Zeto's wireless EEG machine

Zeto Now Offers Remote Routine and Continuous EEG Monitoring Service to Its Customers for an Hourly Flat Rate

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.

Source: https://www.newswire.com/news/zeto-now-offers-remote-routine-and-continuous-eeg-monitoring-service-21786666

How to alleviate burnout for EEG technologists

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.

What is Rapid EEG?

  • 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, we also 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.

Zeto Introduces a Remote EEG Reading Service to Its Customers

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.

remote eeg services phases

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

Source: https://finance.yahoo.com/news/zeto-introduces-remote-eeg-reading-151600029.html

Zeto to Showcase Technology to Make EEG Brain Monitoring More Accessible for New Providers and in Rural and Underserved Communities at 2022 AAN Annual Meeting

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.

To learn more about our products, please visit: www.zetoinc.com or email us at info@zetoinc.com

 

Source: https://www.newswire.com/news/zeto-to-showcase-technology-to-make-eeg-brain-monitoring-more-21675785

Electroencephalogram (EEG) as a Biomarker in Dementia

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.

Electroencephalogram (EEG) as a Biomarker in Dementia

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.

Non-linear features may include:

  • lower fractal dimension (FD) of the EEG
  • lower Lempel-Ziv-Welch (LZW) complexity,
  • and lower Tsallis entropy (TsEn)
  • as compared to normal controls

Conclusion

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 Therapeutic Potential of EEG Neurofeedback in treating Covid-19 Induced Neuropsychiatriatric and Cognitive Symptoms

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

Neurofeedback EEG

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.

Faster & Better EEG Tests with Zeto Health Technology Podcast with Aswin Gunasekar, CEO & Founder, Zeto

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.”

Listen to Aswin’s episode on the Health Technology Podcast.

Source: https://rosenmaninstitute.org/healthtech-leaders/healthtech-leader-of-the-month-aswin-gunasekar-ceo-zeto/

The Role of EEG for Epilepsy Diagnosis, Management and Classification

People with epilepsy typically experience recurrent seizures. Despite the diverse causes of seizures, the common mechanism linking many types of epilepsy is the disruption of the brain’s normal electrical activity, which temporarily halts communication between neurons.

About 60% of epilepsy cases have a cause, a lesion, or abnormality in the brain, detectable by neuroimaging methods [1,2]. Another class of pathogenesis of numerous epileptic symptoms is an abnormal expression of specific receptors in the brain, which leads to increased excitation and decreased inhibition resulting in enhanced neural activity.

Because epilepsy can only be diagnosed based on electrophysiological evidence (detection of two independent epileptic events by EEG tests) the use of EEG is mandatory for epilepsy diagnosis and management. Furthermore, based on the EEG evidence a trained epileptologist can determine the type of seizure and diagnose the type of epilepsy syndrome of the patients. The exact diagnosis can help to provide effective antiepileptic medication and prognosis.

Let’s find out the role of EEG in diagnosis, classification, and management in more detail. But first, let’s discuss what an EEG is.

What is EEG?

Electroencephalogram (EEG) is non-invasive research and diagnostic tool used to measure the changes of the brain’s electric potential over time, commonly called brain waves. This electric potential is generated by the discharges of millions of neurons. Although EEG does not have the spatial resolution of detecting the discharges of individual neurons, it can discern levels of activity associated with the major lobes of the human cerebral cortex. In other words, the EEG is a test that helps to detect electrical activity and abnormalities in a patients’ brain and localize them with a certain precision sufficient to make a diagnosis. An EEG equipment uses small sensors (electrodes) made of a conductive material attached to the scalp or they contact the skin. Often these electrodes are preconfigured inside an EEG headset to speed up the positioning.

Typically, specialists, clinical neurophysiologists, neurologists, and researchers carry out an EEG recording. Traditionally it has been done in clinics or academic laboratories and also has been adapted for home monitoring. While EEG has numerous research applications from basic research to Brain-Computer-Interface (BCI), in the field of clinical neurology it is mainly used to diagnose and monitor epilepsy and sleep disorders.

