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Simplifying Routine EEGs: Zeto Improves Care for Neurology Practices

Routine EEGs are one of the cornerstones of neurological care[1], yet traditional EEG systems often create unnecessary hurdles.  It enables non-emergency diagnosis, extended follow-up of many types of neurological conditions, and the performance of non-emergent EEGs.

For practices with limited resources there can be significant scheduling constraints (and no possibility of scheduling many consecutive patients) to messy gels, sticky pastes, and time-consuming set-up processes, the old way of doing things isn’t just inefficient—it’s inconvenient for patients, eeg technicians and medical providers.

Enter Zeto: a wireless, no-gel EEG solution for brain monitoring that’s reshaping how neurologists approach routine testing.

Here’s how Zeto transforms the routine EEG experience and contributes to improving outcomes for doctors, patients, and practices:

1. EEG Solutions When Techs Aren’t Available

EEG Technicians are considered the gold standard for EEG performance, but they’re not always available. Zeto offers flexibility to EEG workflows, enabling medical assistants (MAs) to perform tests when needed. This can help practices reduce reliance on strict scheduling, making it easier to conduct EEGs without waiting for technician availability.

Benefits of Zeto for Routine EEG include:

  • Reduced scheduling complexity: Patients can have their EEG performed during regular office visits without the need to schedule several weeks out. Due to the ease of set-up and lack of cleanup needed, an office can schedule consecutive EEGs, maximizing their resources.
  • Enhanced flexibility: EEGs can be offered on-demand, streamlining workflow and reducing delays in diagnosis.
  • Improved patient compliance: By eliminating scheduling barriers and increasing patient comfort during the recording, patients are more likely to follow through with testing.

“I love it because our MAs (medical assistants), who were trained by the Zeto team, can set up and run the EEG studies. If they ever have issues, I step in to troubleshoot, but this is really rare. We have been able to work more efficiently with the limited resources we have, which is important because I am in a multispecialty private practice group.” – Dr. Komal Rastogi, Granger Medical Clinic.

2. Five-Minute Setup and Ease of Use

Zeto’s wireless, rapid EEG system is designed for efficiency in routine EEG use. The headset enables quick and easy setup in about 5 minutes, meaning less time preparing for the test and more time focusing on the patient. The no-gel electrodes eliminate the hassle of cleanup, and removal is just as simple, taking only one minute.

Why Ease of EEG Setup Matters:

  • Faster setup means less time preparing for the test and more time focusing on patient care.
  • The streamlined process enables practices to serve more patients in a day, improving patient care and speeding up clinical diagnosis.
  • Faster testing means patients spend less time in the office, which they appreciate.

“The setup for routine EEG has decreased to 5-10 minutes from previous durations of 30 minutes to 1 hour. Quality of both EEG and video is very impressive.” – Dr. Raj Gupta, San Jose Pacific Neurology Center PC.

3. No Gel, No Mess, More Patient Comfort

Gone are the days of sticky gels and lengthy cleanup times. Zeto’s no-gel system[2] makes EEGs more comfortable for patients and easier for staff.

Patient benefits include:

  • Comfort: Without messy gels, patients don’t have to deal with the discomfort and inconvenience of washing their hair after the test.
  • Convenience: Patients can resume their day – whether going back to work, school, or home – immediately after the procedure.

This improved patient experience increases compliance with testing, making it easier for neurologists to provide timely care.

“Patients find the experience quicker and more streamlined, resulting in shorter visits compared to traditional setups. Overall, they respond positively to the technology. I have personally worn the Zeto headset for extended periods and can attest to its comfort.” – Dr. Christina M. Patterson, UPMC

4. Remote Access for Results, Anytime, Anywhere

Zeto’s cloud-based platform enables neurologists to access EEG results remotely[3], providing flexibility. This makes it possible for tests to be performed in one location while neurologists review the results if needed in real time from another, facilitating faster diagnoses and streamlined workflows.

Benefits for neurologists:

  • Efficient workflows: No need to be physically present to review results and make a diagnosis.
  • Faster diagnoses: Immediate access to EEG studies speeds up the diagnostic process.

“I’ve been remotely reading EEGs done by the Zeto EEG headset for one of my local colleagues through Zeto’s EEG cloud platform since the beginning of 2022. How it works: EEGs are done in the clinic here in San Diego by trained staff. The EEG is streamed and saved in real-time to the Zeto cloud and I receive a notification when the recording is finished. At that point, I go online, read the EEG study, and prepare the report. Overall, the process is easy, fast, and straightforward.” – Dr. Boris Khamishon, Neurology San Diego

5. Transforming Neurology Workflows

By integrating Zeto into their practices, neurologists have found their workflows become more efficient, patient-friendly, and seamless. The ability to offer on-demand EEGs keeps things running smoothly and increases the speed of care.

Key impacts include:

  • Increased patient compliance: Patients are more likely to follow through with testing when it’s convenient and hassle-free.
  • Streamlined care: On-demand EEGs eliminate bottlenecks, enabling for faster diagnoses and improved outcomes.
  • Improved patient care: Timely EEG testing ensures patients receive the diagnostics they need without unnecessary delays, enhancing treatment planning and overall care quality.

“In the short term, we were able to quickly address a backlog of 100+ patients (and incoming new ones) within just a few weeks. In the long term, with how easy the system is to use, we are not bottlenecked to only certain staff members and their availability to utilize the device and ensure essential diagnostics were getting completed in a timely manner.” – Dr. Randi Baculi, RHBNeuro

6. Perfect for Solo Neurologists: Ease of Use That Saves Time and Costs

For solo neurologists, Zeto’s intuitive design makes performing EEG studies seamless. The headset is easy to apply with minimal artifacts[4], enabling practitioners to focus on patient care without the need for additional staff or complicated scheduling.

Benefits include:

  • Increased efficiency: Solo practitioners can perform EEGs independently without needing to rely on additional staff, and use the time between studies for administrative tasks or patient care.
  • Flexibility: Ideal for part-time neurologists or those performing a limited number of studies per week.
  • Accessible support: Zeto offers easy access to technical assistance for troubleshooting when needed.

“I’m my own technician. I work part-time and perform 2 to 4 EEG studies a week, or about 12-15 studies a month. Technical assistance is easy when I have questions. It’s easy to use and maneuver. I usually read the results immediately after seeing patients and share the results in near real-time.” Dr. Virginia Thornley, Elite Neurology

7. Cloud-Based Software: Seamless and Up-to-Date Technology

Zeto’s cloud platform ensures that its software is always up-to-date, requiring minimal IT expertise or budget.

Benefits include:

  • User-friendly interface: The intuitive design makes reading EEGs straightforward and accessible.
  • Cross-device compatibility: Works effortlessly across laptops, phones, tablets, and desktop computers.
  • Streamlined accessibility: The cloud system provides reliable access, eliminating the need for complex setups or maintenance.

“The cloud interface is truly wonderful – user-friendly, easy to access, and visually appealing. I’ve used it on various devices, and it has consistently provided a seamless and headache-free experience.” Dr. Christina M. Patterson, UPMC

Zeto’s cloud-based platform meets stringent data security standards, such as HIPAA compliance, ensuring patient data is safe, accessible, and protected.

8. Report Writer: Designed with Neurologists in Mind

Zeto’s report writer features customizable templates that meet the specific needs of neurologists, enabling easy adjustments.

Benefits include:

  • Time-saving templates: Streamlined templates reduce the time spent on documentation.
  • Accessibility: Reports can be reviewed and adjusted from any device with internet access using the same login credentials.
  • Flexibility: Neurologists can adapt templates to align with individual practice preferences or patient needs.

“The biggest advantage is the Zeto report writer. The template features for the report are designed perfectly for a neurologist’s needs, and it’s very easy to make adjustments. The program is also easy to maneuver, and you can read the EEGs from any computer or device with a stable internet connection using the same login credentials.” – Dr. Boris Khamishon, Neurology San Diego

9. Accommodates All Hair Types

Zeto’s innovative electrode design eliminates barriers for patients with thick, curly, or styled hair, such as braids or dreadlocks.

Benefits include:

  • Patient comfort: No need for patients to alter or remove hairstyles, reducing stress and preserving dignity.
  • Cultural inclusivity: Accommodates protective hairstyles often tied to culture and identity.
  • Unique electrodes: Zeto’s patented electrodes can move past braids, cornrows, twists, or dreadlocks up to 1 inch thick and even work with thicker hair bundles.

We’ve written an entire blog on this topic: Textured Hair EEGs: Accessibility for All Hair Types 

10. Signal Quality on Par with Traditional EEG Systems

Zeto is committed to delivering high-quality EEG brain monitoring results. With full-montage 10-20 electrode placement and advanced technologies such as Active Electrode Technology (AET) and Dynamic Noise Cancellation (DNC), Zeto provides data that is non-inferior to traditional EEG systems.

Benefits include:

  • Reliable results: Signal quality is the same as traditional EEG systems but the setup is easier and faster and no gel is included.
  • Evidence-backed performance: Clinical studies across 50 subjects demonstrated parity between Zeto EEG (zEEG) and clinical EEG (cEEG) systems.

“I like the idea of quick setup using soft gel electrodes like Zeto. It’s an easy & efficient way to do quality routine video EEGs”. Dr. Jaivir S. Rathore, Falcon Advanced Neurology Center.

For a deeper dive into Zeto’s signal quality, read our article, “Comparison of Dry Electrode EEG System with Conventional EEG System,” or review the abstract, “Technical Validation of the Zeto Wireless, Dry Electrode EEG System,” presented at the American Epilepsy Society.  

Zeto’s signal quality meets the performance and technical standards outlined in EEG Guidelines provided by American Clinical Neurophysiology Society (ACNS).

The Future of Routine EEGs is Here

Zeto’s wireless EEG system is more than a technological upgrade — it’s a practical solution that addresses the inefficiencies of traditional EEG workflows. By making EEGs faster, more comfortable, and more accessible, Zeto is helping neurologists provide better care for their patients.

