Providing this end-to-end solution will make EEGs accessible to any healthcare facility in the US
SANTA CLARA, Calif., August 29, 2022 (Newswire.com) – Zeto, Inc., a medical technology company, has announced its partnership with Next Gen Neuro, a continuous and routine EEG monitoring company, to provide remote EEG monitoring services.
Next Gen Neuro (NGN) will serve Zeto customers with real-time EEG monitoring within 30 minutes of a request via the Zeto software. Their registered EEG technologists (R.EEG.T) would then remotely view the EEG and patient video and make annotations. More importantly, they will promptly notify care providers of important clinical events.
“We can help improve patient outcomes by reducing delays in EEG care and allowing for patients to receive care in place, when and where they need it. We are eager to embrace new technologies such as Zeto and develop innovative workflows that will allow us to accomplish these goals while providing the highest quality EEG and cEEG services,” said Leisha Osburn, CEO of NGN.
“Our new service will make an end-to-end solution for EEG monitoring accessible to any health care facility in the US, from our easy-to-use device to continuous technologist monitoring to timely physician reading, all via our secure cloud, enabling timely, high-quality care for patients. Zeto continues its progress towards serving the growing unmet need of EEG brain monitoring. We are excited to partner with NGN, which provides cutting-edge remote Neurodiagnostic services without boundaries,” said Aswin Gunasekar, CEO of Zeto, Inc.
Zeto also offers remote EEG reading service to its customers and the monitoring service would serve as an ideal complement to customers. Continuous or intermittently monitored EEGs are also eligible for higher reimbursements by payers.
To learn more on how this new service will work and how it can benefit the patients in hospitals and physician practice settings, read the interview excerpt with Next Gen Neuro Co-founders, CEO Leisha Osburn, and COO Amanda Ritchey.
About Zeto, Inc.
Zeto, Inc. is an award-winning, privately held medical technology company located in Santa Clara, CA, that is focused on transforming the way electroencephalography (EEG) is performed at hospitals and clinics. Zeto’s revolutionary FDA-cleared EEG headset and cloud platform bring the traditional EEG procedure to the 21st century. The company plans to leverage its hardware and software technology to improve noninvasive monitoring of the brain’s electrical activity and achieve better outcomes for neurological conditions such as epilepsy, sleep disorders, autism, stroke and concussion.
Next Gen Neuro (NGN) is a veteran and women-owned organization inspired and determined to make a difference in the field of Neurodiagnostics. NGN’s goal is to be your partner of choice in providing cutting-edge remote Neurodiagnostic services without boundaries. NGN strives to provide flexible, up-to-date Neurodiagnostic Solutions.
To learn more about Next Gen Neuro services, please visit www.teamngn.com
On August 3rd, Zeto announced the launch of its new remote routine and continuous EEG monitoring services. To provide this service, we partnered with Next Gen Neuro LLC.
We asked Next Gen Neuro Co-founders CEO Leisha Osburn and COO Amanda Ritchey, innovative leaders in the neurodiagnostic industry, about this new service and how it would benefit patients in hospital and clinic settings.
What is your mission and how can your services improve patient outcomes?
Our mission is to be the Next Generation EEG-focused Neurodiagnostic service provider for our partners and their patients, helping them navigate this ever-changing field. We believe we can help improve patient outcomes by reducing delays in EEG care and allowing the opportunity for patients to receive care “in place, when and where they need it.”
We are eager to embrace new technologies and develop innovative workflows that will allow us to accomplish these goals while providing the highest quality EEG and cEEG services.
Why did you decide to start offering remote EEG monitoring?
Leisha Osburn: Around 2007, my team in the Neurophysiology Department at IU Health Methodist hospital became involved in the care of a man in his early 40s who was in status epilepticus. We began EEG monitoring and treatment aimed at stopping the seizures with high doses of medications that placed him in a medically induced coma. The medications had to be kept at just the right levels—enough to suppress the seizures, but not too suppressed — through continuous recording of the EEG.
At that time, the technology involved in continuously recording long periods of EEG and video data was not very evolved. The concept of having EEG technologists available to continuously monitor the recordings of patients in the ICU like this had never been applied. We would leave the machine on to record at the bedside overnight and the nurses and physicians would check intermittently to see if the brainwaves were still relatively suppressed or if the patient had again begun to have seizures. Then, about halfway through some nights, the storage capacity on the EEG machine would fill up and they would lose the best tool in caring for the patient.
Unfortunately, this patient passed away after several weeks in the ICU. It motivated all of us to look for better tools and methods for EEG monitoring in the future.
In 2008, I pushed to gain approval for the first ICU continuous EEG program in the country that would have registered EEG technologists (R.EEG.Ts) watching the brainwaves continuously, in real-time. We launched this program successfully and because of the significant impact it had on the care of ICU patients at Methodist hospital, we soon expanded this service to Riley Children’s hospital and Indiana University hospital. It wasn’t long after, that we began providing the service remotely for other IU Health hospitals.
