1
|
Warsito IF, Komosar M, Bernhard MA, Fiedler P, Haueisen J. Flower electrodes for comfortable dry electroencephalography. Sci Rep 2023; 13:16589. [PMID: 37789022 PMCID: PMC10547758 DOI: 10.1038/s41598-023-42732-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/14/2023] [Indexed: 10/05/2023] Open
Abstract
Dry electroencephalography (EEG) electrodes provide rapid, gel-free, and easy EEG preparation, but with limited wearing comfort. We propose a novel dry electrode comprising multiple tilted pins in a flower-like arrangement. The novel Flower electrode increases wearing comfort and contact area while maintaining ease of use. In a study with 20 volunteers, we compare the performance of a novel 64-channel dry Flower electrode cap to a commercial dry Multipin electrode cap in sitting and supine positions. The wearing comfort of the Flower cap was rated as significantly improved both in sitting and supine positions. The channel reliability and average impedances of both electrode systems were comparable. Averaged VEP components showed no considerable differences in global field power amplitude and latency, as well as in signal-to-noise ratio and topography. No considerable differences were found in the power spectral density of the resting state EEGs between 1 and 40 Hz. Overall, our findings provide evidence for equivalent channel reliability and signal characteristics of the compared cap systems in the sitting and supine positions. The reliability, signal quality, and significantly improved wearing comfort of the Flower electrode allow new fields of applications for dry EEG in long-term monitoring, sensitive populations, and recording in supine position.
Collapse
Affiliation(s)
- Indhika Fauzhan Warsito
- Institute of Biomedical Engineering and Informatics at the Technische Universität Ilmenau, Ilmenau, Germany
| | - Milana Komosar
- Institute of Biomedical Engineering and Informatics at the Technische Universität Ilmenau, Ilmenau, Germany
| | - Maria Anne Bernhard
- Institute of Biomedical Engineering and Informatics at the Technische Universität Ilmenau, Ilmenau, Germany
| | - Patrique Fiedler
- Institute of Biomedical Engineering and Informatics at the Technische Universität Ilmenau, Ilmenau, Germany
| | - Jens Haueisen
- Institute of Biomedical Engineering and Informatics at the Technische Universität Ilmenau, Ilmenau, Germany.
- Department of Neurology, Biomagnetic Center, University Hospital Jena, Jena, Germany.
| |
Collapse
|
2
|
Villamar MF, Ayub N, Koenig SJ. Automated Seizure Detection in Patients with Cardiac Arrest: A Retrospective Review of Ceribell™ Rapid-EEG Recordings. Neurocrit Care 2023; 39:505-513. [PMID: 36788179 DOI: 10.1007/s12028-023-01681-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/23/2023] [Indexed: 02/16/2023]
Abstract
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.
Collapse
Affiliation(s)
- Mauricio F Villamar
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
- Department of Medicine, Kent Hospital, Warwick, RI, USA.