Diagnosis, Classification, and Patient Management

Diagnosis and treatment of epilepsy are often challenging. However, modern therapy provides many patients with multiple treatment options and often complete control of the seizure. After the first two seizures, evaluation should concentrate on:
1. Ruling out any non-epileptic medical or neurological condition that may generate seizures (e.g., psychogenic seizures)
2. Determine the type and location of seizures (e.g., focal, generalized, convulsive, non-convulsive)
3. Evaluating the relative risk of a seizure episode
4. Evaluating treatment options (e.g., diet, pharmacological treatment, surgical intervention, implanted control device)

The Use of EEG in Diagnosis of Epilepsy

Regardless of technological advancements, the first seizure episode typically is not captured in EEG. Numerous paroxysmal events can be confused with epileptic seizures, such as movement disorders, syncope, psychogenic seizures, etc. Probably, the most common event confused with epileptic seizures is syncope. To rule out non-epileptic seizures one needs to record abnormal activity from the brain as primary evidence. This is done by EEG equipment because all other methods to record brain activity are more expensive. At the same time, it is generally recommended to carry out a brain imaging study, such as magnetic resonance imaging (MRI). The MRI can reveal underlying cerebral lesions such as a tumor, stroke, vascular malformation, that could explain the seizure and also help localize it. However, not all epileptic seizures are associated with morphological differences in the brain that can be resolved by MRI. The class of epilepsy associated with electrographic seizures without visually observed MRI evidence is called non-lesional epilepsy.

The Vital Role of EEG in Epilepsy Diagnosis

Why does EEG play a central role in epilepsy diagnosis and treatment? Because EEG can:

● detect epileptiform activity,
● strengthen the putative diagnosis,
● identify the focal cerebral abnormalities, which may indicate a focal structural anomaly such as brain tumor, hemorrhage, vascular malformation and
● document particular epileptiform activity patterns linked to specific epilepsy syndromes

Trained clinicians can recognize a particular type of epilepsy based on their signature waveforms and distribution using an EEG device. Each type of epilepsy diagnosis entails specific treatment strategies. Typical EEG results provide a multiaxial diagnosis of epilepsy describing whether the seizure disorder is generalized or focal, symptomatic or idiopathic (unknown cause), or part of a particular epilepsy syndrome. Because no two epilepsy cases are identical, providing a detailed description of the type of epileptic waveforms, the topography (location in the brain), the frequency of occurrences, the triggering stimulus if there is any, and the effect of seizure on the cognitive and motor functions are all important aspects shaping the treatment strategy.

One critical aspect of epileptic seizures that can be captured by an EEG study is whether it is generalized or focal. The two require completely different medication and treatment strategies. In the case of generalized seizures, abnormal synchronized discharges quickly spread to both cerebral hemispheres, while in focal seizures the abnormal discharges remain localized to a certain area or areas. To capture these events, one needs to spend hours or days with a continuously recording EEG because these events are rare unless it is triggered by a known stimulus (light, sound, touch, anxiety, hyperventilation, etc.).

Because of the scarcity and unpredictable nature of epileptic seizures, these events may not be captured in the clinic during the EEG. However, the description of a seizure by a witness combined with the patient’s self-report can complement the information available from EEG. Abnormal EEG activity patterns that indicate the potential for seizures are called inter-ictal events (sharp waves and spike and waves). These events play an important role in localizing and seizures. Today, a lot of attention is paid to interictal events as potential biomarkers of an impending seizure. One of the biggest machine learning challenges in medicine is to predict seizures based on the types and occurrences of these interictal events.