Take advantage of Zeto’s end-of-year offer for neurology practices: upgrade your routine EEG workflow with our wireless, no-gel EEG system by the end of the year and enjoy the . Don’t miss this limited-time opportunity to revolutionize patient care and streamline your practice — offer ends December 20th, 2024!

References:

  1. Worrell, G. A., Lagerlund, T. D., & Buchhalter, J. R. (2002). Role and Limitations of Routine and Ambulatory Scalp Electroencephalography in Diagnosing and Managing Seizures. Symposium on Seizures, 77(9), 991–998.
  2. Sensors (Basel). (2014, July 18). Dry EEG Electrodes – PMC, 14(7), 12847–12870. doi: 10.3390/s140712847
  3. Reider-Demer, M., & Shah, V. (2019, October). Telemedicine & Epilepsy: Your Smartphone Is Not Just for Communication – It Can Be Your Medical Care on the Go! Practical Neurology.
  4. Lopez-Gordo, M. A., Sanchez-Morillo, D., & Pelayo Valle, F. (n.d.). Common Artifacts During EEG Recording. In Electroencephalography (EEG): An Introductory Text and Atlas of Normal and Abnormal Findings in Adults, Children, and Infants. NCBI Bookshelf.

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Textured Hair EEGs: Accessibility for All Hair Types

Getting an EEG shouldn’t be a hassle – no matter your hairstyle. For most patients, an EEG test typically requires no special preparation. However, for individuals with curly hair, textured hair or specific hairstyles, such as braids, dreadlocks, cornrows, twists, hair extensions or coily/kinky curly hair, the setup process can be more challenging than it needs to be. Thanks to innovative technology by Zeto, there’s a solution that makes textured hair EEG accessible and efficient for everyone.

Understanding Hair Types

Before addressing the challenges and solutions, it’s important to understand that hair types vary widely based on texture and curl patterns. The commonly recognized Andre Walker Hair Typing System classifies hair into four main types:

Andre Walker Hair Typing System

Type 3 and Type 4 hair, in particular, tend to be thicker, curlier, or kinkier, which can present unique challenges for textured hair EEG setups. Additionally, protective hairstyles such as braids, cornrows, and dreadlocks further complicate traditional EEG setups. For many patients, even getting a test can be difficult or uncomfortable, creating unnecessary barriers to essential healthcare.

EEG and Hair Diversity: The Urgent Need for Inclusive Solutions

For decades, EEG technology has not been inclusive of everyone. Traditional EEG electrodes are designed to sit flat on the scalp, which is especially challenging for people with thick, curly hair or dreadlocks. The process can become even more difficult, requiring technologists to ask patients to alter or remove their hairstyle to achieve quality EEG data.

Imagine being told that you need to take down intricate braids or cut your dreadlocks – hairstyles often deeply tied to culture, identity, and personal expression – just to undergo an EEG. What may seem like a minor inconvenience to some can become a major obstacle to others, delaying critical diagnostic tests and adding stress to an already daunting medical experience.

This issue has disproportionately impacted patients, whose natural hair types and protective hairstyles are often incompatible with the rigid requirements of traditional EEG technology. As a result, many patients have encountered frustrating barriers to accessing the care they need.

Zeto Offers EEGs That Work for All Hair Types

The good news is that Zeto EEG technology is removing these barriers. Zeto’s wireless EEG headsets are designed to accommodate all hair types, from straight and wavy to curly and coily, including protective styles like dreadlocks, cornrows, and braids.

Unlike traditional EEG systems, Zeto headsets do not require the use of abrasive pastes or applications of messy electrolytes to obtain accurate readings. Instead, it sits comfortably on the head, regardless of hair volume, texture, or style. This ensures that patients with textured hair or complex hairstyles no longer need to worry about altering their hair for the test.

With Zeto, EEGs are no longer a stressful ordeal but a straightforward, accessible solution for all patients.

The photos  illustrate the flexibility of dry electrodes used in the Zeto EEG system. Any of the three bristles touching the skin would provide sufficient skin-to-electrode contact for stable signal recording.

Zeto’s Unique Electrodes

Zeto’s electrodes are designed to work with a wide variety of hair types and densities. Flat electrodes are ideal for areas without hair, such as the forehead. Taller electrodes with legs are designed to navigate through thicker hair, allowing for easy placement on the scalp, even with complex hairstyles.

Zeto’s patented electrode tips seamlessly move through hair and braids without leaving behind any sticky residue. The electrodes are capable of moving past braids, cornrows, twists, or dreadlocks up to 1 inch thick, and can even work with thicker hair bundles, depending on the style.

Zeto offers EEG solution for protective hairstyles

Convenient for EEG Technologists

Zeto makes life easier for EEG technicians by eliminating time-consuming skin preparation and messy gels. The setup is quick and efficient, even for patients with type 4 kinky/coily hair, taking just 5-10 minutes at most. Zeto’s headsets come with handy light-based signal quality indicators  built into each electrode that lets users know when the electrodes have a good connection (green light) or if they need a little adjustment (Red, orange, or yellow ). The adjustment is made by rotating and repositioning the electrode, to make sure they’re properly touching the scalp.

Comfortable for Patients

Zeto provides a significantly better EEG experience for patients. The setup is faster and more comfortable, with no sticky gels or adhesives to wash out afterward. There’s no need for special preparation or skin abrasion, which minimizes the risk of irritation or discomfort. Additionally, Zeto’s electrodes are single-use, eliminating the risk of cross-contamination. Patients enjoy a hassle-free experience with precise and reliable results, all without being asked to change or remove their hairstyle.

Many patients have shared that after their Zeto EEG test, they could go about their day as planned, without the need to wash or restyle their hair.

Remaining Limitations

While Zeto’s EEG technology works with most hairstyles, blocking the electrode tips from contacting the scalp may still prevent accurate recordings. However, weaves or sew-ins that allow scalp contact are generally not an issue for Zeto’s electrodes.

EEGs should be accessible to everyone, regardless of hairstyle. Zeto is proud to offer a solution that makes brain monitoring more inclusive, comfortable, and efficient. By offering innovative EEG headsets with unique electrodes, Zeto ensures that no patient is left behind due to their hair type or style.

From WR19 to Zeto ONE: Inclusivity and Reliability Across 90,000 Studies

Zeto has two innovative EEG headsets: the WR19 for EEG studies up to 6 hours and the Zeto ONE for continuous  monitoring for 24+ hours. Both headsets use the same electrode technology and work seamlessly with textured hairstyles, ensuring reliable and high-quality EEG recordings.

Zeto EEG headsets, WR19 and Zeto ONE, offer EEG solutions for all hair types.


Zeto’s commitment to accommodating various hair types and styles began with the clearance of our first-generation WR19 device in 2018. From the outset, the WR19 was capable of recording EEGs on patients with diverse hairstyles and hair types without requiring additional effort or compromising signal quality. This dedication to inclusivity and performance was carried forward into the design of our next-generation device, the Zeto ONE EEG system, launched in 2024. 

Out of the 90,000 EEGs conducted using Zeto’s EEG system across over 200 healthcare facilities in the U.S., there has not been a single complaint or failure related to hair type.

Say Goodbye to Bad Hair Days

To find out more about Zeto’s patient-friendly EEG technology and how it can work for you, explore our website or schedule a consultation with our team. Zeto is committed to making brain monitoring accessible for everyone, no matter your hair type or style.

We explored the compatibility of Zeto EEG with different hair types, including braids, cornrows, and kinky/coily hair, in a recent webinar. During the webinar, we also conducted live demos with various hairstyles to demonstrate how well Zeto EEG works. Be sure to check it out! 

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Zeto Offers Reliable FDA Cleared Seizure Detection Software

Advancements in seizure detection technology provide essential tools for precise diagnosis and management of neurological conditions. Zeto integrated a full suite of FDA cleared EEG Trending, Seizure, and Spike Detection tools from encevis into the Zeto cloud platform for quick and seamless assessment of full montage EEG signals in the ICU, inpatient and outpatient environment providing more capability vs. competitors.

Zeto’s cutting-edge EEG solutions are designed to enhance patient care and streamline clinical processes. Encevis is powered by the AIT Austrian Institute of Technology, a renowned research and technology organization in Europe, and their EEG analysis software is widely utilized and peer reviewed by physicians across the world.

Zeto Offers:

Zeto EEG Setup Time< 5 minutes after only 2 hours training
Full Montage EEG19 channels, non-inferior to traditional EEG[3]
Time to Seizure Detection < 2-3 minutes
Seizure Detection [4]High sensitivity at low false alarm rates. Proven by three independent clinical trials to get a reliable system that will provide a detailed overview of seizures and suspicious EEG activity. [2, 4]
Spike Detection [5]Detects spikes and sharp waves with a very high sensitivity combined with a high specificity. Sensitivity of 89% was measured together with a specificity of 70%.[1, 5]
EEG Trending [4,5,6]Graphically visualizes the results of several hours of EEG to allow a quick assessment of the state of the patient. The software works in near real time and allows reading of trends in the functional state of the patient’s brain in one glimpse.[1]
Amplitude-Integrated EEG  [6]General amplitude and symme­try can be read easily in the quantitative EEG panels and in the amplitude-integrated EEG. This al­lows a quick assessment of the state and trend of the patient
Burst Suppression [6]Burst suppression events and the relative amplitude attenuation including suppression time of the bursts.
Artifact Reduction: PureEEG [1,2]PureEEG removes artifacts automatically. It removes artifacts such as electrode movements, muscle contractions, line noise and head movements, etc. 
Notification FeaturesOne-time setup enables notification templates (email or text) to be shared automatically with a select group of stakeholders (physicians, nurses, techs) when programmable seizure thresholds are exceeded. This is not a seizure alarm but a notification infrastructure that informs decision makers about the results of the Encevis seizure detection tool.