| | - Neishay Ayub
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Seth J Koenig
- Department of Medicine, Kent Hospital, Warwick, RI, USA
| |
Collapse
|
3
|
Barton DJ, Coppler PJ, Talia NN, Charalambides A, Stancil B, Puccio AM, Okonkwo DO, Callaway CW, Guyette FX, Elmer J. Prehospital Electroencephalography to Detect Traumatic Brain Injury during Helicopter Transport: A Pilot Observational Cohort Study. PREHOSP EMERG CARE 2023; 28:405-412. [PMID: 36857200 PMCID: PMC10497709 DOI: 10.1080/10903127.2023.2185333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/09/2023] [Accepted: 02/21/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVE Early recognition of traumatic brain injury (TBI) is important to facilitate time-sensitive care. Electroencephalography (EEG) can identify TBI, but feasibility of EEG has not been evaluated in prehospital settings. We tested the feasibility of obtaining single-channel EEG during air medical transport after trauma. We measured association between quantitative EEG features, early blood biomarkers, and abnormalities on head computerized tomography (CT). METHODS We performed a pilot prospective, observational study enrolling consecutive patients transported by critical care air ambulance from the scene of trauma to a Level I trauma center. During transport, prehospital clinicians placed a sensor on the patient's forehead to record EEG. We reviewed EEG waveforms and selected 90 seconds of recording for quantitative analysis. EEG data processing included fast Fourier transform to summarize component frequency power in the delta (0-4 Hz), theta (4-8 Hz), and alpha (8-13 Hz) ranges. We collected blood samples on day 1 and day 3 post-injury and measured plasma levels of two brain injury biomarkers (ubiquitin C-terminal hydrolase L1 [UCH-L1] and glial fibrillary acidic protein [GFAP]). We compared predictors between individuals with and without CT-positive TBI findings. RESULTS Forty subjects were enrolled, with EEG recordings successfully obtained in 34 (85%). Reasons for failure included uncharged battery (n = 5) and user error (n = 1). Data were lost in three cases. Of 31 subjects with data, interpretable EEG signal was recorded in 26 (84%). Mean age was 48 (SD 16) years, 79% were male, and 50% suffered motor vehicle crashes. Eight subjects (24%) had CT-positive TBI. Subjects with and without CT-positive TBI had similar median delta power, alpha power, and theta power. UCH-L1 and GFAP plasma levels did not differ across groups. Delta power inversely correlated with UCH-L1 day 1 plasma concentration (r = -0.60, p = 0.03). CONCLUSIONS Prehospital EEG acquisition is feasible during air transport after trauma.
Collapse
Affiliation(s)
- David J. Barton
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Patrick J. Coppler
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Nadine N. Talia
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | | | - Ava M. Puccio
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA
| | - David O. Okonkwo
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA
| | | | - Francis X. Guyette
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Jonathan Elmer
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA
| |
Collapse
|
4
|
Ng CR, Fiedler P, Kuhlmann L, Liley D, Vasconcelos B, Fonseca C, Tamburro G, Comani S, Lui TKY, Tse CY, Warsito IF, Supriyanto E, Haueisen J. Multi-Center Evaluation of Gel-Based and Dry Multipin EEG Caps. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22208079. [PMID: 36298430 PMCID: PMC9612204 DOI: 10.3390/s22208079] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/13/2022] [Accepted: 10/19/2022] [Indexed: 05/27/2023]
Abstract
Dry electrodes for electroencephalography (EEG) allow new fields of application, including telemedicine, mobile EEG, emergency EEG, and long-term repetitive measurements for research, neurofeedback, or brain-computer interfaces. Different dry electrode technologies have been proposed and validated in comparison to conventional gel-based electrodes. Most previous studies have been performed at a single center and by single operators. We conducted a multi-center and multi-operator study validating multipin dry electrodes to study the reproducibility and generalizability of their performance in different environments and for different operators. Moreover, we aimed to study the interrelation of operator experience, preparation time, and wearing comfort on the EEG signal quality. EEG acquisitions using dry and gel-based EEG caps were carried out in 6 different countries with 115 volunteers, recording electrode-skin impedances, resting state EEG and evoked activity. The dry cap showed average channel reliability of 81% but higher average impedances than the gel-based cap. However, the dry EEG caps required 62% less preparation time. No statistical differences were observed between the gel-based and dry EEG signal characteristics in all signal metrics. We conclude that the performance of the dry multipin electrodes is highly reproducible, whereas the primary influences on channel reliability and signal quality are operator skill and experience.