The role of EEG in Classification of Epilepsy

The classification of epilepsy and the recognition of diagnostic categories based on EEG is an ongoing, evolving process. The categories we use today are not the same as the ones we used 30 years ago, and they change as we understand the disease better. We tend to overclassify epilepsy syndromes as each is associated with particular EEG features. Therefore, it is the task of an internationally elected committee of experts ”International League Against Epilepsy (ILAE” to update the classification systems from time to time, based on consensus and published empirical evidence [3]. Because the classification is evidence-based, and evidence is subject to technological advances, the EEG and other methods, such as neuroimaging, molecular biology, and genomics have a great impact on the classification progress. And will be informed as times go on by developments in imaging, molecular biology, and genetics.

The role of EEG in Management of Epilepsy

The main objective for treating epilepsy patients is to control seizures entirely without causing undesirable side effects. Therefore, besides EEG being an indispensable part of diagnosis, it is also necessary for epilepsy management. Until today the primary measure of the efficacy of epileptic drugs was the extent it reduces seizure frequency. This assessment was often based on self-reports, diary, and caretakers’ notes. With the widespread availability of EEG, this is expected to change and EEG could be utilized for quantifying the efficacy of any treatment, from drug therapy to special diets.

Conclusions

Patients diagnosed with epilepsy have more therapeutic options available to them today than yesterday. To maximize the benefit of these options, clinicians must make an accurate diagnosis of epilepsy syndrome, select and use medications effectively, and promptly refer patients where necessary.

Among the broad range of available diagnostic methods, EEG is still the most versatile and affordable research and diagnostic tool that helps study the brain’s electrical activity and recognize patterns associated with epilepsy. Most importantly EEG provides detailed information about the type and localization of epilepsy.

While it has a very limited spatial resolution and is prone to misinterpretation, EEG remains the gold standard of epilepsy diagnosis. It is and it will remain in the equation to provide better care for patients and to feed our curiosity about the inner workings and communications of brain tissue.

References:

1. Nguyen DK, Mbacfou MT, Nguyen DB, Lassonde M. Prevalence of nonlesional focal epilepsy in an adult epilepsy clinic. Can J Neurol Sci. 2013 Mar;40(2):198-202. doi: 10.1017/s0317167100013731. PMID: 23419568.
2. Téllez-Zenteno JF, Hernández Ronquillo L, Moien-Afshari F, Wiebe S. Surgical outcomes in lesional and non-lesional epilepsy: a systematic review and meta-analysis. Epilepsy Res. 2010 May;89(2-3):310-8. doi: 10.1016/j.eplepsyres.2010.02.007. Epub 2010 Mar 15. PMID: 20227852.
3. https://www.ilae.org/guidelines/definition-and-classification/proposed-classification-and-definition-of-epilepsy-syndromes

Active And Passive Electrodes – What Are They, Pros & Cons

When the British physician Richard Caton first recorded the brain’s electrical activity on a rabbit in the late 19th century he didn’t know his groundbreaking experiment would inspire the invention of a line of revolutionary technologies that turned out to be indispensable assets of neuroscience. One of those inventions is Hans Berger’s electroencephalography (EEG), which transformed the diagnosis of neurological conditions. Since then EEG has gone through several advancements, of which a key one is active EEG electrodes.

Because every innovation comes with certain pluses and minuses, it is of primary importance to clarify them for users. The guiding principle of any EEG innovation is to improve the quality of signals recorded from the brain while balancing usability and user comfort. Only after fully understanding these pros and cons could one make the right choices for their use case be it clinical, research, or other.

What are Active and Passive Electrodes?

The brain’s electrical activity (brain potential) is a sum of the myriad discharges generated from neuronal action potentials. Although a single action potential is detectable in the millivolt (mV) range, the combined effect of a large population of neurons on the voltage of the brain tissue relative to a neutral point is the sum of all action potentials. Because of the inherent stochasticity of these action potentials, the simultaneous positive and negative fluctuations cancel each other. Therefore, the net voltage fluctuation in the brain tissue is a fraction of that of the neuron, yielding to a fluctuation in the microvolt (uV) range. Fortunately, neurons often act in concert to achieve effective control of target tissues. When they do so, the millions of action potentials synchronize in oscillatory patterns like flocking birds synchronize their flying. Those oscillations form traveling waves over the surface of the cerebral cortex penetrating the skull and yielding to discernable voltage fluctuation over the scalp, a signal known as EEG.