Seizure Detection Technologies and Their Impact

EEG trending plays a pivotal role in patient assessment, allowing clinicians to view near real-time data and react swiftly to patient needs. Innovations such as amplitude-integrated EEG and burst suppression analysis provide deeper insights, while PureEEG technology effectively reduces artifacts, ensuring cleaner and more accurate readings.

Integrated EEG Trending, including Burst Suppression, Seizure Detection and Load:

Zoom-In of the EEG Trending Panel:

Enhancing Clinical Efficiency

The integration of seizure detection features streamlines clinical workflows and enhances communication among healthcare professionals. This is achieved through effective notifications  that alert clinical staff about critical patient developments, improving decision-making and patient care.

Seizure Detection vs Seizure Burden

Seizure detection and seizure burden are two critical but distinct concepts in epilepsy management. Seizure detection focuses on the immediate identification and recognition of individual seizure events using technologies such as EEG monitoring systems, which can pinpoint abnormal brain activity in near real-time. This allows for timely intervention and management during an episode. On the other hand, seizure burden refers to the cumulative impact of seizures over time, encompassing the frequency, duration, and severity of the episodes. While seizure detection aims to identify seizures as they happen, seizure burden assesses the broader, ongoing effects of the condition. 

Zeto offers an FDA-cleared seizure detection tool compared to competitors that only perform seizure burden.

AI-enabled Notifications for Seizure

AI-enabled notifications provide near real-time notifications enhancing timely intervention and patient management. It works by continuously analyzing EEG data in near real-time using advanced algorithms, instantly notifying healthcare providers when abnormal brain activity indicative of a seizure is detected.

FeatureBenefit to Clinicians
Rapid EEG SetupMinimizes patient discomfort and maximizes clinical efficiency
Full Montage EEGProvides comprehensive brain activity analysis
High Sensitivity with Low False PositivesEnhances diagnostic accuracy
Amplitude-Integrated EEGSimplifies interpretation of EEG data
Burst Suppression AnalysisCrucial for assessing severe neurological conditions
Artifact Reduction with PureEEGEnsures clarity and accuracy of EEG readings

Zeto’s advancements in EEG technology mark a significant milestone in neurological care, promising improved patient outcomes and operational efficiencies. The future of EEG monitoring looks bright, with ongoing innovations poised to further revolutionize the field.

To learn more about Zeto’s wireless, dry-electrode, full-montage EEG headset with remote monitoring and seizure detection, please contact us to schedule a chat and a demo.

References:

[1] PureEEG: Automatic EEG artifact removal for epilepsy monitoring, Hartmann, M.M., Schindler, K., Gebbink, T.A., Gritsch, G., Kluge, T., Neurophysiologie clinique/Clinical Neurophysiology, November 2014

[2] https://www.accessdata.fda.gov/cdrh_docs/pdf17/K171720.pdf

[3] https://www.accessdata.fda.gov/cdrh_docs/pdf17/K172735.pdf

[4] Seizure detection

[5] Spike detection

[6] EEG monitoring in the intensive care

EEG in the ICU: Brain Monitoring in Critical Care Settings and Emergency Departments

EEG in the ICU offers unparalleled insight into the neurological status of patients. Facilitating ease of use is a cornerstone of making sure this vital marker is not overlooked.

In the fast-paced world of healthcare, where every moment can be crucial, monitoring a patient’s neurological status is often overlooked in emergency situations. However, research findings suggest that integrating EEG (electroencephalogram) monitoring into critical healthcare settings can have profound benefits, especially for patients requiring prompt neurological evaluation

EEG in the ICU

In Intensive Care Units (ICUs), where vigilant monitoring of patient health is crucial, traditional focus areas like heart rate, blood pressure, and oxygen levels are routinely scrutinized. EEG monitoring in the ICU is often used for continuous, long-term monitoring of brain activity in critically ill patients. It’s particularly crucial for detecting non-convulsive seizures, assessing the depth of coma, and monitoring for changes in brain function in patients with severe brain injuries, stroke, or those at risk of neurological deterioration. The second biggest neurological emergency after stroke is Status Epilepticus, defined as “A seizure that lasts longer than 5 minutes, or having more than 1 seizure within a 5 minute period, without returning to a normal level of consciousness between episodes is called status epilepticus. This is a medical emergency that may lead to permanent brain damage or death.” For more info see here. 

Unfortunately, the monitoring of brain activity doesn’t receive the same level of attention. This is despite various critical care and neurophysiology societies providing guidelines for EEG indications in the ICU. This oversight can be critical, especially since conditions like non-convulsive seizures can go unnoticed without proper EEG monitoring. Research indicates that timely access to EEG monitoring is vital for effective patient management, and any delays can have significant impacts, not just on patient outcomes but also on hospital operational efficiencies.

Challenges in the ICU

The Neurocritical Care Society guidelines advise that patients suspected of having Nonconvulsive Status Epilepticus in ICU should get an EEG test within 15 to 60 minutes.

The primary challenge in intensive care unit is the lack of specialized EEG or neurology staff, which can lead to delays in detecting and treating critical neurological conditions.

The complexity of traditional EEG equipment also poses a challenge, as it requires time and expertise to set up and interpret. This can be problematic in the ICU, where rapid response and treatment are often necessary. Non-convulsive seizures, for instance, are common in critically ill patients but can be difficult to detect without proper EEG monitoring. Studies suggest that delays in EEG access can extend hospital stays, emphasizing the need for more accessible EEG solutions.

A pressing challenge is accurately assessing brain activity, especially in post-cardiac arrest patients. While vital signs like heart rate and blood pressure are meticulously monitored, determining the status of the brain remains a complex task. In the case of patients who have experienced cardiac arrest, assessing neurological function without EEG is nearly impossible. These patients may exhibit varying degrees of consciousness to comatose, making it difficult to discern subtle neurological changes. Traditional methods often fall short in providing a comprehensive understanding of brain activity, highlighting the critical need for accessible and efficient EEG monitoring solutions like that of Zeto EEG.

Additionally, a key factor with EEGs in the ICU is timing. Even large academic hospitals offering 24/7 coverage of conventional EEG have reported a median delay of four hours to initiate EEG monitoring. Additionally, the process of applying EEG leads on a patient’s head using a traditional EEG system further contributes to these time delays, impacting the speed at which critical monitoring can begin.

Another major barrier to effectively leveraging EEG in the ICU is the lack of bedside diagnostic capabilities. Live, remote interpretation by a physician is simply a must, to ensure that an expert is on hand to diagnose and treat in a timely manner. Live video and continuous monitoring by remote techs would provide the highest quality of care in these situations. 

Solving the Problem of EEG in the ICU, With Zeto

Zeto’s EEG system is designed to meet the unique demands of the ICU. Zeto’s EEG headset is full-montage with single-use electrodes. Additionally, it is wireless and portable, eliminating the need to wait for a cart to be brought into the ICU. It offers a rapid setup and user-friendly interface, making it accessible to healthcare professionals who may not have specialized training in neurology. This ease of use is a significant advantage in the ICU, where time and accessibility are crucial. The system’s design allows for quick application and immediate monitoring, facilitating faster response times in critical situations.

With Zeto EEG, bedside diagnostics becomes possible, with remote, continuous real-time monitoring by EEG techs and interpretation services from neurologists available, Zeto EEG facilitates high quality care. 

The Zeto EEG system also addresses the challenge of interference from other medical devices in the ICU with its state-of-the-art active electrode technology, noise shielding and noise cancellation technology.  

Benefits and Features of Zeto EEG in the ICU

Zeto’s EEG system offers several key features that make it particularly suited for the ICU environment:

  • Bedside Diagnostics with Accurate Seizure Detection: Timely detection of non-convulsive seizures is crucial for patient care. Zeto’s system integrates FDA-cleared seizure detection with notifications, ensuring that these critical events are not missed. Learn more about seizure detection tool here.
  • Live video through the cloud: Zeto is compatible with any integrated or USB-enabled camera. The cloud’s live/remote capabilities allow for real-time observation of patients during suspected seizures. 
  • The portability and ease of setup of the Zeto system mean it can be quickly deployed and used across different patients, adapting to the dynamic and fluid nature of the ICU. 
  • Special response service for Stat EEG (Status Epilepticus): If you do not have neurologists available to interpret your EEGs, you can easily order this service through our cloud platform. 
  • Remote monitoring by EEG techs
  • Remote monitoring by board certified neurologists

EEG in the ED

In Emergency Departments (EDs), EEG is typically used for acute diagnostics rather than long-term monitoring. It may be employed to differentiate between epileptic seizures and other conditions (like syncope, psychogenic nonepileptic seizures, or coma) or to confirm status epilepticus when a seizure is not visible.

While ED staff excel at providing immediate care for life-threatening conditions, brain activity monitoring is not always a routine part of the process. However, research findings suggest that

integrating EEG monitoring into the ED’s toolkit can have far-reaching benefits,

especially for patients with conditions requiring prompt neurological evaluation. 

Challenges with EEG in the ED

One of the primary challenges in the ED is the limited time available for comprehensive assessments. Research shows that this constraint can lead to missed opportunities for detecting critical neurological conditions, such as non-convulsive seizures or non-convulsive status epilepticus. Patients in the ED may not exhibit obvious seizure symptoms, even after injuries that would seem to typically present them, such as traumatic brain injury, making EEG monitoring even more essential for timely diagnosis.

Furthermore, EDs typically lack specialized neurology staff, and the complexity of traditional EEG equipment can hinder its utility in this fast-paced environment. The need for quick setup and interpretation is evident, given that delays in EEG access can impact patient outcomes. Numerous research findings emphasize the critical role of EEG monitoring in emergency department (ED) settings, highlighting the potential risks associated with overlooking neurological conditions.

Zeto’s Solution for the ED

Zeto’s EEG system is tailored to address the unique challenges of the ED. It offers a streamlined setup process that can be quickly implemented by ED staff, who may not have specialized neurology training. This ease of use is vital in an environment where every minute counts, and rapid response can be a matter of life and death.

