Abstracts

Rationale: EEG is a gold standard for epilepsy diagnosis. Nevertheless, bottlenecks for reaching its full potential in neurology practice include the shortage of trained EEG technologists and the technical skills of manual electrode setup (i.e., marking locations, preparing skin, applying conductive paste, etc) to ensure consistent signal quality. Following investment from an Epilepsy Foundation grant, Zeto, Inc., Santa Clara, CA) has developed a 19-channel, wireless, zero-preparation, adjustable headset (zEEG) equipped with replaceable magnetic tip, dry electrodes. EEG is uploaded real time via Wi-Fi to cloud servers and data can be viewed/analyzed real time from any location. To validate the effectiveness of zEEG as routine EEG, we will perform simultaneous recordings of a reference EEG system and zEEG at an outpatient clinic and will compare the subjective quality of recordings and the ease of use with a clinical reference system. This preliminary report details our use in three healthy volunteers. Methods: For three healthy volunteers, standard cup electrodes were placed according to the 10-20 system using standard techniques by registered EEG technologists. To avoid overlapping electrodes, electrodes were moved 5-6mm to the right to clear space for zEEG positions. The zEEG headset was then placed. The approximate time for each placement (starting electrode preparation to first recording) was recorded. EEGs were recorded for 20-30 minutes and included standard routine EEG procedures (eye closure, hyperventilation). Eye movements, talking, and swallowing artifacts were recorded. EEGs were then exported to common review software (Persyst, Solana Beach, CA) and reviewed in a longitudinal bipolar montage using set viewing settings (TC 0.16s, LFF 70Hz, notch 60Hz). Blinded review was performed on the latter half of recordings and scored according to subjective 5 point Likert scales (5=highest quality, 1=lowest quality: A. overall noise, B. presence of electrode faults, C. demonstration of waking background activities, D. demonstration of activation procedures (buildup)).  Results: Median time of study initiation for standard EEG was 17 min. Median time of zEEG initiation improved serially from 25 min to 5 min as staff learned zEEG techniques. Sensitivities required adjustment from the different systems. Likert scales for noise: standard 4, zEEG 4; electrode faults: standard 4, zEEG 3; waking background: standard 4, zEEG 4; activation procedures: not scored.  Conclusions: Preliminary results indicate that the feasibility of study design is appropriate for beginning trials with patients. Use of zEEG requires adjustment of standard procedures and practice to improve zEEG recording speed-of-initiation and quality. We anticipate enrolling 30 patients for study and multi-reviewer blinded assessment.  Funding: ZETO, Inc