Abstract
Today's modalities for short-term monitoring of EEG are primarily meant for supporting clinical diagnosis of epilepsy or classifying seizures and interictal epileptiform discharges while long-term EEG adds the value of differential diagnosis investigation or pre-surgical evaluation. However, longitudinal epilepsy care relies on patient diaries, which is known to be unreliable for most patients and especially those with focal impaired awareness or nocturnal seizures. The subcutaneous ultra long-term EEG (ULT-EEG) systems alleviate those issue by enabling objective, continuous EEG monitoring for days, weeks, months, or years. Albeit a great advance in continuous EEG over extended periods, it comes with the caveat of limited spatial resolution of two channels. Therefore, the new subcutaneous EEG modality may be especially suited for a selected group of patients. We convened a panel of experienced epileptologists to consider the utility of a subcutaneous, two-channel ULT-EEG device with the goal of developing a consensus-based expert recommendation on selecting the optimal patient types for this investigative technique. The ideal patients to select for this type of monitoring would have focal impaired awareness seizures without predominant motor features and seizures with medium to high voltage patterns. As this technology matures and we learn more about its limitations and benefits we might find a wider array of use case scenarios as it is believed that the benefits for many patients are most likely to outweigh the risks and cost.
Highlights
The clinical use of human electroencephalography (EEG) is approaching its 100th anniversary
The more than 99% of time spent between seizures is often used to look for biomarkers as a surrogate for ictal activity with the presence of interictal epileptiform discharges (IEDs) used to infer the diagnosis of epilepsy, the risk of future seizures, and especially in genetic generalized epilepsies; the response to antiseizure medication (ASM) [6]
In the current paper we have identified the optimal patient for at two-channel subcutaneous ultra long-term EEG (ULT-EEG) device, but we would like to elaborate a bit further on different use cases
Summary
The clinical use of human electroencephalography (EEG) is approaching its 100th anniversary. Technical advances in computational power, hardware size and power requirements, data storage, and network bandwidth have resulted in digitization of data and in large growth of the use of inpatient continuous EEG [1] as well as an increase in the use of 1–3 days ambulatory recordings. In terms of using the EEG for ultra long-term monitoring as done with electrocardiography in cardiac diseases, no notable advances have taken place until recently
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