The Zeto EEG system also features advanced seizure detection capabilities, aligning with the need for timely diagnosis in the ED. Seizures will be automatically detected and marked in the EEG for review. Near real-time detection notifies medical staff about patients with ongoing clinical seizures. This capability is particularly valuable in the ED, where rapid neurological assessments are essential.

Benefits and Features of Zeto in the ED

Zeto’s EEG system offers several key features that make it a valuable tool in the ED:

  • Quick Setup: In the high-pressure environment of the ED, simplicity is paramount. Zeto’s full-montage headset is designed for quick deployment without any preparation needed, enabling ED staff to initiate EEG monitoring rapidly (the average time is 5 minutes). 
  • Ease of Use: If EEG techs are not available, any ED nurse or medical assistant can be trained to do EEG with Zeto. Wireless and portable, Zeto headset enables straightforward setup at a patient’s bedside, facilitating immediate EEG monitoring using a laptop.
  • Video EEG via cloud: Zeto is compatible with any integrated or USB-enabled camera and the cloud’s live/remote capabilities allow for real-time observation of patients during suspected seizures.  
  • Single-use disposable electrodes: Zeto’s electrodes are dry and soft, and designed for convenience and patient comfort, requiring no paste, gel, or cleanup. 
  • Fast turnaround time: Zeto’s EEG system facilitates a swift turnaround time, allowing for instant EEG monitoring and rapid decision-making, essential for prompt diagnosis and treatment in emergency scenarios.
  • Remote EEG Reading: Zeto offers a Remote EEG Reading Service accessible through the Zeto Cloud Platform. A team of remote, certified, and specially trained adult and pediatric epileptologists provides real-time or retrospective EEG interpretation across all 50 states, the District of Columbia, and Puerto Rico.
  • Remote EEG monitoring: Zeto 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.
  • These features collectively enhance the ED’s ability to provide comprehensive care, including neurological assessments, to patients who may present with complex medical conditions. The Zeto EEG system’s adaptability and efficiency align with the dynamic nature of the ED, where quick assessments and decision-making are critical.

Contact us to learn more and to schedule a demo or consultation. You’ll discover how our technology can advance your hospital’s neurodiagnostic capabilities. Join us in leading the change towards better, more efficient patient care.

How Digital EEG Filters Impact EEG Signal Morphology

Filters are commonly used during clinical assessment of EEG brainwaves. They are recommended in the ACNS guidelines¹ to reduce electrical noise and improve EEG data quality. The basics of filter theory are part of the training curriculum for physicians and EEG techs² alike, yet the impact of filters on interpreting data is not always apparent to everyone in the day to day clinical operations. This blog summarizes the issues, explains what filters exist, and what effects they can have on the morphology of the EEG waveforms. Selecting the right filter settings can help improve readability and reduce misinterpretations.

Why We Filter and Why It’s Appropriate

A considerable amount of raw data in EEGs are contaminated by noise and artifacts. This noise originates from various sources such as the environment, recording instruments, or from within the body that are not of interest to analyzing the EEG (i.e. “physiological noise”). The problem arises when these noise sources mask the target EEG signal or interfere with its assessment. Oftentimes, however, the artifact noise and target EEG signal occupy different spectral regions, and selectively filtering out specific frequencies may improve the overall signal-to-noise ratio (SNR).

For example, a direct current (DC) or baseline offset of the amplifier system or slow fluctuations induced by sweat artifacts may be removed with a high-pass filter. Electrical power line noise in the recording environment can be attenuated by using a notch filter at 50 or 60 Hz. And, unwanted high-frequency components from muscle artifacts can be removed by “smoothing” the data with a low-pass filter. The advantages of filters are that they can help increase the SNR of target signals especially in situations in which the target EEG signals are in a limited band.

Filters are applied selectively to exclude frequencies from further evaluation. Three main types of filters used to accomplish this for EEG are i) high-pass filters (also called low-cut-off filters), ii) low-pass filter (also called high-cut-off filters), or iii) band-reject filters (or also called notch filters) – See Figure 1. Most EEGs evaluated in clinical day to day operations have a combination of these filter types applied before a reviewer assess clinical characteristics for triaging or diagnosis.³

Figure 1: A Low pass filter is a filter that passes low frequency components and blocks high frequency signals. A High pass filter is a filter that passes high frequency signals and blocks low frequency signals. Bandpass filter is a filter that passes a certain range of frequencies and blocks both lower and higher regions. A Band Reject filter is a filter that passes most of the frequency except a very narrow range of the frequencies.³

Because of their useful properties, filters are found at all stages during the EEG recording and review process. EEG amplifiers often contain an analog low-pass filter ahead of the analog-to-digital (AD) converter to address aliasing artifacts that are otherwise introduced due to the discrete sampling rate. However, most filters in EEG processing are digital and take place after the AD conversion. That makes filters omnipresent when working with EEG data and their settings will affect the look and shape of the EEG tracings on a reader’s screen. More in-depth analysis of filter times and filter theory.⁴

Wanted and Unwanted Effects of Filters on EEG Morphology 

The way that many filters operate is to apply a weighted average of consecutive data points of the raw signal to obtain a smoothed, output (filtered) waveform. Depending on the type and width of this averaging window, specific frequency components disappear from the output waveform. The filtered signal may not show excluded frequencies anymore, but this was made possible after having created a causal relationship with the surrounding data segments. Figure 2 illustrates this principle.

Every sample of the output depends on multiple samples of the input, as illustrated.

Figure 2. Every sample of the output depends on multiple samples of the input, as illustrated in Figure 2 (top).  Conversely, each sample of the input impacts several samples of the output (Figure 2, bottom). As a result, the signal that is being filtered is smeared along the temporal axis, and temporal relations between filtered and original waveforms are blurred.

Top: each sample of the output y is the sum of samples of the input x weighted by the impulse response h. For a causal filter, only past or present samples of the input make a contribution (black). For an acausal filter, future samples too can contribute (gray). Bottom: another way of describing this process is that each sample of the input x affects multiple samples of the output y, with a weight determined by the impulse response h.⁴

Filters that lead to this kind of temporal smearing are called causal filters and are frequently used in EEG assessments. However, causal filters are known to create ripples in the EEG data that will show up as slow waves in the EEG data. These causal filters create a phase shift but have the advantage that they can be applied in real-time to ongoing EEG data streams.

To avoid phase shifts and to get outputs much closer to the true biological signal, so-called forward/backward filters (or zero phase) filters are another option. Zero phase shift filters first run the filter in one direction and again in the other direction. As a result, any phase shift is mitigated and no temporal smearing occurs. However, the disadvantage of these zero-phase filters is that they can only be applied in real-time recordings with a significant delay because they have to wait for data to be recorded before they can run backwards.

Figure 3 illustrates the output of a causal (blue) or zero phase filter (green) when applied to a test signal (black). The output of the causal filter (blue) creates a well visible phase shift and relevant filter ripple along with a long overshoot. In contrast, the zero phase shift filter keeps the integrity of the main signal peak intact and only creates minor symmetrical ripples around the peak.

Temporal Response Function Estimated from Simulated Stimulus-Response Data

Figure 3. Temporal Response Function Estimated from Simulated Stimulus-Response Data. Black: “true” TRF. Thick blue: TRF estimated using response data that has been filtered by a causal filter (Butterworth band pass 1–10 Hz, order 4+4). Green: same with acausal filter (MATLAB’s filtfilt).⁴

Examples of Causal and Zero Phase Filters in EEG 

The most noticeable difference between causal and zero phase shift filters on actual EEG data occurs for high pass filters in the delta range (<1.5Hz) because they can visibly alter the appearance of commonly occurring biological signal components of the EEG such as vertical or horizontal eye movements (i.e., blinks and saccades), sweat artifacts, and even specific epileptiform discharges (e.g. absence seizures). For an overview, see Figure 4.

Effects of causal filters in higher frequencies (>50Hz) certainly exist as well but these are much less noticeable due to much faster oscillations that have smaller amplitude and are harder to pick out visually.

Effects of causal filters in higher frequencies (>50Hz) certainly exist.

Figure 4 – Here an example of two channels (FP1, FP2) filtered with a 1Hz causal filter (black tracings) or zero-phase filter (gray tracings) – causal filters introduce relevant slow wave filter ripples.

Implementation of Causal and Zero Phase Filters on the Zeto Cloud Platform

Most clinical EEG hardware or software manufacturers have filter master-settings that pre-determine the exact type and properties of the filters available in their products. That can result in situations in which the same biological signal may appear slightly differently depending on the manufacturer’s default digital filter settings. Zeto is improving the tradition by introducing features that enable users to easily switch between different filter types and settings to optimally control the use of filters while reviewing EEG data.

As a result, users can configure their filter preferences to match their individual viewing and training history, resulting in filter outputs that match their expectations. Instead of retraining themselves on a new system’s filter settings, they can now adjust filter attributes and reduce the time to a confident read significantly.

With Zeto, EEG data is saved in raw unfiltered (DC) formats that do not distort the original signal attributes. Subsequent digital filtering can then be used to match desired filter attributes. For example, Zeto can display data after running causal or zero phase shift filters and switch between these filter settings more easily, making it possible to compare which setting is preferred on the spot.

Figure 5 illustrates this filter switch approach on different data samples. The tiles on the left are filtered using zero phase filters and tiles on the right show the same data using causal filters of the same cut-off frequency. Switching between these filters reveals signal ripples, most noticeable for the blinks but also in other signal components.

1Hz Filter – left: zero phase; right: causal filters.

