Zeto's wireless EEG machine

EEG in the ICU: Why, When, and How

Introduction

EEGs are an invaluable tool for monitoring real-time brain function at the bedside in the ICU.

Nonconvulsive seizures and nonconvulsive status epilepticus in the ICU are very shockingly common. Now that continuous EEG monitoring (cEEG) has entered clinical practice, we know the incidence of nonconvulsive seizures is between 8% and 37% of ICU patients.1 Up to 22% of patients in the medical ICU without brain injury have periodic discharges or seizures.2 Up to 16% of patients in the surgical ICU have seizures.3

Nonconvulsive seizures and nonconvulsive status epilepticus are extremely hard to detect at the ICU bedside—physicians missed 88% of these cases in one retrospective study.4 Sadly, delays in diagnosing and treating nonconvulsive status epilepticus treatment are associated with poor patient outcomes.5,6 Because of this dire need, professional societies and experts are calling on ICU staff to routinely order EEG monitoring in critical care units.7-9

Why order EEG in the ICU?

Seizures and/or status epilepticus causes neuronal damage10 and in some cases, hippocampal atrophy.11 These treatable conditions lead to poor outcomes in both children and adults. Prolonged seizures are associated with chronic cognitive problems and neurological sequelae . In short, undiagnosed and untreated seizures are dangerous for patients.

Making matters worse, seizures are often missed in the ICU setting when the diagnosis is based on clinical signs alone.4 Indeed, as Dr. Lawrence J. Hirsch of the Comprehensive Epilepsy Center of Columbia University in New York put it, “it is fair to say that anyone who works with critically ill neurologic patients and does not see nonconvulsive seizures and nonconvulsive status epilepticus on a regular basis is missing the diagnosis.”12

Given the complex nature of patients’ deficits in the ICU, it is unreasonable to rely on physical/neurological examination alone to detect nonconvulsive seizures.

EEG monitoring does appear to be better able to detect both subclinical seizures and subclinical status epilepticus compared to routine EEG according to a systematic review and meta-analysis study of over 20,000 critically ill adult patients.13 

However, this might not translate into long-term clinical benefit, as suggested by a recent multicenter randomized clinical trial in Switzerland called the CERTA study, which evaluated 364 patients using continuous EEG or two routine 20-minute EEGs.  The researchers did not find that mortality significantly differed between the two groups at 6 months. 

Nevertheless, Neurocritical Care Society guidelines recommend the institution of continuous EEG within an hour of suspecting status epilepticus in all patients.14 Availability of EEG technologists, who can set up a routine and continuous EEGs, play a vital role in enabling ICU EEG monitoring, yet only 26% of institutions have technologists accessible 24/7 in-house.15

According to a study of 625 critically ill patients, preliminary findings from the first minutes of EEG recording have a high predictive value in detecting patients at greater risk for seizures and who would benefit from long-term monitoring.16 The absence of epileptiform discharges after two hours of EEG recording reduced the probability of seizure occurrence to less than 5%, and less than 10% after only 15 minutes.

When to order EEG in the ICU

EEG should be ordered without delay for any ICU patient with suspected nonconvulsive seizures. As mentioned, however, clinical suspicion is not terribly reliable4, thus the bar for ordering cEEG in ICU patients should be very low.

Continuous EEG should be ordered in ICU patients with7,12

  • Fluctuating mental status
  • Head trauma
  • History of convulsive seizures (especially convulsive status epilepticus; about one in two patients with coma and previous convulsive status epilepticus have nonconvulsive seizures.1)
  • Ischemic stroke
  • Intraparenchymal hemorrhage
  • Aneurysmal subarachnoid hemorrhage
  • CNS infection
  • Brain tumor
  • Sepsis
  • Recent history of ECMO
  • Hypoxic brain injury of any cause

Continuous EEG monitoring can help critical care physicians properly characterizing “spells” in the ICU “sudden posturing, rigidity, tremors, chewing, agitation, or sudden changes in pulse or blood pressure without an obvious explanation.”12 cEEG can also provide useful information about the level of sedation and can detect clinically silent, but significant neurologic events.12

How to get EEG in the ICU: Rapid EEG Solution

Rapid access to clinical EEGs in ICUs has a significant impact on diagnosis and outcomes in patients with seizures and acute neurological disorders. Despite the obvious need, it is still difficult for most critical care staff to get a rapid EEG in the ICU. The biggest hurdles to EEG in the ICU are a lack of dedicated EEG equipment and full-time staff that can run and read EEG and cEEG studies.

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

How Zeto Can Help

Zeto offers a rapid full montage EEG solution that can be easily deployed in the ICU without a dedicated technologist. Zeto might be used for cEEG for up to 4 hours and for routine EEG. Zeto EEG can provide accurate, high-quality, 19-channel medical-grade EEGs in a matter of minutes (average setup time is about 5 minutes) without skin prep or cleanup.

