In this article the variety of Video-EEG applications in modern clinical practice will be reviewed.
Prolonged Video-EEG monitoring is a "gold standard" for diagnosis of epilepsy, but this technique is now widely used in different areas: neonatal neuromonitoring, polysomnography, EEG at ICU, ambulatory long-term monitoring at patient's home with remote access via Internet.
Clinical guidelines
There are lots of national and several international organizations, who are responsible for clinical guidelines for long-term video-EEG monitoring:
How it works
In the very beginning systems for simultaneously recording EEG and video was vary complicated and uncomfortable for the patient. Here you can see the paper-recording EEG machine with analog video camera and system of mirrors. With help of mirrors it was possible to record on the video both patient clinical behavior and EEG traces in the paper.
With modern computer-based EEG machines LTM becomes more easy and comfortable for the patient, especially with wearable portable EEG recorders.
Nowadays 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 usually 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.
With special computer programs operator can fast and easy review EEG and video. Video can be recorded from several cameras.
Quite often for review and analysis EEG dual monitor systems are used.
Stationary Video-EEG laboratory
To equipt stationary Video-EEG lab usually stationary EEG recorder used with one, two or three video cameras.
Neuron-Spectrum-64 in the “Video” delivery set:
- 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 connection)
- Automatic search and extraction of spikes, sharp waves and other types of epileptiform activity on the EEG
Video-EEG monitoring at ICU
More and more often neuromonitoring is used at ICU. EEG in ICU helps:
- To monitor the adequacy of the functional state of the central nervous system.
- To assess the level of suppression of the functional activity of the brain (at different levels of suppression of consciousness).
- To assume the prognosis and outcome of the disease.
That is why the popularity of EEG in ECU is growing up now.
Usually it is a mobile EEG complex:
Or system with notebook:
EEG registration in intensive care units imposes additional restrictions on the characteristics of the equipment. We need a mobile complex based on a modern electroencephalograph 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.
Equipment for EEG in Intensive Care Units
Registration of EEG in intensive care units imposes additional restrictions on the characteristics of the equipment. A mobile complex based on a modern electroencephalograph with a reliable noise reduction system and the highest signal recording quality is needed.
Video monitoring and tests with stimulation is a mandatory requirement for such a complex.
It is not uncommon for EEG registration in intensive care units not from scalp electrodes, but from invasive electrodes installed directly on the cerebral cortex.
The number of registration channels can be from 16 up to 64.
Software for analysis EEG at ICU
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 inter electrode distance 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.
Portable EEG/PSG recorder
Stationary EEG recorders has few disadvantages: big size, wire connection. Modern EEG recorders are small, light and powerful. They can be placed on a patient body and record EEG to internal memory or transmit EEG signal via wireless interface to the acquisition station.
Neuron-Spectrum-AM device is designed for EEG and PSG recording. It is powered by 4 AA batteries, has internal SD memory card, display, buttons and Wi-Fi interface for transmitting EEG data in real time.
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.
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.
Also portable EEG devices are more convenient in the clinic at specialized video EEG labs:
It is possible to build like this clinic with several video EEG labs, where patients can move during examinations and stay connected to acquisition stations via Wi-Fi:
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
More and more popular nowadays becoming cloud data storages for EEG data. Such cloud databases have lots of advantages:
- 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
PSG is another technique where EEG and video recording is used.
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 electrodes and sensors:
The software for PSG study quite simula to Video-EEG, but during exam we record not only EEG signalsPSG, but lots of other PSG data:
Neurosoft PSG Solutions
- 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
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.