Nowadays long-term video EEG monitoring is widely used in modern clinical practice.
Clinical guidelines
There are lots of national and several international organizations, who are responsible for clinical guidelines for long-term video-EEG monitoring:
1.International Federation of Clinical Neurophysiology (IFCN).
2.International League Against Epilepsy (ILAE).
3.American Clinical Neurophysiology Society (ACNS).
How it works
Long-term EEG video monitoring can be performed both in a hospital (in a specially equipped room) and at the patient's home (using portable EEG recorders).
EEG is recorded from 21 to 64 EEG electrodes. As a rule, cup electrodes or electrode systems with pre-installed electrodes are used.
Synchronously with the EEG, a high-resolution video is recorded to compare the patient’s clinical behavior with the electrical activity of the brain. In modern video monitoring systems, as a rule, network video cameras (IP-cameras) are used.
The duration of the examination can be from several hours to several days. As a rule, the purpose of such examinations is to confirm the diagnosis of epilepsy or to clarify the focus of paroxysmal activity, so the software of such systems should provide for the search and identification of phenomena of epileptiform activity on the EEG.
Stationary Video-EEG laboratory
First video-EEG labs were equipped with mirrors and analog video cameras.
Nowadays modern clinics and epilepsy monitoring units (EMU) use IP-video cameras and computer based EEG recorders:
Important technical parameters of Neuron-Spectrum-64 - modern video-EEG complex:
- 21–25 EEG channels
- High-quality continuous synchronous EEG and video recording
- Support for up to 3 network cameras with full HD resolution
- Possibility of using various electrode systems
- Online impedance measurement
- Recording with invasive electrodes
- Stationary or mobile design (USB or LAN)
- Automatic search and extraction of spikes, sharp waves and other types of epileptiform activity on the EEG
Video-EEG monitoring at ICU
EEG registration in intensive care units imposes additional restrictions on the characteristics of the equipment. We need a mobile complex based on a modern EEG-recorder with a reliable noise suppression system and the highest quality of signal recording.
Video monitoring and testing with stimulation is a mandatory requirement for such a complex.
Sometimes EEG acquisition in intensive care units is carried out not from scalp, but from invasive electrodes installed directly on the cerebral cortex.
The number of registration channels can be from 19 to 64.
Among the requirements for the software, in addition to convenient means of viewing the recorded EEG, is the calculation of various kinds of trends in quantitative indicators, such as :
- Amplitude-integrated EEG.
- Frequency spectrum trend (DSA).
- Trend of alpha rhythm variability (and other rhythms).
- Average EEG amplitude trend.
- Wave rhythm index trends.
- Representation of wave rhythms.
Cerebral Function Monitoring (CFM)
Cerebral function monitoring is indicated for newborns born prematurely, with deviations or suspicions of defects in the development of the central nervous system. The rules for monitoring newborns are described in the “Atlas of
AMPLITUDE-INTEGRATED EEGs in the NEWBORN” and in “The American Clinical Neurophysiology Society’s Guideline on Continuous Electroencephalography Monitoring in Neonates”.
In accordance with the international recommendations for cerebral function monitoring, continuous recording of EEG from needle, cup or disposable hydrogel electrodes in one or two derivations with the interelectrodedistance of more than 75 mm is used.
For analysis, the amplitude-integrated EEG (aEEG) trend is used, which has characteristic patterns typical for various kinds of deviations in the development of the central nervous system.
Computer systems for cerebral function monitoring are usually built on the basis of a two-channels electroencephalograph and are located on a mobile stand/trolley.
For ease of use in intensive care units, such devices usually use a computer with a touch screen.
Also, monitoring complexes are usually equipped with video cameras to determine the moments of feeding the baby and identify other recording artifacts.
For ease of applying electrodes, some complexes are equipped with special remote units.
The software of such complexes should provide viewing of aEEG trends with the possibility of automatic or manual interpretation of patterns, native EEG traces and video.
In addition, in the program, the operator can set labels and markers of events, view the results of EEG analysis and prepare examination reports.
The software of modern monitors supports the distribution of alarm notifications on the progress of the examination and the ability to remotely view the progress of the examination on a local network or via the Internet.
Neuromonitor system possibilities:
- Up to 11 reference EEG channels
- Built-in neuromonitoring montages
- Portable patient unit
- All-in-one computer with touch screen
- Synchronous video recording
- Automatic or manual interpretation of aEEG patterns
- Notifications about aEEG patterns changing or epilepsy form activity detected
- Remote monitoring of several examinations
Portable EEG/PSG recorder
Despite its compact size, Neuron-Spectrum-AM incorporates an impressive set of channels:
- 21 channel EEG channels.
- A complete set of PSG channels:
- ECG, EOG, EMG,
- Breath, Chin, Thorax, Snoring,
- Spo2,
- DC channel,
- Body position sensor,
- Light sensor.