In 2013, I left IU Health and the idea of expanding these remote monitoring services led me to meet our COO, Amanda Ritchey in 2014. Together, with the help of a great team, we built this service successfully for another company, and left at the end of 2019 to create Next Gen Neuro, with the goal of focusing on partnerships with hospitals and other healthcare providers to provide this service with patient care and quality first, above all else.
You recently partnered with Zeto to provide remote EEG monitoring services to Zeto’s customers. Could you describe how this service works?
When Zeto customers need real-time EEG monitoring coverage from Next Gen Neuro they can notify us two ways. If the patient is already set up for the EEG using the Zeto headset, the Zeto customer will click on a service request button in the Zeto software that notifies our monitoring team immediately and monitoring can start in 30 minutes or less. Alternatively, monitoring services can be requested via email at least 30 minutes before the EEG is set to begin. In this case, monitoring will start immediately when the setup is complete.
Then, continuously, in real time, an R.EEG.T remotely views the EEG and patient video, making annotations hourly, and more often as appropriate. Most importantly, they also rapidly notify care providers of relevant EEG and clinical events, per pre-established, customer directed protocols, as they occur. EEG annotations and logs of all significant events are available immediately at study completion. Technical summary reports inclusive of a descriptive analysis of the EEG are available within 2 hours of study completion.
Will the service actually be available in real time on demand, within 30 minutes, 24/7/365?
Yes, we have R.EEG.Ts scheduled around the clock and multiple layers of redundancy built in to assure this. In addition to the technologists who are pre-scheduled to provide monitoring, we also have shift coordinators available and ready to assist within 5 minutes of add-on requests, monitoring technologists on-call, and a clinical administrator on-call, all of whom are available within 30 minutes.
Will EEG monitoring be done only by registered EEG technologists?
Yes, to be eligible for a position with Next Gen Neuro all candidates must at a minimum, have their R.EEG.T, at least 3 years of ICU and/or epilepsy monitoring unit (EMU) experience (including experience with neonatal, pediatric and adult EEG), and they must commit to obtain their CLTM certification within 2 years of hire if they do not already have this higher-level credential. They must also pass an oral competency and skills assessment as a part of the initial interview process.
Is it possible for healthcare providers to combine their own EEG services with this remote EEG monitoring service? For example, how would this work if one of Zeto’s customers wants to use their own EEG technologists only during certain hours and order remote EEG monitoring from you at times when their EEG specialists are not available.
Yes, in fact this is very common. Many of our customers have their own EEG staff to monitor during the day and only need coverage overnight and on weekends. In the example you gave, we would work with the Zeto customer during the implementation planning process to determine what times, each day, we would receive and hand off EEG patients to and from the facility.
You work with many healthcare providers. What is the most popular use case and what are the biggest benefits of remote EEG services for healthcare providers?
Generally, there are two common scenarios.
We are contacted by hospitals or physician offices to provide on-site EEG technologists after they have been unsuccessful at this due to the ongoing significant staffing shortages in our field.
Our most popular hospital use case is to provide supplemental/as-needed remote and hybrid on-site/remote coverage of cEEGs and Stat EEGs, primarily overnights and weekends. We believe the biggest benefit of remote EEG services for healthcare providers comes when there are no onsite EEG staff available to set up and perform EEGs and cEEG monitoring. That’s where we provide credentialed, highly qualified technologists, available remotely, in real-time, to perform these services and sound the alarm on any critical events or findings during the EEG.
The ASET Annual Meeting just finished! What are your career recommendations for EEG technologists?
Be a sponge and learn as much as you can. Get involved with ASET and ABRET. Seek formal and informal mentors who can encourage and support your growth in this wonderful profession. There are many areas of focus in Neurodiagnostics, both current and on the horizon. Explore them all and find your passion!
This service is available in real time upon request with a 30-minute notice 24/7/365.
SANTA CLARA, Calif., August 3, 2022 (Newswire.com) – Zeto, Inc., announced today that it now offers remote routine or continuous electroencephalography (EEG) monitoring services to its customers. At a fixed hourly rate, an accredited monitoring service provides real-time remote video EEG monitoring by registered EEG technologists (R.EEG.T) when such personnel are unavailable on-site. This service is available in real time upon request with a 30-minute notice 24/7/365, at no extra charge during nights, weekends, or holidays.
Driven by the shortage of in-house monitoring capability, this additional service has become increasingly relevant to hospitals and clinics alike to meet the need for timely, high-quality patient care. Zeto is committed to opening its EEG cloud platform for such services as remote work by medical personnel is gaining adoption.