Collapse
Affiliation(s)
- Chuen Rue Ng
- Institute of Biomedical Engineering and Informatics, Technische Universität Ilmenau, 98693 Ilmenau, Germany
| | - Patrique Fiedler
- Institute of Biomedical Engineering and Informatics, Technische Universität Ilmenau, 98693 Ilmenau, Germany
| | - Levin Kuhlmann
- Faculty of Information Technology, Monash University, Building 63, 25 Exhibition Walk, Clayton, VIC 3800, Australia
| | - David Liley
- Brain and Psychological Sciences Research Centre, Swinburne University of Technology, P.O. Box 218, Hawthorn, VIC 3122, Australia
| | - Beatriz Vasconcelos
- Faculdade de Engenharia, Universidade do Porto, Rua Dr. Roberto Frias, s/n, 4200-465 Porto, Portugal
| | - Carlos Fonseca
- Faculdade de Engenharia, Universidade do Porto, Rua Dr. Roberto Frias, s/n, 4200-465 Porto, Portugal
- Institute of Science and Innovation in Mechanical and Industrial Engineering, LAETA/INEGI, 4200-465 Porto, Portugal
| | - Gabriella Tamburro
- BIND-Behavioral Imaging and Neural Dynamics Center, University “G. d’Annunzio” of Chieti–Pescara, Via Luigi Polacchi, 11, 66100 Chieti, Italy
| | - Silvia Comani
- BIND-Behavioral Imaging and Neural Dynamics Center, University “G. d’Annunzio” of Chieti–Pescara, Via Luigi Polacchi, 11, 66100 Chieti, Italy
| | - Troby Ka-Yan Lui
- Department of Psychology, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
- Center of Brain, Behavior and Metabolism, University of Lübeck, Marie-Curie-Straße, 23562 Lübeck, Germany
| | - Chun-Yu Tse
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, China
| | - Indhika Fauzhan Warsito
- Institute of Biomedical Engineering and Informatics, Technische Universität Ilmenau, 98693 Ilmenau, Germany
| | - Eko Supriyanto
- IJN-UTM Cardiovascular Engineering Centre, School of Biomedical Engineering & Health Sciences, Universiti Teknologi Malaysia, Johor Bahru 81300, Malaysia
| | - Jens Haueisen
- Institute of Biomedical Engineering and Informatics, Technische Universität Ilmenau, 98693 Ilmenau, Germany
| |
Collapse
|
5
|
Sutcliffe L, Lumley H, Shaw L, Francis R, Price CI. Surface electroencephalography (EEG) during the acute phase of stroke to assist with diagnosis and prediction of prognosis: a scoping review. BMC Emerg Med 2022; 22:29. [PMID: 35227206 PMCID: PMC8883639 DOI: 10.1186/s12873-022-00585-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 02/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stroke is a common medical emergency responsible for significant mortality and disability. Early identification improves outcomes by promoting access to time-critical treatments such as thrombectomy for large vessel occlusion (LVO), whilst accurate prognosis could inform many acute management decisions. Surface electroencephalography (EEG) shows promise for stroke identification and outcome prediction, but evaluations have varied in technology, setting, population and purpose. This scoping review aimed to summarise published literature addressing the following questions: 1. Can EEG during acute clinical assessment identify: a) Stroke versus non-stroke mimic conditions. b) Ischaemic versus haemorrhagic stroke. c) Ischaemic stroke due to LVO. 2. Can these states be identified if EEG is applied < 6 h since onset. 3. Does EEG during acute assessment predict clinical recovery following confirmed stroke. METHODS We performed a systematic search of five bibliographic databases ending 19/10/2020. Two reviewers assessed eligibility of articles describing diagnostic and/or prognostic EEG application < 72 h since suspected or confirmed stroke. RESULTS From 5892 abstracts, 210 full text articles were screened and 39 retained. Studies were small and heterogeneous. Amongst 21 reports of diagnostic data, consistent associations were reported between stroke, greater delta power, reduced alpha/beta power, corresponding ratios and greater brain asymmetry. When reported, the area under the curve (AUC) was at least good (0.81-1.00). Only one study combined clinical and EEG data (AUC 0.88). There was little data found describing whether EEG could identify ischaemic versus haemorrhagic stroke. Radiological changes suggestive of LVO were also associated with increased slow and decreased fast waves. The only study with angiographic proof of LVO reported AUC 0.86 for detection < 24 h since onset. Amongst 26 reports of prognostic data, increased slow and reduced fast wave EEG changes were associated with future dependency, neurological impairment, mortality and poor cognition, but there was little evidence that EEG enhanced outcome prediction relative to clinical and/or radiological variables. Only one study focussed solely on patients < 6 h since onset for predicting neurological prognosis post-thrombolysis, with more favourable outcomes associated with greater hemispheric symmetry and a greater ratio of fast to slow waves. CONCLUSIONS Although studies report important associations with EEG biomarkers, further technological development and adequately powered real-world studies are required before recommendations can be made regarding application during acute stroke assessment.