- Continuous operation up to 24 hours on a single battery charge.
- Wireless interface + memory card.
Ambulatory Long-Term Video EEG Monitoring
With the advent of portable EEG recorders, video EEG monitoring has become possible not only in a hospital, but also at the patient’s home. This is more convenient for the patient, cheaper for the medical clinic, and moreover, the effectiveness of such an examination, as a rule, is higher, since in the usual conditions of life for the patient, epileptic seizures occur more often.
For acquisition, a portable EEG recorder with the ability to record from 19 to 32 EEG channels is required.
The duration of the examination can be up to 3 days, while the EEG machine should provide continuous recording of EEG and video around the clock.
For video monitoring, from 1 to 3 wireless video cameras can be used. Sometimes video recording is used when recording motion only.
Modern systems allow the operator to remotely view the recorded data in real time via the Internet and, if necessary, instruct the patient.
Neuron-Spectrum-AM in the delivery set for “Ambulatory video EEG monitoring”:
- Fully autonomous portable EEG recorder
- 21 EEG channels
- High-quality long-term synchronous registration of EEG and video at the patient’s home (up to several days)
- Mobile wireless video cameras with integrated microphone and day/night mode
- Freedom of movement of the patient in familiar conditions
- Possibility of remote monitoring of the examination (via the Internet)
With "Neuron-Spectrum-SM" your patients can move freely within the clinic, while remaining under the control of medical staff.
The operator can remotely connect to any recorder and check the quality of the recorded signal.
Due to the presence of 21 EEG channels, Neuron-Spectrum-AM can be used to record both routine and long-term EEG examinations.
To connect the electrodes, you can use both individual connectors of the Touchprooftype, as well as a common connector for connecting the electrode cap.
EEG examinations can be performed both in the hospital and at the patient’s home.
Neuron-Spectrum-AM is an ideal recorder for long-term EEG video monitoring both in a stationary video EEG laboratory and at the patient’s home. It supports synchronous recording of video and audio from one, two or three high-resolution cameras with automatic day / night mode.
Automatic detection of epileptic activity in real time with the ability to notify the doctor by SMS, Telegram or email is supported.
Cloud databases and remote access to examinations data
Modern telecommunication technology allows to store and review EEG and video data on remote cloud servers:
- Rented cloud storage in the Internet or your own server in your hospital
- Flexible customization of data transfer
- Authorized access with user permissions administration window
- Patients data safety (data encryption)
- Customizable backup service on all levels
Polysomnography and cardiorespiratory monitoring
We often forget that we spend a third of our life sleeping. Modern medicine knows many different sleep disorders that significantly reduce the quality of life and the level of health. Insomnia, parasomnia, obstructive apnea syndrome - these are just some of them. For the diagnosis of sleep disorders the special medical devices (polysomnographs) were developed. The AASM singles out the following types of such devices:
Type I - stationary PSG recorders operating under the supervision of medical personnel
Type II - portable PSG recorders operating without the supervision of medical personnel
Type III - devices for cardiorespiratory monitoring
Type IV - devices for detecting signs of sleep apnea
PSG lab is very similar to the video-EEG lab:
The main difference between PSG and EEG is in electrodes:
Cardiorespiratory monitoring uses less number of channels:
- Airflow channel
- SpO2 channel
- ECG channel
- Snoring channel
- Thorax and abdominal effort channels
- Body position
- Limb movement
- Stationary polysomnograph (Type I)
- A complete set of PSG channels in accordance with the AASM recommendations
- Ability to use a patient unit
- Synchronous video recording of PSG examination
- Portable expert class polysomnograph (Type I, II)
- A complete set of PSG channels in accordance with the AASM recommendations
- Wireless interface to transfer data to a computer
- Built-in memory card to store PSG data
- Type III portable cardiorespiratory monitor
- Simplicity and usability
Conclusion
Video-EEG monitoring is widely used nowadays in modern clinical practice in EMUs, ICU, neonatology for CFM, PSG and CRM.
Useful materials
- EEG Long-Term Monitoring Guidelines (ILAE and IFCN).
- Learn to find spikes in the EEG: Operational criteria for interictal epileptiform discharges.
- Applying EEG to Multimodality Neurologic Monitoring in Pediatric Neurocritical Care.
- EEG in ICU.
- Video-EEG. Long-Term Monitoring.
- Glossary of terms most commonly used by clinical electroencephalographers (Revision 2017).
- Electroencephalography. Review of techniques.
- Neurosoft Neuromonitor system.
- QEEG. Quantitative EEG tools in modern clinical practice.
- Personalized MDD treatment with TMS (Individual Alpha Peak Frequency).
- Applying EEG to Multimodality Neurologic Monitoring in Pediatric Neurocritical Care.
- How to use two EEG amplifiers for 64 channel recordings.