How it works: When Zeto customers need EEG specialists, they simply click on a service request button in the Zeto software, which notifies the monitoring service immediately, and monitoring starts within 30 minutes. By choice, this service can be requested in advance. In real time, an R.EEG.T remotely views the EEG and patient video, making annotations and notifying care providers when needed.
At an affordable hourly flat rate, providers now have the choice to use this simple and quick remote service. Alternatively, providers can use the Zeto Cloud to have their own EEG technologists monitor and annotate from afar. These options are crucial steps that ensure patient needs can be met with minimal delay while complying with standard practices and documentation requirements.
“We believe this service will be beneficial for everyone, including hospitals that would not be limited by the shortage of EEG professionals and can take care of their patients as fast as needed. Patients can have an EEG recorded, monitored, and reviewed for escalation of critical findings within minutes after the doctor orders it, and registered EEG technologists across the U.S. can apply their skills, even if they are not on-site 24/7/365,” said Florian Strelzyk, Chief Sales Officer at Zeto.
In May, Zeto began offering a remote EEG physician reading service to its customers. This was made possible through a partnership with a physician-led organization dedicated to providing expert, high-quality telemedicine-assisted EEG interpretation to hospitals and outpatient settings, regardless of geographic location.
About Zeto
Zeto, Inc. is an award-winning, privately held medical technology company located in Santa Clara, California, that is focused on transforming the way electroencephalography (EEG) is performed at hospitals and clinics. Zeto’s revolutionary FDA-cleared EEG headset and cloud platform bring the traditional EEG procedure to the 21st century.
To learn more about Zeto’s products, including the remote EEG monitoring, please visit:https://zeto-inc.com/ or email us at info@zetoinc.com.
As with all healthcare professions, neurodiagnostic technologists struggle with staffing shortages, unpredictable situations, and caring for patients with life-threatening physiological disorders. While many healthcare roles have shortages, qualified neurodiagnostic technologists are a rare breed and positions can go unfilled for many months.
In healthcare, there are many things around you that may be out of your control, but you can control how you respond to stressors by being proactive rather than reactive.
Burnout in healthcare workers is very real and is a major concern. Recognize it before it gets worse – people are often so busy that they don’t notice they’re burning themselves out until it’s too late.
We asked Renee DeVere, MS, REEGT, CNIM, Associate Director of Customer Success at Zeto, and an experienced registered EEG technologist to share her recommendations on how to alleviate burnout. She also holds a Masters degree in Industrial-Organizational Psychology.
Self-acceptance
Don’t persecute yourself for what you are experiencing. Burnout is not a weakness, it is a physiological condition.
Take time each day to walk, stretch, and perform relaxing breathing exercises.
Eat healthily and watch your caffeine and alcohol consumption. If you’re drinking a lot of caffeine to keep going and then having an alcoholic drink to reverse it at the end of the day, your physical and mental well-being will suffer. It can be a real rollercoaster and it will affect the quality of your sleep as well.
Compartmentalize your work life from your home life; compassion fatigue is real. Acknowledge when you are feeling it and allow yourself to leave your work behind when you get home. You can have compassion for your patients without living in their shoes. Working in healthcare, you have too many shoes to fill.
Sleep
If your schedule allows you to keep the same bedtime and waketime each day, do it. Switching your sleep schedule all the time causes jet lag. Your mind and body will not perform as well.
If you are on rotating shifts or taking calls, make your sleep a quality one. Darken the room, turn off all electronics before bed, if possible, at least an hour before bed, and create a relaxing bedtime routine and a soothing bedroom environment.
Don’t forget to spend time with supportive friends and family. Share with them, but don’t turn your social time into negativity-binging time. Show others you appreciate them and make time for fun.
Set limits
In healthcare, you can’t control when the stat requests come in, when you get called, when you’re on call, or when your colleagues call in sick and leave you shorthanded, but do learn to set limits wherever possible. Sometimes, if your well-being is on the line, you need to learn when to say no and if it is appropriate to do so. If you empower yourself, you can find the line between essential and excessive.
Be efficient
Look at your workflows, processes, etc. Find out the areas where there is waste, extra steps, overprocessing, etc. Streamline your workflow to reduce redundancy and excess so that each action matters and unnecessary actions are eliminated. Work with your team and team leaders to identify and reduce waste. Promote efficiency by making sure you do not run out of materials needed to do the job and finding additional tools and resources to make work faster or simpler.
For managers of healthcare organizations, ensure that your team members have a voice, respect, and resources needed to perform their roles properly.
Technology Helps
Since 1924 when the first EEG was performed, not much has changed when it comes to picking up the signals from the scalp. Measuring the head, marking electrode locations, scrubbing the skin, applying the conductive paste, gluing down the electrodes, and eventually, tethering the patient to a box with wires – EEG technologists’ jobs involve doing all of these steps again and again.
They spend an average of 20 to 40 minutes just on the set-up. And despite the goal of helping patients, the EEG procedure often makes the patient feel sick.
