring tools and methods have evolved and become increasingly sophisticated; from home seizure diaries to EEG monitoring to cutting-edge responsive neurostimulation systems. In this article, the various methods of seizure monitoring are reviewed.