Collapse
Affiliation(s)
- Lou Sutcliffe
- Stroke Research Group, Population Health Science Institute, Newcastle University, Newcastle-Upon-Tyne, UK
| | - Hannah Lumley
- Stroke Research Group, Population Health Science Institute, Newcastle University, Newcastle-Upon-Tyne, UK.
| | - Lisa Shaw
- Stroke Research Group, Population Health Science Institute, Newcastle University, Newcastle-Upon-Tyne, UK
| | - Richard Francis
- Stroke Research Group, Population Health Science Institute, Newcastle University, Newcastle-Upon-Tyne, UK
| | - Christopher I Price
- Stroke Research Group, Population Health Science Institute, Newcastle University, Newcastle-Upon-Tyne, UK
| |
Collapse
|
6
|
Tatum WO, Desai N, Feyissa A. Ambulatory EEG: Crossing the divide during a pandemic. Epilepsy Behav Rep 2021; 16:100500. [PMID: 34778740 PMCID: PMC8578031 DOI: 10.1016/j.ebr.2021.100500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 09/02/2021] [Accepted: 09/06/2021] [Indexed: 01/07/2023] Open
Abstract
The COVID-19 pandemic forced temporary closure of epilepsy monitoring units across the globe due to potential hospital-based contagion. As COVID-19 exposures and deaths continues to surge in the United States and around the world, other types of long-term EEG monitoring have risen to fill the gap and minimize hospital exposure. AEEG has high yield compared to standard EEG. Prolonged audio-visual video-EEG capability can record events and epileptiform activity with quality like inpatient video-EEG monitoring. Technological advances in AEEG using miniaturized hardware and wireless secure transmission have evolved to small portable devices that are perfect for people forced to stay at home during the pandemic. Application of seizure detection algorithms and Cloud-based storage with real-time access provides connectivity to AEEG interpreters during prolonged "shut-down". In this article we highlight the benefits of AEEG as an alternative to diagnostic inpatient VEM during the paradigm shift to mobile heath forced by the Coronavirus.
Collapse
Affiliation(s)
| | - Nimit Desai
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | | |
Collapse
|
7
|
Mondal S, Zehra N, Choudhury A, Iyer PK. Wearable Sensing Devices for Point of Care Diagnostics. ACS APPLIED BIO MATERIALS 2020; 4:47-70. [DOI: 10.1021/acsabm.0c00798] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Subrata Mondal
- Department of Chemistry, Indian Institute of Technology Guwahati, Guwahati 781039, Assam, India
| | - Nehal Zehra
- Department of Chemistry, Indian Institute of Technology Guwahati, Guwahati 781039, Assam, India
| | - Anwesha Choudhury
- Center for Nanotechnology, Indian Institute of Technology Guwahati, Guwahati 781039, Assam, India
| | - Parameswar Krishnan Iyer
- Department of Chemistry, Indian Institute of Technology Guwahati, Guwahati 781039, Assam, India
- Center for Nanotechnology, Indian Institute of Technology Guwahati, Guwahati 781039, Assam, India
| |
Collapse
|
8
|
Singla S, Garcia GE, Rovenolt GE, Soto AL, Gilmore EJ, Hirsch LJ, Blumenfeld H, Sheth KN, Omay SB, Struck AF, Westover MB, Kim JA. Detecting Seizures and Epileptiform Abnormalities in Acute Brain Injury. Curr Neurol Neurosci Rep 2020; 20:42. [PMID: 32715371 DOI: 10.1007/s11910-020-01060-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Acute brain injury (ABI) is a broad category of pathologies, including traumatic brain injury, and is commonly complicated by seizures. Electroencephalogram (EEG) studies are used to detect seizures or other epileptiform patterns. This review seeks to clarify EEG findings relevant to ABI, explore practical barriers limiting EEG implementation, discuss strategies to leverage EEG monitoring in various clinical settings, and suggest an approach to utilize EEG for triage. RECENT FINDINGS Current literature suggests there is an increased morbidity and mortality risk associated with seizures or patterns on the ictal-interictal continuum (IIC) due to ABI. Further, increased use of EEG is associated with better clinical outcomes. However, there are many logistical barriers to successful EEG implementation that prohibit its ubiquitous use. Solutions to these limitations include the use of rapid EEG systems, non-expert EEG analysis, machine learning algorithms, and the incorporation of EEG data into prognostic models.
