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Lifelines Photic Stimulator shines in IPS testing results

January 2017

In the latest volume of the Journal of the Association of Neurophysiological Scientists (JANS), there is a paper that suggests a bright future for the Lifelines Photic lamp. 

The paper in question is the Unimed Prize Winner of 2016 and is an undergraduate BSc dissertation written by Bryony Carr, at the Birmingham Children’s Hospital, UK.

In conclusion the paper states, “The study indicates positive outcome in the Lifelines lamp’s future use in the diagnostic detection of photosensitivity.” Carr,B.(2016) Clinical application of a new strobe lamp in identifying photosensitivity in patients referred to in the Birmingham children’s hospital for EEG testing. Journal of the Association of neurophysiological Scientists. 9(2): 74-80.

The International League Against Epilepsy (ILAE) publishes guidelines for the standardization of the IPS procedure, including the importance of the use of an optimum photic lamp. The Lifelines Photic meets all these requirements.

For more information about the Lifelines Photic, feel free to contact us: enquiries@lifelinesieeg.com or sales@lifelinesieeg.com

The following is the abstract from the paper – but we refer to the full article in JANS for detailed information – Carr, B.(2016). Clinical application of a new strobe lamp in identifying photosensitivity in patients referred to in the Birmingham children’s hospital for EEG testing. Journal of the Association of neurophysiological Scientists. 9(2): 74-80.

Abstract

Epilepsy is a neurological disorder encompassing a variety of disorders characterised by recurrent and unpredictable interruptions of normal brain function known as seizures, brought on by a number of causes. Photosensitive epilepsy is characterised by seizures elicited by flashing lights and is detected during electroencephalogram (EEG) testing during intermittent photic stimulation (IPS) by the presence of photoparoxysmal responses (PPR). Recent literature has seen the development of new guidelines developed for standardisation of the IPS procedure, including the importance of the use of an optimum photic lamp. Previously favoured Grass strobe lamps are becoming increasingly hard to find, and thus it is now desirable to purchase EEG systems with incorporated stimulators. The Neurophysiology department at Birmingham Children’s Hospital uses Micromed systems, incorporating a new compatible Lifelines lamp for IPS. This study anticipates that comparable sensitivity between the existing Grass strobe and new lamps will be achieved for detecting photosensitivity.

Method

A total of 57 patients were exposed to an IPS procedure from both lamps during standard EEG recording. The presence of a PPR upon exposure to either lamp was documented, with the paired data analysed according to McNemar test.

Results 

A total of 7 subjects (12%) were found to be photosensitive upon presentation of both lamps. A single subject (2%) was found to be photosensitive upon Grass strobe stimulation and not upon Lifelines’ lamp stimulation, and a single subject (2%) was found to be photosensitive upon stimulation with the Lifelines lamp and not with Grass strobe stimulation. The McNemar statistic calculated was 0.999, allowing investigators to assume, based on a small sample size, that the Lifelines lamp is as sensitive in photosensitivity detection as the Grass strobe lamp.

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New Definition of Status Epilepticus

May 2016

An International League Against Epilepsy (ILAE) task force has developed a proposed new definition of status epilepticus (SE) according to Medscape Medical News.

“The proposed new definition, published in Epilepsia. 2015;15:1515-1523, is conceptual, with two operational dimensions. The first, time point 1 (t1), indicates the earliest time when treatment should be started. The second, time point 2 (t2), indicates when long-term consequences, such as neuronal injury, neuronal death, alteration of neuronal networks, and functional deficits, are increasingly likely.

Both these time points are based on animal experiments and clinical research but should be considered best estimates as the evidence is still incomplete and there is considerable variation, according to the authors.” – according to Pauline Andersons’s article on the Medscape Medical web.

Neurologists agree that SE is a life-threatening, neurologic emergency that requires intervention and treatment at some stage. However, the fact that the definition initially referred to clinically obvious or generalized convulsive status epilepticus (GCSE), the advent of continuous electroencephalographic (EEG) monitoring has facilitated the recognition of subtle convulsive and non-convulsive (NCSE) forms of status epilepticus as well. According to ILAE guidelines, treatment for SE is typically shall start at 5 to 10 minutes, keeping in mind that the official definition of SE states a time of 30 minutes before injury occurs.

How do doctors know when NCSE starts? The Pathophysiology and the etiology of SE is complicated and can vary. SE is not limited to epileptic patients. Etiologically, SE can be imperfectly divided into 3 groups. SE can represent an exacerbation of a pre-existing seizure disorder, the initial manifestation of a seizure disorder, or an insult other than a seizure disorder. Doctors therefore have to rely on the patient’s relatives and friends who accompany the person to the hospital. The serious nature of this condition certainly supports the early application of EEG. Fortunately such a solution is now available for the ER.