With Zeto, EEG data is saved in raw unfiltered (DC) formats that do not distort the original signal attributes. Subsequent digital filtering can then be used to match desired filter attributes.
With Zeto, EEG data is saved in raw unfiltered (DC) formats that do not distort the original signal attributes. Subsequent digital filtering can then be used to match desired filter attributes.
With Zeto, EEG data is saved in raw unfiltered (DC) formats that do not distort the original signal attributes. Subsequent digital filtering can then be used to match desired filter attributes

The benefits that filters provide are crucial to enable a confident clinical read that is not skewed by unwanted signals. However, filters can introduce artifacts on their own. The well trained EEG reader will need to be vigilant about possible filter artifacts in EEG signals and how these may affect the clinical assessment of the patient’s brain states. As Zeto, we encourage our users to match the available filter settings to their preferences to ensure a fast and efficient diagnostic process. For questions about how to best match your Zeto filter settings and establish adequate default settings, please contact our customer success team at support@zetoinc.com.

References:

  1. Sinha, S. R., Sullivan, L., Sabau, D., et al. (2016). American Clinical Neurophysiology Society Guideline 1: Minimum Technical Requirements for Performing Clinical Electroencephalography. Journal of Clinical Neurophysiology, 33(4), 303-307. DOI: 10.1097/WNP.0000000000000308
  1. ASET Board of Trustees. (2021, March 20). National competency skill standards for performing electroencephalography (EEG). ASET Website. Retrieved from https://www.aset.org/wp-content/uploads/2022/11/EEG_Competencies_FINAL.pdf (Page 4, Section 2.3)
  1. ShareTechnote. (n.d.). RF – Filter. Retrieved from https://sharetechnote.com/html/RF_Filter.bak
  1. De Cheveigné, A., Nelken, I. (2019). Filters: When, Why, and How (Not) to Use Them. Neuron. DOI: 10.1016/j.neuron.2019.02.039

EEG Techs Face Challenges: Portable EEG Creates Solutions

EEG Techs continue to be the gold standard for EEG administration, their training and expertise is crucial for meeting the neurodiagnostic needs of hospitals. Unfortunately, there is a massive nationwide shortage of EEG techs in the United States, and this significantly impacts the delivery of essential neurodiagnostic services throughout the country. This shortage not only strains healthcare systems, and causes delays in diagnosis and treatment, but also places an immense burden on EEG techs.


Zeto’s portable full-montage EEG headset offers a solution to this crisis. By simplifying and streamlining the EEG process, Zeto helps hospitals and medical centers to deftly navigate staffing shortages or a lack of availability of EEG techs on nights and weekends.


Zeto offers an EEG solution with seizure detection, video, and remote monitoring services, enabling hospitals and outpatient settings alike to maintain high-quality neurodiagnostic services even in the face of such staffing constraints.

Enhancing Productivity and Hospital Service Capabilities for EEG Techs

There is a massive nationwide shortage of EEG techs in the United States

In hospital settings, where the demand for EEG services is often high and continuous, the presence of a skilled EEG tech is invaluable. However, the current shortage of these professionals creates significant challenges. Zeto’s portable EEG headset is designed to address this gap, providing solutions that significantly enhance the efficiency and effectiveness of EEG services in hospitals.

Efficiency Improvements for EEG Techs:

Zeto’s headset simplifies the EEG setup and operation process. By reducing the time and effort required for placing electrodes and setting up, Zeto enables EEG techs to manage their workload with more ease.

EEG Techs can Delegate:

One of the key advantages of Zeto’s system is its ease of use, allowing EEG techs to quickly train other healthcare staff, such as nurses or other types of techs, such as respiratory therapists. If EEG tech is not available, support staff can step in. This capability is crucial for providing EEG services, especially during off-hours such as nights and weekends, or in the critical care and emergency departments.

Techs can Focus on Higher Level Duties:

With Zeto’s user-friendly system, EEG techs can dedicate more time to monitoring and annotating EEG readings, which are vital for accurate diagnoses. This shift in focus from setup to analysis enables EEG techs to apply their expertise where it matters most.

Upskilling for the Future:

As the healthcare industry evolves, there is a growing need for EEG techs to adapt and upskill. Technologies like Zeto not only provide immediate solutions to current challenges but also pave the way for techs to enhance their skills in areas like data analysis, remote monitoring, and advanced neurodiagnostic techniques.

Remote Validation of EEG Studies with Zeto’s Cloud Platform:

Zeto’s cloud platform enables EEG techs to remotely monitor EEG studies when the setup is performed by non-technical personnel. Utilizing live video, EEG techs can oversee EEGs in real-time from anywhere, ensuring the quality of each study. This remote capability is essential for maintaining high standards in EEGs, regardless of who performs the initial setup.

Use of Zeto’s portable EEG headset for hospitals is a significant step forward in managing the current EEG tech shortage. By enhancing efficiency, facilitating skill development, and ensuring continuous high-quality EEG services, Zeto helps hospitals to better manage their challenges, and to deliver excellent healthcare.

Improve Outpatient EEG Services Using Portable EEG 

In outpatient settings, the EEG tech shortage presents unique challenges, particularly in terms of efficiency and patient throughput. Zeto’s wireless EEG headset addresses these challenges head-on, contributing to improvements in how EEG services are delivered in outpatient clinics.

Reduction in Setup and Cleanup Time:

Traditionally, EEG setup and cleanup can take up to an hour, burdening both the EEG tech and the patient. Zeto’s portable EEG system reduces this to just a few minutes.

Minimal Space Requirements and Increased Flexibility:

The need for a sink and extensive setup space, as required for conventional EEG, is eliminated with Zeto’s portable EEG headset. Clinics can conduct EEG tests with just a bed or chair, making better use of available space. This compact setup allows a single tech to manage multiple EEG sessions simultaneously, with EEG data accessible via the cloud.

Enhanced Patient Throughput:

With Zeto, the primary limit to conducting EEGs is the number of headsets available. This capability to run multiple sessions concurrently significantly increases patient throughput, a vital factor in busy outpatient settings.

Streamlined Data Management:

Zeto’s cloud-based system means that data transfer concerns are a thing of the past. EEG techs no longer need to spend time ensuring data is properly transferred and stored, as it’s automatically synced to the cloud and accessible for whomever needs it, instantaneously.

Focus on Value-Added Patient Care:

Freed from time-consuming setup and data management tasks, techs can focus more on direct patient care, education, and comfort. This shift not only enhances the patient experience but also provides more job satisfaction for techs.

Patient Satisfaction and Comfort:

Zeto offers a more comfortable, shorter, and cleaner experience for patients. The use of no-residue electrodes that do not use gels or pastes, means there’s no need for a patient to wash their hair afterwards. It works perfectly with different hair types, including kinky, coil, and braided hair.

Expanding EEG Setup Skills Across Your Team with Zeto:

In outpatient settings where EEG techs might not always be available, Zeto’s system offers a practical solution. Any staff member, such as a medical assistant, can be trained to do the EEG setup. This flexibility allows clinics to utilize their resources more efficiently, ensuring that EEG services are readily available when needed. With Zeto, clinics can schedule patients for EEGs swiftly, enhancing patient care and operational efficiency even with limited staffing.

Zeto’s portable EEG headset addresses the critical challenges posed by the EEG tech shortage. By enabling more efficient use of time and resources, reducing the need for extensive physical infrastructure, and enhancing the quality of patient care, Zeto is setting a new standard in outpatient neurodiagnostic services.

To learn more about Zeto’s wireless, dry-electrode, full-montage EEG headset with real-time remote monitoring and near real-time seizure detection, please contact us to schedule a chat and a demo.

7 Core Benefits of Portable EEG for Growing Hospitals

In critical care, every second counts. Zeto’s portable EEG system cuts through complexity, offering a seamless solution that far out-delivers the competitors. Is it cumbersome? Far from it. Is it fast? Absolutely. Is it complete? With full-montage capabilities versus other portable EEG systems’ limited channels, it redefines thoroughness in EEG technology.

Zeto’s portable EEG has everything required for on-the-spot, point-of-care service without added demands on facility resources. For critical care monitoring, this is the only full-montage portable EEG that offers bedside monitoring with seizure detection. Unlike traditional systems, Zeto’s portable EEG is rapid, cloud-based, and real-time with video. Zeto also offers 24/7 remote monitoring and interpretation services — these can be ordered directly from the platform. 

Read on to discover the seven core benefits that Zeto’s portable EEG technology brings to growing hospitals, enhancing patient care and operational efficiency. 

Benefit #1) Signal Quality: Clarity in Every Reading

Zeto's dry-electrode portable EEG provides high quality results.Reliable EEG data is the backbone of neurodiagnostic accuracy. Zeto ensures that signal quality is never compromised. With full-montage 10-20 placement and advanced technology that shields and removes noise, the data captured is non-inferior to traditional EEG. This precision is what sets Zeto apart, allowing for confident clinical decision-making.

Data is streamed to a secure cloud platform that provides live viewing with video. Physicians access this high-quality data in real-time from anywhere, directly impacting patient care efficiency. Zeto’s commitment to signal integrity means that every reading is rapid and reliable.

For an in-depth look at how Zeto maintains superior signal quality, refer to our article, “Comparison of Dry Electrode EEG System with Conventional EEG System.” You can also review our published abstract on this topic at the American Epilepsy Society.

Benefit #2) Portable EEG Offers Ease of Use and Rapid Setup

Zeto’s EEG technology redefines hospital efficiency with its plug-and-play design.

Any member of your staff can be trained to administer Zeto EEG. If an EEG technician is not available, a health care professional can be trained to use Zeto EEG.

Setup is swift, taking less than five minutes from its case to your patient’s bedside and the dry electrodes eliminate the need for a time-consuming messy setup and clean-up. This simplicity accelerates patient throughput, enabling technologists and clinicians to focus on diagnostics rather than device preparation. With Zeto’s system, hospitals can reduce downtime and streamline their EEG operations.

Visit our device page to learn more and to see the EEG headset in action, and watch our usage videos to witness firsthand the ease of setup that Zeto offers.

Benefit #3) Patient Comfort: A Top Priority with Portable EEG

Comfort during EEG tests is a patient’s right, not a luxury. Zeto’s portable EEG headsets are designed with this principle in mind. The lightweight (1.4lb or 650 g) and adjustable design minimizes the strain on patients, making the experience as stress-free as possible. By using dry electrodes and eliminating the need for gels and pastes, our headsets also do away with the discomfort of traditional systems.