Collapse
Affiliation(s)
- Shobhit Singla
- Department of Neurology, Yale University, Box 208018, 15 York Street
- LLCI Room 1004B, New Haven, CT, 06520, USA
| | - Gabriella E Garcia
- Department of Neurology, Yale University, Box 208018, 15 York Street
- LLCI Room 1004B, New Haven, CT, 06520, USA
| | - Grace E Rovenolt
- Department of Neurology, Yale University, Box 208018, 15 York Street
- LLCI Room 1004B, New Haven, CT, 06520, USA
| | - Alexandria L Soto
- Department of Neurology, Yale University, Box 208018, 15 York Street
- LLCI Room 1004B, New Haven, CT, 06520, USA
| | - Emily J Gilmore
- Department of Neurology, Yale University, Box 208018, 15 York Street
- LLCI Room 1004B, New Haven, CT, 06520, USA
| | - Lawrence J Hirsch
- Department of Neurology, Yale University, Box 208018, 15 York Street
- LLCI Room 1004B, New Haven, CT, 06520, USA
| | - Hal Blumenfeld
- Department of Neurology, Yale University, Box 208018, 15 York Street
- LLCI Room 1004B, New Haven, CT, 06520, USA
| | - Kevin N Sheth
- Department of Neurology, Yale University, Box 208018, 15 York Street
- LLCI Room 1004B, New Haven, CT, 06520, USA
| | - S Bulent Omay
- Department of Neurology, Yale University, Box 208018, 15 York Street
- LLCI Room 1004B, New Haven, CT, 06520, USA
| | - Aaron F Struck
- Department of Neurology, University of Wisconsin-Madison, Madison, WI, 53792, USA
| | - M Brandon Westover
- Department of Neurology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Jennifer A Kim
- Department of Neurology, Yale University, Box 208018, 15 York Street
- LLCI Room 1004B, New Haven, CT, 06520, USA.
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Chalela JA, Britell PE. Tactical Neurocritical Care. Neurocrit Care 2020; 30:253-260. [PMID: 29589329 DOI: 10.1007/s12028-018-0524-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Neurocritical care is usually practiced in the comfort of an intensive care unit within a tertiary care medical center. Physicians deployed to the frontline with the US military or allied military are required to use their critical care skills and their neurocritical skills in austere environments with limited resources. Due to these factors, tactical critical care and tactical neurocritical care differ significantly from traditional critical care. Operational constraints, the tactical environment, and resource availability dictate that tactical neurocritical care be practiced within a well-defined, mission-constrained framework. Although limited interventions can be performed in austere conditions, they can significantly impact patient outcome. This review focuses on the US Army approach to the patient requiring tactical neurocritical care specifically point of injury care and care during transportation to a higher level of care.