Modern technology has helped make this process easier in recent years. Today, portable EEG devices offer maximum convenience without compromising the quality of the results. For the EEG techs, these devices reduce prep times (they’re easy to put on and adjust, and there’s no messy glue or wires to clean up), and for the patient, they offer increased comfort (for example, Zeto’s electrode tips are gentle on the skin).
New EEG systems are wireless, portable, easy to use, and cloud-based. Also known as rapid EEGs, these devices make EEG technology much more accessible, allowing more people to benefit from it.
EEG performed acutely for new onset of patient events and/or seizures
Designed to be started within a critical time window with the goal of triaging/treating sooner to prevent brain damage
Can be placed quickly by bedside care providers
May be in “screening-quality” category, or may be equivalent to standard EEG quality
EEGs during COVID times
The pandemic in a way drove innovative change in neurodiagnostics. When COVID initially broke out, many healthcare facilities experienced reduced onsite staffing, and EEG studies were only scheduled on-call by EEG staff. Healthcare worker burnout from COVID reached crisis levels. That’s when registered nurses (RN) started using rapid EEG solutions overnight or for acute needs while onsite EEG staff focused on continuous EEG studies.
After returning to a routine when COVID restrictions lessened, rEEG techniques remained and slowly became a part of the daily workflow at many healthcare facilities. Now RNs and other healthcare providers can perform the setup for acute needs.
Zeto’s Role in Assisting EEG Technologists
Zeto’s mission is to make neurodiagnostics accessible to more patients using the latest technologies. Even though the gold standard in obtaining quality neurodiagnostic recordings is to deploy a registered EEG technologist, there is an undeniable shortage of them in the US.
According to statistics, there were a mere 6,500 EEG technologists in 2018, with a likely need of 30,000. Throughout the pandemic, the need for EEG technologists has further increased. We believe that Zeto can help fill this gap by providing time-saving innovations with remarkable simplicity.
The Zeto team sees every day how their technology enhances EEG tech work. Modern EEG technology cannot replace EEG technologists, but it can make their job easier and less burdensome. For example, the Zeto setup process generally takes less than 5 minutes, and it is also convenient for patients because no skin preparation is required and no gel is used. Zeto allows technologists to focus on the most important parts of the EEG study – obtaining quality EEG data, scanning EEG patterns, and alerting neurologists as soon as possible when needed.
“In addition to assisting EEG technologists, wealso see a tremendous value of Zeto during triage situations where clinical necessity requires immediate neurodiagnostic testing. In many acute settings, EEG technologists aren’t physically able to arrive soon enough, and ‘time is brain’ for the patient.
In these situations, any trained healthcare professional, such as a nurse, medical assistant, or respiratory specialist, can hook up the patient using Zeto. During recording, it is necessary to know what a high-quality EEG should look like. This is where Zeto’s cloud platform becomes essential. Remotely, using a simple video tool, neurodiagnostic technologists can monitor the EEG in real-time to validate the EEG’s studies quality.
In situations where in-house registered EEG technologists are unavailable, Zeto is partnering with accredited monitoring services that provide live remote video monitoring at an hourly flat rate.
Zeto headsets can bridge the gap until more traditional EEG recordings by registered EEG technologists become available. In the past two years, we saw multiple examples of how Zeto technology helped support providers by making EEGs more accessible even under the most challenging circumstances,” said Florian Strelzyk, Chief Sales Officer at Zeto.
SANTA CLARA, Calif., May 26, 2022 (GLOBE NEWSWIRE) — Zeto, Inc., announced today that the company is now offering its customers a remote electroencephalography (EEG) reading service. This was made possible through a partnership with a physician-led organization dedicated to providing expert, high-quality telehealth-assisted EEG interpretation to hospitals and outpatient settings, regardless of geographic location.
There is a growing need for EEGs to be read in a timely manner, especially in healthcare settings when a neurologist is not on call. “Telehealth-driven technologies, such as Zeto’s EEG cloud platform, are great modern tools that allow EEGs to be interpreted quickly and seamlessly. We are delighted to partner with a board-certified EEG reader group, to cover long-term, acute (“stat”) and routine studies, and help improve patient care. The physician readers use innovative technologies, evidence-based protocols, and medical expertise to help hospitals and clinics start, expand, or improve seizure-related care. We are pleased to offer this service to our customers,” said Florian Strelzyk, Chief Sales Officer at Zeto.
As part of the Zeto Reading Service, a team of remote, certified, and specially trained adult and pediatric epileptologists provide real-time or retrospective EEG interpretation in outpatient settings across all 50 states, the District of Columbia, and Puerto Rico.
Current and new customers can request this service by contacting their Zeto account representative. Via this feature, the user can mark a study for interpretation and the platform notifies the customer-approved reader group to safely and securely read that study. Based on urgency and recording length, users are billed a flat professional reader fee and can receive their results within 24 hours.