This patient-centered approach not only improves the EEG experience but also facilitates better compliance and quality of results. When patients are at ease, EEG recordings are done faster, providing clinicians clinical-grade EEG data for diagnosis and treatment planning.

For a closer look at how Zeto prioritizes patient comfort and its impact on care, view our patient page. 

Benefit #4) Zeto Offers Versatility in Patient Care

Zeto’s EEG headset is suitable for both adult and pediatric patients. This adaptability ensures that hospitals can provide high-quality EEG services across a diverse patient demographic. The headset’s adjustable nature allows for a comfortable fit for various head sizes, reflecting the device’s broad utility in a clinical environment.

For additional information on the headset’s versatile applications, please visit our FAQ page.

Benefit #5) Bedside Notifications and Ease of Monitoring

Efficient monitoring is key in critical care. Zeto’s EEG technology brings this efficiency directly to the patient’s bedside. Zeto offers near real-time notification of ongoing seizures by using reliable FDA-cleared seizure detection software. Seizures are automatically identified and highlighted in the EEG for review. Near real-time detection promptly informs medical staff about patients experiencing ongoing clinical seizures. With laptop-based monitoring, an ICU nurse becomes a vital link, swiftly alerting physicians to significant findings.

These bedside notifications are designed to enhance vigilance without overwhelming the staff, streamlining the observation process. They serve as an extension of the care team’s capabilities, ensuring that attention is drawn when it matters most.

For detailed information on how Zeto’s bedside alerts improve patient monitoring, read our recent article about EEG in the ICU.

Benefit #6) 24/7 Real-Time Remote Monitoring with Expert Oversight

Access to immediate EEG data and expert analysis is critical for any hospital. Zeto portable EEG systems offer real-time remote monitoring, with registered EEG technicians available to review and flag critical issues in EEG reports. When Zeto customers need EEG specialists, they can simply click on a service request button in the Zeto software, which notifies the monitoring service. With Zeto portable EEG, abnormalities are promptly identified, facilitating quick intervention.

Hospitals utilizing Zeto’s advanced EEG solutions can also benefit from expedited interpretation and clinical guidance. We partner with qualified reading and monitoring services that stand ready to provide expert analysis and recommendations. Patient care decisions are informed by specialist insights, anytime they’re needed.

For a comprehensive view of how Zeto’s remote monitoring services enhance patient care, refer to our article on the topic by clicking here.

Benefit #7) Reduced Costs to Hospitals

Zeto’s EEG system seamlessly integrates with standard billing practices, enabling billing as with a similar full montage EEG.

Incorporating a portable EEG device into a hospital’s diagnostic arsenal can potentially lead to:

  • Reduced Overhead Costs: Portable devices often require less setup and maintenance, decreasing operational costs.
  • Increased Patient Throughput: Faster setup times can lead to more tests conducted per day, enhancing service capacity.
  • Expanded Service Offering: The ability to perform EEGs in various settings, including at the patient’s bedside, attracts patients seeking convenience and comfort.
  • Optimized Utilization of Staff: Simplified operation allows a broader range of staff to conduct EEG tests, potentially reducing the need for specialized technicians.
  • Reduce Patient Transfer Cost: Diagnose patients on-site instead of sending them away.

With the Zeto portable EEG’s swift, dry electrode, full-montage capabilities, Zeto simplifies neurodiagnostic procedures, offering a seamless and efficient solution for growing hospitals. From ensuring top-notch signal quality to providing patient comfort and 24/7 remote monitoring, Zeto delivers on all fronts—without necessitating specialized operators be on-site and available at all times, easing their workload without compromising care.

The integration of Zeto’s EEG technology not only elevates the standard of patient care but also reduces operational costs and enhances your hospital’s services. Its versatility extends from adult to pediatric care, embodying the essence of adaptability in modern healthcare.

Contact us to learn more and to schedule a demo or consultation. You’ll discover how our technology can advance your hospital’s neurodiagnostic capabilities. Join us in leading the change towards better, more efficient patient care.

EEG after Cardiac Arrest is Vital, Says American Heart Association

The American Heart Association (AHA) recommends prompt electroencephalography (EEG) neuroprognostication for post-cardiac arrest patients in their 2020 guidelines on cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC). The prompt use of EEG in post-cardiac arrest patients is important because it allows for early identification of brain injury and can guide decisions about the continuation of life-sustaining treatment.

Hypoxic-ischemic brain injury is a leading cause of morbidity and mortality in survivors of hospital cardiac arrest.1 Sadly, most of the post-resuscitation deaths are caused by the active withdrawal of life-sustaining treatment. The decision to actively remove life-sustaining treatment is made when a poor neurological outcome is expected. For this reason, it is critical to perform accurate neuroprognostication, as recommended by the American Heart Association (AHA) in their 2020 guidelines on cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC).2

Proper post-cardiac arrest neuroprognostication, or EEG after cardiac arrest, is essential to distinguish those who may achieve a meaningful neurological recovery from those who will inevitably have a poor neurological outcome.2,3

Who Should Receive Neuroprognostication After Cardiac Arrest?

The AHA recommends multimodal neuroprognostication on all patients who remain comatose after cardiac arrest (Level 1 recommendation).2 Multimodal neuroprognostication includes EEG, MRI, quantitative pupillometry, and serum neuron-specific enolase, among others. In addition to neuroprognostication, EEG testing is recommended to identify seizures and, if necessary, provide treatment.

Nonconvulsive seizures, for example, are common after cardiac arrest, and cannot be reliably detected without EEG.4 The American Academy of Neurology also provides data on its importance. Also, EEG after cardiac arrest should be used to rule out underlying ictal activity in cardiac arrest survivors with status myoclonus. The 2020 Emergency Cardiovascular Care Science with Treatment Recommendations (CoSTR) advises seizures to be treated when diagnosed in cardiac arrest patients with return of spontaneous circulation (ROSC).5

When Should Neuroprognostication After Cardiac Arrest Start?

Importantly, prognostic assessments should not be started too early. If they are administered too soon after the cardiac arrest and during initial post-resuscitation care, the results may appear worse than they actually are because of medications, or acute post-injury changes.6 Perhaps surprisingly, clinical prognostic testing such as pupillary light reflex should not be used for neuroprognostication until at least 5 days after ROSC (return of spontaneous circulation) in patients treated with targeted temperature management (TTM), in order for such testing to have prognostic significance.

Testing should not begin until the patient has been normothermic for at least 72 hours.6-8 Imaging or EEG to detect status myoclonus may begin as early as 24 hours after ROSC; two studies including 347 patients, showed the presence of status myoclonus within 72 hours of ROSC predicted poor neurological outcome with specificity of 97% to 100%.9,10 However, postanoxic status epilepticus may not manifest until 72 hours or more after ROSC and sedative drug dosages have been reduced, so waiting for neurological prognosis assessment is necessary.

How to Use EEG for Neuroprognostication After ROSC

The 2020 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) recommend the use of EEG after cardiac arrest in patients who remain in a coma after ROSC for the purposes of neuroprognostication.2

Findings that are consistent with poor outcomes include postanoxic status epilepticus and/or burst suppression 72 hours or more after ROSC.2 Another potentially useful electrodiagnostic test is the somatosensory evoked potential (SSEP).

SSEP testing is conducted by stimulating the median nerve and looking for a resulting cortical N20 wave. N20 SSEP waves that are absent bilaterally correlate with poor prognosis.2 Likewise, rhythmic periodic discharges on EEG are also consistent with poor prognosis.

Importantly, the AHA notes that the absence of EEG reactivity within 72 hours after cardiac arrest should not be used as the sole determinant of poor neurological outcomes. A lack of EEG reactivity during this time does not necessarily predict a poor neurological outcome.

Obtaining EEG after ROSC

Conventional EEG in the Intensive Care Unit is Critical Care and Cumbersome

While conventional EEG is an acceptable means to obtain EEG in the ICU, it is impractical. Post-cardiac arrest patients who need post-cardiac arrest care in the ICU will, as standard care, be intubated, and have central venous and possibly arterial lines, and intracardiac devices.

Conventional EEG after cardiac arrest is challenging. Attempting to obtain EEG signals through a dozen wires in a critical care setting without quality-limiting artifacts is challenging. Indeed, providing continuous conventional EEG in the ICU is a literal barrier to care for ICU or neurocritical care nurses and staff.

Zeto EEG – Wireless Full-Montage Monitoring For Use on Coma Patients After ROSC

According to the AHA, proper neuroprognostication could prevent withdrawal of life support as it will indicate the accurate neurologic prognosis of a patient who has a chance at successful neurological recovery. Thus, the AHA recommends performing multimodal neurologic prognostication including EEG in all patients who remain in a coma after ROSC following cardiac arrest.

Zeto has developed a full montage, 19-channel (10-20 system) wireless headset with dry electrodes for rapid EEG monitoring. The benefits of Zeto’s electrodes include no skin preparation, no cleanup, and no gel or paste residue. The electrodes are single-use and soft.

The Zeto EEG device collects high-quality EEG recordings and transmits them wirelessly to the cloud for remote viewing and interpretation. ZETO’s EEG platform also offers an FDA-cleared seizure detection and trending algorithm developed by Encevis.

The Zeto EEG headset can be placed after a short training, and the setup takes only 5 minutes – which is crucial for patients in a coma. Once placed, the Zeto headset provides continuous EEG monitoring for up to 5-6 hours.

Overall, prompt EEG for post-cardiac arrest patients is a vital aspect of proper neuroprognostication and plays an important role in determining prognosis in patients and guiding treatment decisions. It is important for healthcare providers, especially intensive care medical providers to be aware of the AHA guidelines and incorporate EEG into their standard care management of post-cardiac arrest patients.