Collapse
Affiliation(s)
- Julio A Chalela
- Neurology and Neurosurgery, Medical University of South Carolina, 1-151, AV BN, SCARNG, Charleston, USA.
| | - Patrick E Britell
- Anesthesiology and Neurosurgery, Medical University of South Carolina, 75th CSH, USAR, Charleston, USA
| |
Collapse
|
11
|
Manfredonia F, Saturno E, Lawley A, Gasverde S, Cavanna AE. The role of electroencephalography in the early diagnosis of non-convulsive status epilepticus in elderly patients with acute confusional state: Two possible strategies? Seizure 2019; 73:39-42. [DOI: 10.1016/j.seizure.2019.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 11/02/2019] [Accepted: 11/03/2019] [Indexed: 11/26/2022] Open
|
12
|
Requena M, Fonseca E, Olivé M, Abraira L, Quintana M, Mazuela G, Toledo M, Salas‐Puig X, Santamarina E. The ADAN scale: a proposed scale for pre‐hospital use to identify status epilepticus. Eur J Neurol 2019; 26:760-e55. [DOI: 10.1111/ene.13885] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 12/06/2018] [Indexed: 12/20/2022]
Affiliation(s)
- M. Requena
- Epilepsy Unit Hospital Universitario Vall d'Hebron Barcelona Spain
| | - E. Fonseca
- Epilepsy Unit Hospital Universitario Vall d'Hebron Barcelona Spain
| | - M. Olivé
- Epilepsy Unit Hospital Universitario Vall d'Hebron Barcelona Spain
| | - L. Abraira
- Epilepsy Unit Hospital Universitario Vall d'Hebron Barcelona Spain
| | - M. Quintana
- Epilepsy Unit Hospital Universitario Vall d'Hebron Barcelona Spain
| | - G. Mazuela
- Epilepsy Unit Hospital Universitario Vall d'Hebron Barcelona Spain
| | - M. Toledo
- Epilepsy Unit Hospital Universitario Vall d'Hebron Barcelona Spain
| | - X. Salas‐Puig
- Epilepsy Unit Hospital Universitario Vall d'Hebron Barcelona Spain
| | - E. Santamarina
- Epilepsy Unit Hospital Universitario Vall d'Hebron Barcelona Spain
| |
Collapse
|
13
|
Santamarina E, Parejo B, Abraira L, Gutiérrez-Viedma Á, Alpuente A, Abarrategui B, Toledo M, Mazuela G, Salas-Puig X, Quintana M, García-Morales I. Cost of status epilepticus (SE): Effects of delayed treatment and SE duration. Epilepsy Behav 2018; 89:8-14. [PMID: 30384104 DOI: 10.1016/j.yebeh.2018.09.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 09/29/2018] [Accepted: 09/29/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The health expenditure related to status epilepticus (SE) is high because of lengthy hospitalization requirements and possible sequelae. We aimed to study the factors associated with this cost including the different timings of the treatment and SE duration. METHODS We evaluated retrospectively all SE recorded in 2 hospitals. The factors studied included the mean cost of hospitalization, demographics, clinical data, duration of hospitalization, in-hospital/out-of-hospital debut, time from onset to treatment, duration of SE, and destination at discharge. RESULTS Three hundred five patients were evaluated (December/2012-July/2017), 195 with out-of hospital and 110 with in-hospital debut. The cost of SE with out-of-hospital onset was significantly lower (6559€ vs 15,174€; p = 0.0001). In out-of-hospital cases, the factors independently related to expenditure were the level of consciousness (p < 0.001), presence of complications (p = 0.005), a potentially fatal etiology (p = 0.008), and duration of the episode (p = 0.003). Duration was significantly higher in patients discharged to a convalescence center (p = 0.006); this variable was significantly related to the time SE onset-arrival to hospital, and SE onset-administration of the treatment. In the in-hospital cases, cost was related to male sex (p = 0.002), the development of complications (p = 0.003), and the etiology (p = 0.016) but was not directly related to the SE duration or to the time onset-treatment. CONCLUSIONS The duration of SE and the speed with which proper management is applied have a direct impact on the healthcare expenditure resulting from out-of-hospital SE. In contrast, the etiology and development of complications are the main factors responsible for expenditure related to in-hospital SE.