About Zeto
Zeto, Inc. is an award-winning, privately held medical technology company located in Santa Clara, CA, that is focused on transforming the way electroencephalography (EEG) is performed at hospitals and clinics. Zeto’s revolutionary FDA-cleared EEG headset and cloud platform bring the traditional EEG procedure to the 21st century. The company plans to leverage its hardware and software technology to improve noninvasive monitoring of the brain’s electrical activity and achieve better outcomes for neurological conditions such as epilepsy, sleep disorders, autism, stroke and concussion.
To learn more about Zeto’s products including the reading service, please visit: www.zetoinc.com or email us at info@zetoinc.com
Today, Zeto, Inc. announced its participation in the 2022 American Academy of Neurology Annual Meeting, an event for neurologists and neuroscientists, taking place April 2-7, 2022.
The AAN Annual Meeting strives to promote the highest quality patient-centered neurologic care, assert the value of neurology to policymakers and other major stakeholders, and expand the neurology workforce to meet future needs for patient care.
“We are excited to be back in person for the 2022 AAN Annual Meeting. The past two years put a tremendous burden on many private practices and hospitals. In large parts of the U.S., hiring technologists required to record EEGs has been an everyday challenge due to the pandemic. That makes new providers or providers in rural and traditionally underserved communities struggle to offer crucial EEG tests at their own locations.
“For that very reason, Zeto will showcase our FDA-cleared EEG monitoring technology that enables providers to offer brain monitoring even without traditionally trained EEG technologists. Zeto EEG technology helps save valuable time and resources, while not compromising clinical standards. Neurologists can perform an EEG rapidly, even without an EEG technologist on site. At no upfront costs, and for as low as $65 per patient, providers can record full-montage EEG in under five minutes at the same quality as conventional gel EEG. Included in that per-patient fee are an EEG amplifier, consumables, cloud software with storage, video integration, warranty, training, and a powerful report writing tool. Optional EEG reading services further support clinical decision-making. In the past two years, we saw countless examples of how Zeto technology helped support providers to make EEG more available even under the most challenging circumstances,” said Florian Strelzyk, Chief Sales Officer at Zeto.
According to statistics, one in three patients recovering from Covid-19 may experience neurological or psychological effects from their infections, reflecting a growing consensus that the disease can have lasting effects on the brain.
The AAN Annual Meeting is the largest meeting and exhibition in the world to share common scientific and clinical interests in neurology.
About Zeto
Zeto, Inc. is an award-winning privately held medical technology company located in Santa Clara, CA, focused on transforming the way electroencephalography (EEG) is performed at hospitals and clinics. Zeto’s revolutionary FDA-cleared EEG headset and cloud platform bring the traditional EEG procedure to the 21st century. The company plans to leverage its hardware and software technology to improve noninvasive monitoring of the brain’s electrical activity and achieve better outcomes for neurological conditions such as epilepsy, sleep disorders, autism, stroke and concussion.
The Electroencephalogram (EEG) can be used as a Biomarker for Dementia. This decades-old technology is finding new life in modern neuroscience.
Old Dog
Introduced to neurologists for the detection and classification of epilepsy by Frederick Gibbs’ in 1934, electroencephalography (EEG) has played an integral role in the history of neurological medicine.
Not even the introduction of Computed Tomography (CT), Magnetic Resonance Imaging (MRI), magnetoencephalography (MEG), and other neuroimaging technologies could replace EEG as a low-cost, noninvasive tool for evaluating cortical function.
Presently, the role of EEG remains limited by the relatively low spatial resolution. However, the superior temporal resolution made EEG an indispensable device in clinical neurology. EEG reading physicians with trained eyes can interpret subtle deviations of electrographic signals from normal brain activity. However, oftentimes these electrographic events cooccur with overt behavioral symptoms that seem to render EEG unnecessary. Nevertheless, these behavioral manifestations can be misleading. For instance, classifying psychogenic seizures, which do not have underlying abnormal brain activity, from epileptic seizures is primary importance for the subsequent treatment plan of the patient. This distinction can only be possible based on EEG evidence or the lack thereof.
Even so, interest in EEG has exploded over the last two decades. The recent leaps forward in computing power and advancements in machine learning have begun to change the practice of medicine. In neuroscience, attention has turned toward overcoming the limitation of the poor spatial resolution of EEG.
There are two streams of advancements in EEG data augmentation and analysis. One is to improve source localization and the other is to utilize the EEG to find biomarkers of diseases using Machine-learning algorithms. What makes the latter approach viable today is the aggregation of large amounts of EEG data on a scale previously impossible. The special characteristics that have kept EEG relevant for so long – non-invasive and inexpensive – have become even more compelling.