When called upon to perform the difficult and highly consequential task of neuroprognostication, choose Zeto for EEG in the ICU.

References

  1. Witten L, Gardner R, Holmberg MJ, et al. Reasons for death in patients successfully resuscitated from out-of-hospital and in-hospital cardiac arrest. Resuscitation. 2019;136:93-99. PMID:30710595 doi:10.1016/j.resuscitation.2019.01.031
  2. Panchal AR, Bartos JA, Cabanas JG, et al. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142(16_suppl_2):S366-S468. PMID:33081529 doi:10.1161/CIR.0000000000000916
  3. Geocadin RG, Callaway CW, Fink EL, et al. Standards for Studies of Neurological Prognostication in Comatose Survivors of Cardiac Arrest: A Scientific Statement From the American Heart Association. Circulation. 2019;140(9):e517-e542. PMID:31291775 doi:10.1161/CIR.0000000000000702
  4. Freund B, Kaplan PW. Myoclonus After Cardiac Arrest: Where Do We Go From Here? Epilepsy Curr. 2017 Sep-Oct;17(5):265-272. doi: 10.5698/1535-7597.17.5.265. PMID: 29225535; PMCID: PMC5716491.
  5. Ryoo SM, Jeon SB, Sohn CH, et al. Predicting Outcome With Diffusion-Weighted Imaging in Cardiac Arrest Patients Receiving Hypothermia Therapy: Multicenter Retrospective Cohort Study. Crit Care Med. 2015;43(11):2370-2377. PMID:26284621 doi:10.1097/CCM.0000000000001263
  6. Samaniego EA, Mlynash M, Caulfield AF, Eyngorn I, Wijman CA. Sedation confounds outcome prediction in cardiac arrest survivors treated with hypothermia. Neurocrit Care. 2011;15(1):113-119. PMID:20680517 doi:10.1007/s12028-010-9412-8
  7. Berg KM, Soar J, Andersen LW, et al. Adult Advanced Life Support: International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation. 2020. PMID:33098922 doi:10.1016/j.resuscitation.2020.09.012
  8. Callaway CW, Donnino MW, Fink EL, et al. Part 8: Post-Cardiac Arrest Care: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(18 Suppl 2):S465-482. PMID:26472996 doi:10.1161/CIR.0000000000000262
  9. Ruknuddeen MI, Ramadoss R, Rajajee V, Grzeskowiak LE, Rajagopalan RE. Early clinical prediction of neurological outcome following out of hospital cardiac arrest managed with therapeutic hypothermia. Indian J Crit Care Med. 2015;19(6):304-310. PMID:26195855 doi:10.4103/0972-5229.158256
  10. Zhou SE, Maciel CB, Ormseth CH, Beekman R, Gilmore EJ, Greer DM. Distinct predictive values of current neuroprognostic guidelines in post-cardiac arrest patients. Resuscitation. 2019;139:343-350. PMID:30951843 doi:10.1016/j.resuscitation.2019.03.035

Enhancing Diagnostic Precision: Exploring the Role of Video EEG

Video EEG is an important tool in diagnosing and monitoring patients with epilepsy or other neurological conditions. It helps distinguish physiologic or external artifacts from epileptic seizures or epileptiform discharges associated with seizures. Video EEG also helps to differentiate epileptic seizures from psychogenic nonepileptic spells that are mistaken for seizures and other episodic abnormal movements associated with other conditions, such as tic disorders, tremor, or periodic limb movements of sleep. Simultaneous video and EEG recordings enable the establishment of correlations between abnormal movements and abnormal wave activity.1,2,3,4

For awake patients, video can identify sources of noise such as muscle artifacts, blinking, chewing, forehead wrinkling, and even ear wiggling. For unconscious patients, video can identify external sources of artifact, such as electronic devices in the ICU (for example, an artificial respiration device). The inclusion of video in the EEG improves the ability to accurately diagnose a patient. Additionally, video can confirm correct electrode placement and headset positioning.

In this blog, we discuss the benefits of using video integration in EEG and what Zeto EEG can offer.

Different noise sources in EEG

EEG recordings can be impacted by various sources of noise and interference, including physiological noise, environmental noise, EEG electrode placement, electrical artifacts from EEG electrode malfunctions or from external electrical devices, and motion artifacts. These artifacts can make it difficult to distinguish genuine brain activity from noise, compromising the ability to accurately interpret EEG recordings.

Physiological noise arises from the body’s internal processes like muscle contractions, heartbeats, and eye movements, generating electrical signals that can interfere with the EEG recording. Environmental noise, on the other hand, encompasses external disturbances like electrical noise from equipment, electromagnetic interference, or ambient noise, which can introduce unwanted signals into the EEG data. Electrical artifacts can also be produced by the EEG equipment itself, resulting from issues like poor grounding, incorrect amplifier settings, or malfunctioning electrodes. Lastly, motion artifacts arise from bodily movements such as head motions, jaw opening and closing, or eye blinks, leading to distortions in the EEG signal and complicating accurate data interpretation.

To account for artifacts and enhance the interpretation of EEG recordings, video recording is often used in conjunction with EEG to identify and exclude sources of noise from the data.

Video EEG: Complement or Necessity?

Video is particularly useful for identifying artifacts related to movements or other physical activities that may produce electrical signals in the EEG recording. For example, if a patient moves their arm during an EEG recording, this movement can cause changes in the electrical activity picked up by the electrodes, which is recorded in the EEG. By observing the video recording, it is possible to identify the movement as an artifact and avoid misinterpreting the EEG data. This helps ensure that EEG signals identified as epileptiform activity represent genuine brain activity, rather than artifacts from other sources. Epileptiform waves can sometimes be difficult to distinguish from artifacts, as they can have similar characteristics in the EEG recording.

Video can also help diagnose and classify epileptic seizures and distinguish them from psychogenic nonepileptic spells and episodic abnormal movements due to other medical conditions that are not epileptic seizures.1,2,3,4,5 For example, if a patient experiences an epileptic seizure during an EEG recording, the video can help correlate the EEG signal with the visible movements and behaviors of the seizure. A psychogenic nonepileptic spell will show motion artifacts on the EEG but will not show underlying abnormal brain wave activity. Furthermore, certain behaviors such as squeezing the eyes shut while shaking, awareness during the seizure, and returning to baseline mental status right after the event can suggest a psychogenic cause.5

Sometimes tics, tremors, muscle twitching, and other abnormal movements in the tongue or a limb or digit can be mistaken for epileptic seizures, particularly in the ICU setting where subclinical seizures occur more frequently.  Subclinical seizures are epileptic seizures that are not associated with characteristic abnormal movements usually associated with seizures.  Video EEG can determine if the suspicious subtle abnormal movements are in fact due to epileptic seizures in most cases.  If the abnormal movements represent subclinical epileptic seizures, they would be expected to correlate with epileptic seizure brain wave activity on the EEG.

Video recording provides additional information about the patient’s behavior or movements at the time of a seizure or seizure-like event, which is called a seizure’s semiology.1,3,5 Gaze deviation and arm stretching right before the seizure or at seizure onset can point to the seizure origin in the brain and inform localization of seizure foci relative to brain hemispheres or specific areas such as the motor cortex, supplementary motor areas, and frontal and parietal eye fields. Seizure semiology also includes the subjective sensations and experiences immediately preceding and during a seizure.  It is critical to the diagnosis and classification of seizure disorders, which in turn affects the treatment plan. A video EEG is critical to presurgical evaluation prior to epilepsy surgery to diagnose and classify epileptic seizures when present and avoid unnecessary surgery due to psychogenic nonepileptic spells or other episodic abnormal movements not due to epileptic seizures.1

Zeto EEG: Seamless Compatibility with Any Camera, Reimbursable, Supports Up to Four Cameras

Zeto’s video integration feature reshapes the users expectations of what is possible with modern technology. The Zeto system enables simple camera controls (zooming and panning) through the cloud, ensuring simple usability.

One of the most appreciated features by users of the Zeto platform is its compatibility with any integrated or USB enabled camera. That eliminates the need for additional camera purchases and helps operators to use Zeto EEG more easily across a wide range of settings and recording locations. The Zeto Cloud Platform supports the use of up to four cameras simultaneously, providing medical professionals with the flexibility to monitor patients from multiple angles.

In addition to its compatibility with integrated and external USB cameras, Zeto offers the simple integration of IP cameras, whether they are wired or wireless. This capability is particularly beneficial when medical personnel already have pre-installed IP cameras in the room, as they can add these cameras to the Zeto Cloud Platform for a seamless integration. IP camera integration often depends on existing local IT infrastructure and cybersecurity guidelines which can result in longer integration timelines compared to integrated or USB – based camera solutions. But with the added configuration time come additional conveniences and features (such as lowlight or night vision capabilities) which often make this extended setup more than worth it.

Setup Time Price Ability to Point
Toward Patient		 Optical Zoom Low Light /
Night Vision
Integrated Cameras Near
instantaneous		 Integrated in most devices Static angles – requires adjusting recording device Mostly
Unavailable		 Mostly unavailable in built-in devices
External
USB
Cameras		 Fast – plug-in
and use		 < $200 for most, <$400 for high-end Manually able to point in any direction Manual zoom in some devices Available for additional cost
IP
Cameras		 Often requires IT support and additional setup < $1,500 for most Manually able to point or use of remote pan/tilt features Automatic or manual zoom options available Available in most devices

With any of these camera options, maximum image resolution depends on the utilized camera hardware, but integrated, USB, or IP camera options are available with Ultra 4k resolutions or higher. The consideration then becomes data storage size and related storage costs more than the technical ability – providers may still choose to save data in lower resolution settings simply to save storage costs.

Another powerful tool of the Zeto Cloud platform is the ability for the clinician to remotely access the recording through any device connected to the internet. Allowing for real time analysis when the provider is not present in the recording environment.

Medical practitioners will find the real-time monitoring capability invaluable, enabling them to observe patients with precision. Additionally, Zeto’s video EEGs, utilizing the integrated cameras, are eligible for reimbursement through CPT codes, specifically for EEGs lasting 24 hours or longer.