Virtually anyone who works in the ICU can place the Zeto device with minimal training, it’s possible to use cross-trained personnel. The Zeto team trains onsite and offers remote support.

Once the wireless EEG system is placed on the patient’s head, the resulting EEG is available in real time for live monitoring. ICU staff has the additional paid-on option of real-time remote patient monitoring by registered EEG techs and short-notice remote reads by certified neurologists.

Most importantly, Zeto integrates FDA cleared Seizure Detection and continuous Seizure Load monitoring tools from encevis into its User Interface for automatic detection/notification of such critical events, providing more integrated functionality vs. competitors.

With Zeto, it is now possible to obtain medical-grade EEGs in the ICU setting without an on-site EEG staff. Within minutes, our integrated EEG solution notifies staff of continuous seizures enabling physicians to intervene in a timely manner and save lives in critical care settings.

References

1. Kennedy JD, Gerard EE. Continuous EEG monitoring in the intensive care unit. Curr Neurol Neurosci Rep. 2012;12(4):419-428. 10.1007/s11910-012-0289-0

2. Oddo M, Carrera E, Claassen J, Mayer SA, Hirsch LJ. Continuous electroencephalography in the medical intensive care unit. Crit Care Med. 2009;37(6):2051-2056. 10.1097/CCM.0b013e3181a00604

3. Kurtz P, Gaspard N, Wahl AS, et al. Continuous electroencephalography in a surgical intensive care unit. Intensive Care Med. 2014;40(2):228-234. 10.1007/s00134-013-3149-8

4. Drislane FW, Lopez MR, Blum AS, Schomer DL. Detection and treatment of refractory status epilepticus in the intensive care unit. J Clin Neurophysiol. 2008;25(4):181-186. 10.1097/WNP.0b013e31817be70e

5. Pang T, Hirsch LJ. Treatment of Convulsive and Nonconvulsive Status Epilepticus. Curr Treat Options Neurol. 2005;7(4):247-259. 10.1007/s11940-005-0035-x

6. Trevathan E. Ellen R. Grass Lecture: Rapid EEG analysis for intensive care decisions in status epilepticus. Am J Electroneurodiagnostic Technol. 2006;46(1):4-17.

7.  Herman ST, Abend NS, Bleck TP, et al. Consensus statement on continuous EEG in critically ill adults and children, part I: indications. J Clin Neurophysiol. 2015;32(2):87-95. 10.1097/WNP.0000000000000166

8. Herman ST, Abend NS, Bleck TP, et al. Consensus statement on continuous EEG in critically ill adults and children, part II: personnel, technical specifications, and clinical practice. J Clin Neurophysiol. 2015;32(2):96-108. 10.1097/WNP.0000000000000165

9. Rossetti AO, Hirsch LJ, Drislane FW. Nonconvulsive seizures and nonconvulsive status epilepticus in the neuro ICU should or should not be treated aggressively: A debate. Clin Neurophysiol Pract. 2019;4:170-177. 10.1016/j.cnp.2019.07.001

10. Palmio J, Keränen T, Alapirtti T, et al. Elevated serum neuron-specific enolase in patients with temporal lobe epilepsy: A video–EEG study. Epilepsy research. 2008;81(2-3):155-160.

11. Vespa PM, McArthur DL, Xu Y, et al. Nonconvulsive seizures after traumatic brain injury are associated with hippocampal atrophy. Neurology. 2010;75(9):792-798. 10.1212/WNL.0b013e3181f07334

12. Hirsch LJ. Continuous EEG monitoring in the intensive care unit: an overview. J Clin Neurophysiol. 2004;21(5):332-340.

13. Sharma, S., Nunes, M., & Alkhachroum, A. (2022). Adult Critical Care Electroencephalography Monitoring for Seizures: A Narrative Review. Frontiers in Neurology, 13.

14. Brophy, G. M., Bell, R., Claassen, J., Alldredge, B., Bleck, T. P., Glauser, T., … & Vespa, P. M. (2012). Guidelines for the evaluation and management of status epilepticus. Neurocritical care, 17(1), 3-23.

15. Gavvala, J., Abend, N., LaRoche, S., Hahn, C., Herman, S. T., Claassen, J., … & Critical Care EEG Monitoring Research Consortium (CCEMRC). (2014). Continuous EEG monitoring: a survey of neurophysiologists and neurointensivists. Epilepsia, 55(11), 1864-1871.

16. Rubinos, C., Alkhachroum, A., Der-Nigoghossian, C., & Claassen, J. (2020, December). Electroencephalogram monitoring in critical care. In Seminars in neurology (Vol. 40, No. 06, pp. 675-680). Thieme Medical Publishers, Inc.

Zeto and Next Gen Neuro Partner for Remote EEG Monitoring

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.

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.

About Next Gen Neuro

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

Source: Zeto and Next Gen Neuro Partner for Remote EEG Monitoring | Newswire

Next Gen Neuro’s Leisha Osburn Knows Remote EEG Monitoring Saves Lives

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!

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.