Collapse
Affiliation(s)
- Estevo Santamarina
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
| | - Beatriz Parejo
- Unidad de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Madrid, Spain
| | - Laura Abraira
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Alicia Alpuente
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Belén Abarrategui
- Unidad de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Madrid, Spain
| | - Manuel Toledo
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Gonzalo Mazuela
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Xavier Salas-Puig
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Manuel Quintana
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Irene García-Morales
- Unidad de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Madrid, Spain
| |
Collapse
|
14
|
Zhao X, Lhatoo SD. Seizure detection: do current devices work? And when can they be useful? Curr Neurol Neurosci Rep 2018; 18:40. [PMID: 29796939 DOI: 10.1007/s11910-018-0849-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW The unpredictability and apparent randomness of epileptic seizures is one of the most vexing aspects of epilepsy. Methods or devices capable of detecting seizures may help prevent injury or even death and significantly improve quality of life. Here, we summarize and evaluate currently available, unimodal, or polymodal detection systems for epileptic seizures, mainly in the ambulatory setting. RECENT FINDINGS There are two broad categories of detection devices: EEG-based and non-EEG-based systems. Wireless wearable EEG devices are now available both in research and commercial arenas. Neuro-stimulation devices are currently evolving and initial experiences of these show potential promise. As for non-EEG devices, different detecting systems show different sensitivity according to the different patient and seizure types. Regardless, when used in combination, these modalities may complement each other to increase positive predictive value. Although some devices with high sensitivity are promising, practical widespread use of such detection systems is still some way away. More research and experience are needed to evaluate the most efficient and integrated systems, to allow for better approaches to detection and prediction of seizures. The concept of closed-loop systems and prompt intervention may substantially improve quality of life for patients and carers.
Collapse
Affiliation(s)
- Xiuhe Zhao
- Epilepsy Center, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.,Neurology Department, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong Province, China
| | - Samden D Lhatoo
- Epilepsy Center, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA. .,NIH/NINDS Center for SUDEP Research, Boston, MA, USA.
| |
Collapse
|
15
|
Ratti E, Waninger S, Berka C, Ruffini G, Verma A. Comparison of Medical and Consumer Wireless EEG Systems for Use in Clinical Trials. Front Hum Neurosci 2017; 11:398. [PMID: 28824402 PMCID: PMC5540902 DOI: 10.3389/fnhum.2017.00398] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 07/18/2017] [Indexed: 02/03/2023] Open
Abstract
Objectives: To compare quantitative EEG signal and test-retest reliability of medical grade and consumer EEG systems. Methods: Resting state EEG was acquired by two medical grade (B-Alert, Enobio) and two consumer (Muse, Mindwave) EEG systems in five healthy subjects during two study visits. EEG patterns, power spectral densities (PSDs) and test/retest reliability in eyes closed and eyes open conditions were compared across the four systems, focusing on Fp1, the only common electrode. Fp1 PSDs were obtained using Welch's modified periodogram method and averaged for the five subjects for each visit. The test/retest results were calculated as a ratio of Visit 1/Visit 2 Fp1 channel PSD at each 1 s epoch. Results: B-Alert, Enobio, and Mindwave Fp1 power spectra were similar. Muse showed a broadband increase in power spectra and the highest relative variation across test-retest acquisitions. Consumer systems were more prone to artifact due to eye blinks and muscle movement in the frontal region. Conclusions: EEG data can be successfully collected from all four systems tested. Although there was slightly more time required for application, medical systems offer clear advantages in data quality, reliability, and depth of analysis over the consumer systems. Significance: This evaluation provides evidence for informed selection of EEG systemsappropriate for clinical trials.