By utilizing video, Zeto ensures accurate positioning of the headset and proper electrode placement. This attention to detail guarantees the collection of reliable and precise EEG data.

In conclusion, video recording is an important complement to EEG recordings. It helps identify and exclude sources of artifact in EEG and confirms the presence of epileptic seizure activity and epileptiform discharges important for the diagnosis and classification of epileptic seizures. Video EEG also helps to identify psychogenic nonepileptic events and episodic abnormal movements from other medical conditions mistaken for epileptic seizures. By using video in conjunction with EEG, clinicians can improve the interpretation of EEG recordings, leading to more accurate diagnoses and better treatment outcomes for patients with neurological conditions.

Zeto’s video integration feature enhances convenience and accuracy, ultimately resulting in better diagnosis and treatment outcomes for patients.

Sources:

  1. https://onlinelibrary.wiley.com/doi/10.1111/j.1528-1167.2006.00656.x
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9259997/
  3. https://researchopenworld.com/wp-content/uploads/2020/06/AWHC-3-3-315.pdf
  4. https://www.sciencedirect.com/science/article/abs/pii/0887899495000217
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4206377/

ZETO – ERP EVENT MARKER INTEGRATION

Event Related Potentials (ERPs) in EEG provide insight into how our brain processes information, reacts to its environment and adapts to challenges. ERPs differ from the traditional clinical tradition of evaluating continuous spontaneous brainwaves in patients. With ERPs, experimenters can examine the brain’s response to succinct events. For a summary on ERPs, see here.

One of the most crucial aspects in capturing clean ERPs is knowing precisely when specific target events occur. So-called event markers are commonly used to timestamp the onset of target events in the continuous EEG tracings to enable further data processing. The target events can have different modalities and can either be initiated or perceived from the person receiving the EEG.

For example, participant initiated movements are known to elicit robust ERPs.1 2 However, more commonly, ERPs are recorded from participants perceiving sounds, language, images, or smells.3,4,5 In principle, ERPs will emerge via subsequent processing as long as experimenters established a reliable method to repeatedly mark the onset of such events in the EEG.

There are two technical aspects that determine the quality of ERP event markers:

  • Delay: Time from when an event occurred to when it is marked in the EEG data
  • Jitter: Consistency of the delay with which the event is marked in the EEG data

Long delays with large jitter complicate EEG analysis up to the point in which the targeted ERP component becomes unobtainable or requires too many trial repetitions to appear. Short delays with minimal jitter create the ideal technical conditions to obtain ERPs with a minimally possible amount of trial repetitions.

With Zeto’s event marker integration, users benefit from accurate event marker timing and distributed cloud data access and management – see Figure 1.

Figure 1. Schematic diagram of Zeto’s local event marker integration and remote data streaming and management features. Event markers from the presentation computer timing are merged with the EEG data locally via the Zeto Interface Box 2 (ZIB2) and then passed on to the Zeto Cloud.  A simultaneous LSL integration and related multi-model data recording become possible out of the box while maintaining Zeto’s existing cloud streaming, data, and user management features.

ZETO ERP FEATURES

The Zeto EEG platform offers the ability to integrate external markers wirelessly at an 8-bit resolution within a 2 ms delay and less than 1 ms technical jitter. In other words, the user can distinguish between 255 unique event markers that they can repeat as closely as 4 ms from one another. With these features, Zeto EEG is equipped to reveal accurate auditory, visual, and senso-motoric ERPs across a wide range of applications.

Event markers are collected by the system via an 8-bit DB9 connector built into the Zeto Interface Box Version 2 (ZIB2) using Transistor-Transistor-Logic (TTL) signals.6 The ZIB2 acts as a data access point for the wireless Zeto WR19 headset. Synchronization between the ZIB2 and Zeto WR19 is handled at a nano-second range, eliminating both the delay and jitter introduced by the wireless data transmission. Incoming event markers are retroactively aligned with the data point at the time of collection.

Users can extract the event marker data from the Zeto system in multiple ways:

1) EDF+ File
Zeto users can export finished EEG recordings in various ways but the most popular is the EDF+ file format that is readable by most common EEG analysis tools. Event markers appear in the EDF+ file as digital I/O channels synchronized with the EEG data. Some EDF readers will also display the embedded event markers in the viewer.

2) Visualization
In the Zeto cloud software, users can visualize the TTL event marker inputs along with the EEG by selecting the “ALL” montage in the montage menu. This view is particularly useful for troubleshooting when setting up the ERP experiment. Offline or in real-time the user will see incoming event marker codes visualized high or low values in separate channels. The event marker channels are simultaneously translated into event marker labels that co-appear at the bottom of the screen (Figure 2).

Figure 2. Close-Up of the “All” Display montage: Output (“A”) or Input (“B”) event marker channels for 8 bits each, translated into up to 8-bit (255) unique event marker labels. The event marker mapping can be freely configured and labeled as desired prior to the recording. In this example, eight input event marker signals are embedded in the data file (pins 1 to 8) and show up as square waves (“C”).  Each input event marker channel is mapped to an annotation, labeled “One” through “Eight” respectively at the bottom of the data screen.

3) Real-time lab streaming layer (LSL) Export
Eight digital input and output channels each are made available via lab streaming layer (LSL) API in real-time, enabling the user to note the stimulus onset directly in the data stream. Event makers and EEG are synchronized and merged prior to providing this data to the LSL streaming socket. As a result, event timing and EEG data remain perfectly synchronized even if there are LSL related streaming delays. Additional LSL API synchronization features remain available to users for additional real-time data integration.

4) Offline Event Marker Files
Users have the option to export marker files after the recording is completed. That marker file contains precise marker timing and label information for all event markers recorded for easy processing in third party analysis tools such as MATLAB, ERPLAB, Python or others. This allows for separate analysis of event data and EEG data found in the exported EDF+ file.

The event file can be exported in “.csv” format (Figure 3), or a comma-delimited format called “.zmrk”. Both are compatible with most common EEG processing tools currently available for research. 

Figure 3. Event Markers listed in .csv format.

ZETO EVENT MARKER TIMING VALIDATION

Zeto validated the event marker timing to establish the delay and jitter attributes under working conditions.
To do this, a testing setup split the incoming TTL trigger voltages via an analog splitter into two exact 8-channel copies. One copy of the event marker signals got connected to the ZIB2 input trigger ports while the second copy got connected to 8 channels of the WR19 headset. As a result, incoming event markers both appeared as digital events in the datastream and voltage changes in the EEG channels (Figure 4). Subsequent processing revealed the real-life delay and jitter between the incoming event marker signals and the EEG recording.

Figure 4. Schematic of the event marker timing test setup. The presentation computer sends 8-bit TTL event markers to an analog splitter box. One copy of the TTL signals arrives at the ZIB2 and gets converted into event labels. The other copy arrives at the headset and feeds into 8 of the EEG channels to show up as signals in the EEG data file.

Using this approach, event marker timing was established as stable, at < 2 ms delay and <1 ms jitter, which is a good basis to reliably capture ERP signals in EEG.

ZETO’S STIMULATION AND SYNCHRONIZATION PLATFORM PARTNERS

It is important to note that the Zeto system provides extremely precise synchronization on the receiving end of the event marker only. In fact, a much more likely source of both delay and jitter in ERP experiments occurs during stimulus presentation and subsequent event marker generation.

To avoid timing complications that occur prior to event markers entering the Zeto system, Zeto has partnered with two stimulus and synchronization platforms – both tested with our products.  These stimulus presentation and synchronization products are designed to eliminate delay and jitter on the event marker onset. In addition, they offer a variety of additional functions, including experiment writing and presentation software, participant response boxes, and photodiodes. 

Both partners have implemented out-of-the-box integrations for Zeto and are ready to service Zeto customers.

Cedrus, Inc. Psychology Software Tools
Cedrus devices are designed for precise, jitter-free event marking and fit a variety of budgets. SuperLab is an experiment writing application, while software support for their hardware interfaces also includes Matlab, E-Prime, Python, C++, etc. Psychology Software Tools isa prominent software and hardware company that helps researchers address challenges in human behavioral studies. PST are creators of E-Prime, a market-leading experiment writing platform.
C-POD
Sent precise event markers via USB		 Chronos
Hardware synchronization and delivery system for millisecond-accurate event markers to external devices using various I/O port options.
M-POD
Sent precise event markers, plus incorporate a response pad and photodiode		 E-Prime
Experiment writing platform that integrates stimulus presentation and behavioral software with research equipment
StimTracker Duo
Comprehensive audio/visual/response synchronization platform
SuperLab
Easy to use experiment writing software that does not require programming

References

  1. Hai Li et al. (2018). “Combining Movement-Related Cortical Potentials and Event-Related Desynchronization to Study Movement Preparation and Execution.” Frontiers in Neurology.
    https://www.frontiersin.org/articles/10.3389/fneur.2018.00822/full
  2. Fedor Jagla, Vladislav Zikmund, in Studies in Visual Information Processing (1994). “Visual and Oculomotor Functions.” ScienceDirect.
    https://www.sciencedirect.com/topics/neuroscience/movement-related-potential
  3. Sean McWeeny, Elizabeth S. Norton. “Understanding Event-Related Potentials (ERPs) in Clinical and Basic Language and Communication Disorders Research: A Tutorial.” PMC.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3016705/
  4. Shravani Sur, V. K. Sinha (2009). “Event-related potential: An overview.” PMC.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3016705/
  5. Thomas Hörberg et al. (2020). “Olfactory Influences on Visual Categorization: Behavioral and ERP Evidence.” Cerebral Cortex.
    https://academic.oup.com/cercor/article/30/7/4220/5811850
  6. Fiorenzo Artoni et al. (2017). “Effective Synchronization of EEG and EMG for Mobile Brain/Body Imaging in Clinical Settings.” PMC.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5770891/