New Tricks
The first practical applications for these augmented EEG data examinations will most likely involve using EEG to locate biomarkers–tools to facilitate the early diagnosis of diseases, dementias especially. A biomarker is a piece of measurable and objective biological data used to diagnose or stage an illness. Presently, the most frequently used EEG detectible dementia-related biomarkers include those used to identify Alzheimer’s disease (AD).
Alzheimer’s disease biomarkers, identified using EEG, improve the objectivity to the detection and prognosis of AD. That objectivity can provide the much-needed confidence for physicians, and presentable evidence to the patients and families under evaluation. Researchers classify AD biomarkers in the following categories:
Biochemical,
Radiologic,
Genetic,
Neurophysiological.
Both biochemical and radiologic biomarkers have found their way onto AD diagnostic criteria.
Biochemical markers incorporated in AD work-ups include CSF analysis checking for the presence of amyloid, total tau, and hyperphosphorylation tau proteins. AD diagnostic evaluations frequently include radiologic biomarkers such as the atrophic findings on structural MRI or metabolic changes on fluorodeoxyglucose (FDG)-PET. Genetic markers have yet to merit inclusion as independent AD criteria. Genetic biomarkers, especially those focused on specific alleles of apolipoprotein E, have shown some promise as supporting markers.
Computer augmented EEG data techniques have been the focus of research attempting to establish neurophysiological biomarkers to add a function-based evaluation to AD diagnosis. Leveraging increased computing power has allowed denoising, improved localization, and non-linear analysis. These advanced EEG techniques now assist in Alzheimer’s disease and dementia diagnosis during preclinical stages. Candidates for EEG-derived biomarkers of Alzheimer’s disease include both linear-spectral and non-linear dynamic features. Linear features of AD typically include:
Slowing of alpha power,
Increase in delta power,
Theta power is higher in patients with vascular dementia compared to AD,
Zero crossing interval (ZCI) increased in slow activity associated with dementia.
The work of laying the foundation for EEG biomarkers in the diagnosis of Alzheimer’s disease and dementia continues. Neuroscientists continue decoding how functional changes in the dementia-impacted brain reveal themselves in EEG data. The list of EEG biomarkers will narrow and expand as our understanding improves. Ultimately, EEG biomarkers will sharpen our ability to diagnose and triage different types of dementia at an earlier phase of the disease than we do today. Utilizing EEG to detect early markers for Alzheimer’s disease and dementias may open the door to new therapeutic possibilities or create the opportunity for patients and their families to plan ahead. For diligent neurologists, the ongoing pursuit of EEG biomarkers will require sustained attention. The future has begun to arrive.
The Covid-19 pandemic has had negative effects on the health and well-being of many individuals around the world, often leaving persistent decreases in quality of life in the post-acute phase of illness. Studies of survivors across the globe, including the United Kingdom, Spain, the United States, and France found lasting neurological effects from Covid 19in thirty percent or more of study subjects when they were followed up after hospital discharge.¹
How does Covid 19 affect the brain?
In terms of how Covid 19 affects the brain, symptoms not only included fatigue and dyspnea, but also neuropsychiatric maladies, such as post-traumatic stress disorder (PTSD), anxiety, depression, and concentration and sleep abnormalities.¹ A prospective cohort study out of Wuhan, China showed similar results. Fatigue/muscular weakness (63%), followed by sleep disturbance (26%) and anxiety/depression (23%) were the most frequent lingering symptoms. Beyond effects on mood and energy, features of Covid-19 infection show that it can affect the brain and central nervous system, including loss of sense of smell and taste, concentration deficits, and headache.² At its most extreme, symptoms can include encephalopathy and seizure.
Source: Shutterstock
EEG Neurofeedback
EEG neurofeedback is a promising technique to provide clinical benefit to those suffering from neuropsychiatric complaints as an alternative or complementary therapeutic modality to conventional psychopharmacology, which carries the risk of many undesirable side effects.
The International Society for Neuroregulation and Research explains the EEG neurofeedback process. They say, “During training, sensors are placed on the scalp and then connected to sensitive electronics and computer software that detect, amplify, and record specific brain activity. Resulting information is fed back to the trainee virtually instantaneously with the conceptual understanding that changes in the feedback signal indicate whether or not the trainee’s brain activity is within the designated range. Based on this feedback, various principles of learning, and practitioner guidance, changes in brain patterns occur and are associated with positive changes in physical, emotional, and cognitive states.”
A review article by Sharon Niv discusses this potential for a variety of disorders, including ADHD, autism spectrum disorders, substance use, PTSD, depression, sleep disturbance, and learning disabilities.³ Although most of these studies were not well-designed and placebo-controlled, the majority suggested clinical benefit.
