EEG Electrode-induced Skin Injury among Adult Patients Undergoing Ambulatory EEG Monitoring

Challenges and Prospects in Epilepsy Monitoring Units: A Comprehensive Review of Logistic Barriers

Epilepsy is one of the most common neurological diseases with a prevalence ranging from 0.5% to 2% in different sittings. The World Health Organization (WHO) estimated that nearly 80% of this burden is borne by resource-poor countries where even conventional electroencephalogram (EEG) coverage is dramatically short.  Video EEG monitoring applied for days as conducted in epilepsy monitoring units (EMUs) is aimed at seizure localization, anti-seizure medication (ASM) adjustment, or epilepsy surgery evaluation and planning. However, the EEG approach in EMUs has its obstacles. The present article is aimed to concentrate on the logistic challenges of EMUs, discussing existing data and limitations and offering suggestions for future planning to enhance the utilization of existing technology. Shortages of adult and pediatric epileptologists, qualified nurses, as well as EEG technologists have been reported in different countries. Moreover, injuries and falls, psychosis, status epilepticus, and unexpected death have been stated to be the most frequent safety issues in EMUs. Enhancements to mitigate logistical and healthcare system-related barriers in EMUs include the implementation of large cohort studies and the utilization of artificial intelligence (AI) for the identification and categorization of specific risks among EMU admissions. The establishment of EMUs and their associated challenges and barriers are best acknowledged through discussions and dialogue with various stakeholders.

A Prospective Randomized Controlled Trial: Alternative Approach to EEG Application to Reduce Electrode-induced Skin Injury among Ambulatory EEG Patients

Ambulatory electroencephalography (AEEG) is a technique of continuous EEG recording of patients in their natural setting, outside the controlled environment of the hospital. Electrode-induced skin injury is a common complication of prolonged EEG monitoring. This randomized study aimed to investigate the performance of two methods of electrode application in reducing electrode-induced skin injury among patients undergoing 4-day AEEG monitoring. A randomized interventional study was conducted from November 2020 to May 2021 in the Neurosciences Ambulatory Care Unit at a metropolitan hospital in Sydney, Australia. We enrolled patients into two groups: i) Group 1 (standard protocol group) received Ten20 Conductive Paste^TM with Tensive® adhesive gel as the primary approach to electrode application and ii) Group 2 (intervention group) received Ten20 Conductive Paste^TM with Tensive® adhesive gel and hydrogel electrodes on hairless locations as the primary approach to electrode application. A total of 79 patients participated in this study. The group that received the addition of hydrogel electrodes (Group 2) performed better than the standard protocol group on electrode site inflammation for the frontal region, particularly FP1, FP2, F8, and the ground electrode sites. EEG quality and self-reports of patient comfort and mood did not differ significantly between the two groups. The addition of hydrogel electrodes using a Ten20 Conductive Paste^TM with a Tensive® adhesive gel protocol results in reduced inflammation at frontal lobe and ground electrode sites.

Reducing EEG (Electroencephalogram) Electrode-induced Skin Injury among Ambulatory EEG Monitored Patients: A Non-randomized Interventional Study of Two Commonly Used Cream-based Products for Electrode Application

Ambulatory electroencephalography (AEEG) seeks to capture inter-ictal epileptiform activity or paroxysmal events when patients are not in the clinic. Skin inflammation is a common complication of prolonged EEG monitoring. This non-randomized study aimed to investigate the performance of two commonly used cream-based methods of electrode application in reducing electrode-induced skin injury among patients undergoing AEEG monitoring. A non-randomized interventional study was conducted from July to December 2019 in the Neurosciences Ambulatory Care Unit at Royal Prince Alfred Hospital, Australia. Patients were enrolled into two groups: i) Group T, which received Ten20® Conductive Paste with Tensive® Conductive Adhesive Gel as the primary approach to electrode application; ii). Group E, which received EC2⁺® Conductive Cream as the primary approach to electrode application. Patients in Group T were enrolled in the 1st and 3rd week of the month, and patients in Group E were enrolled in the 2nd and 4th week for each month of the study. A total of 152 patients participated in this study. Two sub-groups were established: those who were monitored for two days (Group T; n = 36, Group E; n = 30) and those who were monitored for four days (Group T; n = 43, Group E; n = 43). Significant (p < 0.05) differences indicating greater inflammation in the Group E were noted for both Day 2 and Day 4 participants. Skin injury/inflammation was significantly less using the standard method (Group T: Ten20® with Tensive® gel) when compared to EC2⁺® (Group E) as the conductive material at the electrode site.