Abstracts

Rationale: The pediatric population poses unique challenges to obtain quality long-term ambulatory electroencephalography (AEEG) data due to excessive artifact. According to the American Clinical Neurophysiology Society Guidelines, EEG electrodes can be applied with paste or collodion. Collodion is frequently used in EEG studies due to its water resistance and strong adhesive qualities. It works while it is drying due to the evaporation of ethyl ether; the nitrocellulose forms a secure film bonding the electrode to the skin and hair. The main complaint about collodion usage is the ethyl ether smell. Collodion is also flammable, so it needs to be properly stored and managed appropriately for any spillage. Surprisingly, there are limited studies in the literature about the best technique for prolonged EEG studies. Methods: A total of 70 patients were enrolled. Standard application of AEEG was performed. Exclusion criteria included extreme behavior problems and children under 3 years of age, due to their susceptibility to skin breakdown. AEEGs were blindly analyzed by two epileptologists. The studies were evaluated for artifact at baseline and every four hours of running time over 30 second increments. The total number of seconds of artifact was documented at every time point. Sleep state, number of electrodes with artifact, and location of electrodes involved were also documented. T-test was performed to evaluate for any difference between number of electrodes involved and seconds of artifact at each point of time between paste and collodion groups. Binary logistic regression analysis was used to compare the two groups after controlling for covariates. Inter-rater reliability was also assessed by reliability analysis. SPSS version 25 was used for the statistical analysis. Results: All the results reported here are from epileptologist 1. 38 patients were in the paste group; 32 in collodion. Mean age in paste group was 10.34 years; 55.3% males. Mean age in collodion was 12.31 years; 56.3% males. Mean of total electrodes involved and total seconds of artifact between 24 to 48 hours in paste group was 3 (SD: ±2) and 70.09 seconds (SD: ±53.2) in comparison to 3.2 (SD: ±1.8) and 54.71 seconds (SD: ±39.3) in collodion group (P= 0.715 & P= 0.415), (Table 1, Figure 1). Regression analysis did not show any difference between traditional paste versus collodion when accounting for various covariates and categorical variables in the study. Reliability analysis between epileptologists was acceptable to good for seconds of artifact and electrode involvement. Conclusions: We have shown that electrode problems are common with both collodion and traditional paste in the pediatric population. However, for prolonged EEG monitoring (greater than 24 hours), collodion may be a better alternative to prevent artifact. Further studies with a larger sample size are needed to prove this hypothesis. Funding: None