A recent study by Ward, Porter, and Wood showed outpatient EEG neurofeedback reduced neuropsychiatric complaints, including hyperactivity, emotional lability, anxiety, and depression symptoms.4 Research by Escolano et al. demonstrated that neurofeedback could be effectively employed to enhance cognitive function (specifically working memory) that is negatively impacted by major depressive disorder (MDD).5 The benefit of neurofeedback in the setting of depression may be augmented by photic stimulation.6
Source: Shutterstock
EEG and Covid 19
An article by Kopańska et al. reviewed the most recent research on EEG findings in patients with COVID-19, including 17 publications in their evaluation.2 One pattern they identified was that changes frequently involved the frontal area of the brain, which controls focus and executive function. A nonspecific encephalopathic pattern was commonly found, although this pattern could be distinguished from infectious toxic encephalopathy or post-cardiorespiratory arrest encephalopathy using quantitative EEG (qEEG).7 Epileptic discharges and frank seizures or even status epilepticus were detected in a relatively small number of affected individuals.8 The degree of abnormality was associated with Covid severity and pre-existing neurologic disease.
Abnormal EEG patterns identified in patients with Covid-19 are potential targets for EEG neurofeedback. Luckos, Cielebak, and Kaminski published a case study on the therapeutic potential of this modality specifically for Covid.9 A 48-year-old woman developed neurocognitive deficits described as “brain fog” about a month after contracting Covid-19 infection. Her decline was so severe that she was no longer able to function independently.
EEG neurofeedback coupled with goal-directed cognitive training behavioral training was able to greatly alleviate her symptoms, and she was able to resume work. Others affected by Covid’s lasting neurological effects might similarly benefit.
It seems clear that Covid 19 impacts the brain, and that Covid causes lasting neurological effects. It seems equally clear that EEG neurofeedback may be a big help to those who have had Covid 19.
References
1. Nalbandian A, Sehgal K, Gupta A, Madhavan MV, McGroder C, Stevens JS, Cook JR, Nordvig AS, Shalev D, Sehrawat TS, Ahluwalia N. Post-acute COVID-19 syndrome. Nature medicine. 2021 Apr;27(4):601-15.
2. Kopańska M, Banaś-Ząbczyk A, Łagowska A, Kuduk B, Szczygielski J. Changes in EEG recordings in COVID-19 patients as a basis for more accurate QEEG diagnostics and EEG neurofeedback therapy: a systematic review. Journal of clinical medicine. 2021 Jan;10(6):1300.
3. Niv S. Clinical efficacy and potential mechanisms of neurofeedback. Personality and Individual Differences. 2013 Apr 1;54(6):676-86.
4. Ward KP, Porter NA, Wood DS. The effectiveness of neurofeedback in an outpatient setting: A multilevel modeling approach. Research on Social Work Practice. 2019 Nov;29(8):939-48.
5. Escolano C, Navarro-Gil M, Garcia-Campayo J, Congedo M, De Ridder D, Minguez J. A controlled study on the cognitive effect of alpha neurofeedback training in patients with major depressive disorder. Frontiers in behavioral neuroscience. 2014 Sep 2;8:296.
6. Hammond DC. Neurofeedback treatment of depression with the Roshi. Journal of Neurotherapy. 2000 Jun 1;4(2):45-56.
7. Pastor J, Vega-Zelaya L, Martin Abad E. Specific EEG encephalopathy pattern in SARS-CoV-2 patients. Journal of Clinical Medicine. 2020 May;9(5):1545.
8. Antony AR, Haneef Z. Systematic review of EEG findings in 617 patients diagnosed with COVID-19. Seizure. 2020 Dec 1;83:234-41.
9. Luckos M, Cielebak K, Kaminski P. EEG NEUROFEEDBACK IN THE TREATMENT OF COGNITIVE DYSFUNCTIONS AFTER THE INFECTION OF SARS-CoV-2 AND LONG COVID-19. Acta Neuropsychologica. 2021:361-72.
Zeto was among over 1,200 global digital health and life sciences companies competing across 16 categories of the prestigious awards program produced by the UCSF Health Hub.
UCSF Health Hub is a 501c3 non-profit supported and funded by Silicon Valley’s top health-related venture capital firms in a unique affiliation with UCSF.
For the August installment of the Healthtech Leader of the Month series, we interviewed Aswin Gunasekar, founder and CEO of Zeto. Zeto is a device-driven platform for acquiring, accessing, and interpreting electroencephalograms (EEGs). An EEG is a test used to evaluate electrical activity in the brain.