To noninvasively capture the brain’s electric potential fluctuations over the skull, two different EEG electrode technology options are available. One is passive electrodes and the other is active electrode technology. Passive electrodes are traditional EEG electrodes that simply transmit the voltage fluctuation to the amplifier through a conductive wire. To attain a low-impedance contact we use Silver-Silver Chloride (Ag/AgCl), or gold electrodes. However, the need for skin preparation to achieve a low enough impedance (under 10Kohm), the cost of the electrodes (~$10/electrode), the labor-intensive gluing method, the inconvenience to the patient, and most importantly the increasing cases of skin breakdown encouraged innovation in EEG electrode technology. A well glued gold-cup EEG electrode on a clean exposed skin surface with an adequate amount of electrode paste on a relaxed motionless subject in an electromagnetically shielded room, with the amplifier a few feet (1-2 m) distance from the subject, can provide a relatively clean EEG, that shows discernible delta, theta, alpha, beta oscillations in the EEG. These oscillations originate from the brain, hence passive electrode technology was for a while the ultimate low-cost, noninvasive brain activity monitoring modality for extensive clinical and research purposes.

Active electrode technology was developed partly in response to not needing skin preparation. The second factor was to prevent the weak EEG signal from being contaminated by noise while traveling through the long wire. The solution to handle both was moving a part of the amplifier as close as possible to the electrode thereby buffering the signal close to the scalp (Fig. 1). Because in the case of active electrode implementation the cables carry a signal driven strongly by the pre-amplifier which makes it less susceptible to electromagnetic interference thereby improving the signal to noise ratio. A high input impedance pre-amplifier also mitigates the need for abrading skin or using conductive paste in order to drop skin impedance.

Conventional EEG System vs Active Electrode Solution | Zeto

Figure 1. The graphical scheme of conventional EEG with an instrumentation amplifier before the backend (a) versus the active electrode solution where the amplifiers are placed proximal to the electrodes (From Xu et al., 2017).

The Active electrode has two components, the electrode, and the preamplifier circuit. The electrode materials need to be carefully chosen so as to not have polarization effects and are typically silver/silver chloride (Ag-AgCl). The performance of such a dry-active electrode array was first demonstrated at the University of California, Davis, by Babak Taheri in the 1990s.

Passive electrodes, in contrast, are generally plated with Ag-AgCl or gold and need electrolytic paste or gel (they are frequently called wet electrodes for this reason). However, the scalp is first prepared to minimize electrode-scalp impedance which is recommended to be under 10Kohm.

A report of the construction, performance, and results of the first dry-active electrode appeared in a 1994 scientific publication. One of the initial observations made was the fact that the arrayed active electrodes outperformed the passive electrodes.

To understand how active electrodes could achieve such a good performance we need to compare the underlying signal transmissions implemented by these two types of EEG electrodes.

Pros And Cons of Active and Passive EEG Electrodes

Active and Passive Electrodes Pros

Active electrodes allow pre-amplification modules close to the electrode. Hence, these EEG electrodes enable signal amplification before any extra noise attacks the EEG signal.

Active electrodes can make a big difference in a multitude of scenarios. First and most important, they enable the use of dry electrodes. Dry electrodes, in general, are associated with higher noise levels because they are not glued to the skin surface nor do they use a conductive gel that creates a low impedance bridge between the skin and the EEG electrodes.

Likewise, active electrodes do great when the measurement occurs in areas with fair amounts of electromagnetic noise and when there will be a considerable distance between the system and the electrodes used for EEG.

For passive electrodes, a conductive gel is a must to minimize impedance, so as to enable the signal to travel reliably through the wire. Moreover, during extended usage of wet passive electrodes, the gel may dry up leading to poor quality of the recording.