Collapse
Affiliation(s)
- Elena Ratti
- BiogenCambridge, MA, United States,*Correspondence: Elena Ratti
| | - Shani Waninger
- Advanced Brain Monitoring, Inc.Carlsbad, CA, United States
| | - Chris Berka
- Advanced Brain Monitoring, Inc.Carlsbad, CA, United States
| | | | | |
Collapse
|
16
|
Abstract
OBJECTIVE This study investigated sensitivity and false detection rate of a multimodal automatic seizure detection algorithm and the applicability to reduced electrode montages for long-term seizure documentation in epilepsy patients. METHODS An automatic seizure detection algorithm based on EEG, EMG, and ECG signals was developed. EEG/ECG recordings of 92 patients from two epilepsy monitoring units including 494 seizures were used to assess detection performance. EMG data were extracted by bandpass filtering of EEG signals. Sensitivity and false detection rate were evaluated for each signal modality and for reduced electrode montages. RESULTS All focal seizures evolving to bilateral tonic-clonic (BTCS, n=50) and 89% of focal seizures (FS, n=139) were detected. Average sensitivity in temporal lobe epilepsy (TLE) patients was 94% and 74% in extratemporal lobe epilepsy (XTLE) patients. Overall detection sensitivity was 86%. Average false detection rate was 12.8 false detections in 24h (FD/24h) for TLE and 22 FD/24h in XTLE patients. Utilization of 8 frontal and temporal electrodes reduced average sensitivity from 86% to 81%. CONCLUSION Our automatic multimodal seizure detection algorithm shows high sensitivity with full and reduced electrode montages. SIGNIFICANCE Evaluation of different signal modalities and electrode montages paces the way for semi-automatic seizure documentation systems.
Collapse
|
17
|
Ulate-Campos A, Coughlin F, Gaínza-Lein M, Fernández IS, Pearl P, Loddenkemper T. Automated seizure detection systems and their effectiveness for each type of seizure. Seizure 2016; 40:88-101. [DOI: 10.1016/j.seizure.2016.06.008] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 05/23/2016] [Accepted: 06/07/2016] [Indexed: 01/08/2023] Open
|
18
|
Blokland Y, Farquhar J, Lerou J, Mourisse J, Scheffer GJ, Geffen GJV, Spyrou L, Bruhn J. Decoding motor responses from the EEG during altered states of consciousness induced by propofol. J Neural Eng 2016; 13:026014. [PMID: 26859192 DOI: 10.1088/1741-2560/13/2/026014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Patients undergoing general anesthesia may awaken and become aware of the surgical procedure. Due to neuromuscular blocking agents, patients could be conscious yet unable to move. Using brain-computer interface (BCI) technology, it may be possible to detect movement attempts from the EEG. However, it is unknown how an anesthetic influences the brain response to motor tasks. APPROACH We tested the offline classification performance of a movement-based BCI in 12 healthy subjects at two effect-site concentrations of propofol. For each subject a second classifier was trained on the subject's data obtained before sedation, then tested on the data obtained during sedation ('transfer classification'). MAIN RESULTS At concentration 0.5 μg ml(-1), despite an overall propofol EEG effect, the mean single trial classification accuracy was 85% (95% CI 81%-89%), and 83% (79%-88%) for the transfer classification. At 1.0 μg ml(-1), the accuracies were 81% (76%-86%), and 72% (66%-79%), respectively. At the highest propofol concentration for four subjects, unlike the remaining subjects, the movement-related brain response had been largely diminished, and the transfer classification accuracy was not significantly above chance. These subjects showed a slower and more erratic task response, indicating an altered state of consciousness distinct from that of the other subjects. SIGNIFICANCE The results show the potential of using a BCI to detect intra-operative awareness and justify further development of this paradigm. At the same time, the relationship between motor responses and consciousness and its clinical relevance for intraoperative awareness requires further investigation.
Collapse
Affiliation(s)
- Yvonne Blokland
- Radboud University Medical Centre, Department of Anaesthesiology, Pain and Palliative Medicine, PO Box 9101, 6500 HB Nijmegen, The Netherlands. Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Montessorilaan 3, 6525 HR Nijmegen, The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|