Zeto Offers a Seamless EEG Experience
Zeto is the first true dry electrode EEG system cleared by the FDA for clinical use. Founder and CEO Aswin Gunasekar breaks down the inefficiencies of traditional EEG. “If you look at it, the value chain from acquiring the EEG, accessing the data, interpreting the info, and then diagnosing; all these steps were broken,” he says. “The elaborate set up process makes EEG inaccessible. If you need a trained operator, who needs to go through a 10-month certification program just to do this procedure, that’s an instant bottleneck.” Clinical EEG is arduous: a trained EEG technologist must measure for exact electrode locations, abrade the skin, apply conductive paste, and glue each electrode to the scalp before recording the electrical activity. EEGs are used to diagnose conditions such as brain tumors, inflammation of the brain, seizure disorders including epilepsy, and more. Zeto’s first product is a wireless, adjustable headset that allows for EEG acquisition with no skin prep or cleanup. Physicians receive live remote viewing of video EEG through the cloud. Zeto’s integrated platform also offers data management and analysis tools for a seamless experience of acquiring EEG, enabling physicians to deliver better neurological care to patients.
Three Lessons Learned
When Aswin Gunasekar worked as an electrical engineer at AMD, designing semiconductor chips, he learned to ask himself: how does the piece that you’re working on fit into the bigger puzzle? “I did a lot of statistical analysis on yield of chips,” he says. “You can get lost in the weeds, or you can put the pieces together and say ‘you can design for this.’” In the capstone class for his MBA at UT Austin, Aswin formed a team that was eager to solve a pressing issue in healthcare. “My cousin’s story came up. My cousin grew up with epilepsy in the 90s. It took a big toll on his mental and social development, because he was being overdosed on anti-epileptic drugs,” Aswin says. “The drugs are very coarse in nature; they’re not that fine-tuned. His development could have been much better had better tools and care existed back then. We started digging deeper and discovered that EEG is the gold standard for diagnosing conditions like seizures and epilepsy. We instantly knew that it shouldn’t be done the way it’s being done right now, by gluing wires onto the scalp.” Aswin and the team began developing a headset with soft tip electrodes. “For us, conceptually, I knew there was nothing in science that limited us from doing this. But I knew it would be a journey of constant iterative learning,” he says. Here are a few things Aswin has learned on the way.
Lesson #1: Protect your psychology as a leader.
“Your psychology as a leader is 75% of the ball game. It’s about managing your state, not just about positive thinking. If you are locked in on something that you absolutely need to get done, from a destination standpoint, from a vision standpoint, you will find a way. Never go easy on that,” Aswin says. He recalls how difficult it was as a first-time entrepreneur to find Zeto’s first supporters. In 2016, Aswin pitched at a Shark Tank competition organized by the Epilepsy Foundation of America, demonstrating Zeto’s prototype on the judges. They won both the People’s Choice and Judge’s Choice awards, raising their first check and confirming that they were on the right path. Aswin cites how important that first inflection point was in boosting their confidence. “Without clarity of thought and managing your psychology as a leader, you’re not going to be able to inspire people to join forces with you,” he says.
Lesson #2: Think big but execute small.
“Think big but execute in small steps. It’s also self-motivating; you can celebrate those wins and it motivates the people in your team and it’ll motivate more people to come in and join you,” Aswin says. One of his big-picture goals for Zeto is to bring more companies onto their platform and to give valuable information about the brain to clinical providers and neuroscientists. He plans to get there with the same strategy he’s used from the start: take it step by step. “Plan and execute. Take out the biggest risk first. Always keep chopping away at that,” he says. “It doesn’t matter whether it’s a technical issue, a commercial traction issue, it’s the same thing: take that problem, break it down into pieces, understand the biggest risk within that bucket, and knock that down first. And then move to the next one.”
Lesson #3: Hire for grit.
“The ground floor, especially the first hundred people in a company, are so important to how the company lives, breathes, and develops into an organism of its own,” Aswin says. “I’m personally involved with every little hire; it doesn’t matter whether it’s a consultant, or part-time, or full-time; I’ll be involved with the first three hundred people.” Aswin looks for people who not only have the skillset and experience, but for those who demonstrate the “startup spirit;” the ability to persevere, to get knocked down and get back up. “It’s not just resume. It’s not just their experience and their accomplishments, you also need to hire for grit and tenacity,” he says. “You don’t see that just on the resume. We actively try to unearth that.”
Beyond the Business Books: Final Thoughts
One of the ways that Aswin wants to grow as a CEO is by growing overall as a person. “I’ve always learned the most from unconnected sources. I think I’m past the stage where I just go read business books. Those are good too, but I think the world is a little bit more complex than that,” Aswin says. “If we are taking a product and selling it to a customer, we are selling it to a human being who has their own life going on. How are we presenting our product as they go through their lives? That kind of learning will come from a better understanding of the nuances of the world.”
Zeto’s next goal is to expand its product portfolio and make their cloud infrastructure more capable. “Right now, Zeto is extremely useful for short-term EEG, but brain monitoring is a lot bigger,” Aswin says. “We need to make products that will allow people to be monitored for hours or days on end. There is a real need here, and we’re talking about brain monitoring! Once you give people a better platform, they’re going to do wonderful things with it.”