Active and Passive Electrodes Cons

On the other hand, passive electrodes are simpler to manufacture, and they cost and weigh less as they lack the pre-amplification modules that active electrodes have. Active electrodes also require more wires (additional power and ground) to enable the functioning of the pre-amplifier. Passive electrodes can achieve very good performance when the electrode has a stable low impedance.

Comparing Active and Passive EEG Electrodes in Amplification System Test

A growing number of studies demonstrated a superior signal quality of active electrodes over passive electrodes. When the active electrode technology is applied to dry electrodes, it can compensate for the higher impedance of the dry electrodes and achieve equivalence with the gel-loaded passive electrodes with all the benefits deriving from the active electrodes.

The illustration below was taken from a study involving 8 participants after recording EEG reading following the emission of auditory stimuli.

EEG results after emission of auditory stimuli | ZetoSource | INMHC

The reading produced by the active electrodes was instantaneous in response to the Event-Related Potentials (ERPs) recorded after the emission of the auditory stimulus. Furthermore, there was a significantly reduced error in the voltage difference between the EEG electrodes’ recorded measurement and the reference signal.

Another study compared the active and passive electrodes in an ERP during cognitive tasks (Laszlo et al., 2014). The study involved two experiments. In the first experiment, researchers manipulated interelectrode impedance in an electrically quiet setting to check if active electrodes produced better results under such recording conditions. In the second experiment, they studied active electrodes’ ability to record when limited by natural skin impedance. The investigation also explored the relationship between voltage stability and active amplification circuitry in EOG. Results from both experiments showed complicated connections between voltage stability, electrode types, and impedance. Ultimately, the study indicated that active electrodes outperformed passive electrodes at different impedance levels except for very low ones. To be specific, passive electrodes obtained higher quality data only when impedance was less than 2 kΩ. That said, it’s worth noting that passive ones also were better at accurately following the EEG than active ones in the event of rapid voltage fluctuations.

Conclusion

The quality of EEG recordings depends on several factors. Whether you prefer to use an active electrode EEG system or not, it is vital to know the pluses and minuses. Active electrode technology when used with high-quality electrodes (e.g., gold-plated) with conductive paste provides the best of both worlds, i.e., low skin impedance and a well-driven signal that is less susceptible to noise. However, in such cases when these electrode wires need to be disposed of due to wear and tear along with the pre-amplifier assembly, the cost could become prohibitively expensive. Hence active electrodes most commonly enable the use of dry electrode EEG systems, which allows you to reuse the EEG cap and dispose of just the electrodes. Such wireless EEG systems also enable the fast and easy setup of EEG without elaborate prep work. Signal quality in such cases has shown to be as good or in some cases better than just conventional passive electrodes. In summary, active electrode technology always makes the EEG signal quality better. They cost more because of the additional circuitry and wires needed. If disposed of with the electrode wires, they could be too expensive; however, if reused with a cap-like system, the cost is not a concern. With costs dropping fast for such commodity parts, there is adequate reason to believe active electrodes will replace passive ones in the next few years.

REFERENCES:

1) Xu J, Mitra S, Van Hoof C, Yazicioglu RF, Makinwa KAA. Active Electrodes for Wearable EEG Acquisition: Review and Electronics Design Methodology. IEEE Reviews in Biomedical Engineering. 2017 ;10:187-198. DOI: 10.1109/rbme.2017.2656388.

2) Kelly, J. W., Siewiorek, D. P., Smailagic, A., & Wang, W. (2013). Automated filtering of common-mode artifacts in multichannel physiological recordings. IEEE transactions on bio-medical engineering, 60(10), 2760-2770. https://doi.org/10.1109/TBME.2013.2264722

3) Laszlo S, Ruiz-Blondet M, Khalifian N, Chu F, Jin Z, A direct comparison of active and passive amplification electrodes in the same amplifier system, Journal of Neuroscience Methods, 2014, Volume 235, 298-307, https://doi.org/10.1016/j.jneumeth.2014.05.012.