According to information on the Medscape web, the annual incidence of GCSE in Europe is estimated in the range from 3.6 to 6.6 per 100,000, whereas NCSE is estimated from 2.6 to 7.8 per 100,000. In the United States, a prospective study that included all forms of SE (GCSE, subtle convulsive status epilepticus, and NCSE) cited a markedly higher incidence rate of 41 per 100,000. Mortality rates for status epilepticus range from 3% to 33%, and such variability is heavily dependent on etiology, age, and clinical seizure form.

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Diagnostic Home Video Telemetry (HVT)

March 2016

Diagnostic Home Video Telemetry (HVT) is safe and financially superior to Inpatient Video Telemetry (IVT) according to a study performed by experts at King‘s College Hospital in London. The paper was published in Seizure – the European Journal of Epilepsy in 2014.

Electroencephalogram (EEG) is a key factor in the diagnosis and evaluation of epilepsy and sleep disorders. A long-term EEG monitoring (LTM) is often needed for such an evaluation, where a routine EEG has not captured events needed or may remain diagnostically uncertain.

An LTM on an inpatient is expensive, not only for healthcare systems but also for the patient himself, having to travel to the hospital and make arrangements with family and job, so that he can stay in the hospital for 2-4 days. The ability to perform the LTM monitoring in the patient‘s home is feasible for the patient and the healthcare alike for several reasons. But the service for this remains to be established in some countries although some countries like the US have expanded this business considerably in the past years.

In their paper ‘Development, evaluation and implementation of video-EEG telemetry at home’, Bunnhuber et al., describe the challenges and the benefits of such a service:

‘Video-EEG telemetry has conventionally been regarded as a highly specialised investigation requiring inpatient admission. It is costly, often availability is geographically limited, and several days admission to an inpatient monitoring unit is prohibitively difficult for some patient groups who may considerably benefit from the investigation. We saw an opportunity and a need to develop a new service of video-EEG telemetry in the patient’s home, maintaining the highest clinical standards; our purpose here is to describe the process of feasibility testing and implementation, in particular emphasizing the potential obstacles and cost savings. We acknowledge that our enthusiasm to develop this service may create a bias in the findings of the Pre-Implementation Pilot Study questionnaires, but believe that the data are sufficiently clear to justify our conclusions.’

Their results: ‘The feasibility study found no difference in the quality of recording or clinical yield between IVT and HVT. The pre-implementation study showed excellent patient satisfaction. We also discuss the findings of the main stakeholder survey (consultants and technicians). Our economic modelling demonstrates a clear financial superiority of HVT over IVT.

Their conclusion is: ‘….that diagnostic HVT for seizure classification and polysomnography can be carried out safely in the patients’ home and poses no security risks for staff. HVT can be effectively integrated into an existing tertiary care service as a routine home or community-based procedure. We hope to encourage other clinical neurophysiology departments and epilepsy centers to take advantage of our experience and consider adopting and implementing HVT, with the aim of a nationwide coverage.’

The full article: Brunnhuber F, Amin D, Nguyen Y, Goyal S, Richardson MP. Development, evaluation and implementation of video-EEG telemetry at home. Seizure 2014; 23: 338-343.

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FDA approval for the R40 amplifier

Regulatory News | February 2016

We are pleased to announce that our R40 amplifier has been cleared for marketing by the FDA. The R40 amplifier is designed, tested and manufactured in Britain with particularly the Clinical and Home VT users in mind.

This means that our customers in the US can now join our customers in the EU for use of this slick, high performance amplifier for high quality recordings. For more information, contact us.

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Now wash your hands, please!

Medical Research & Innovations | October 2016

We recently came across an interesting article on Medscape, our favorite resource for information on healthcare topics and latest research. 

The “Medscape Evidence-Based Patient Safety Minute” was written by Dr. George Lundberg and was about washing hands in healthcare – or lack thereof. Somehow, you expect that general hygiene and handwashing to be part of all procedures within the hospital, but that may not necessarily be the case.

Dr. Lundberg points out that long before Pasteur and Lister and modern understanding of germs, Ignaz Philipp Semmelweis challenged medical dogma in the mid 1800s. He discovered that washing hands after autopsies and before delivering babies drastically reduced the incidence of, frequently fatal, puerperal fever.

What Dr. Lundberg may not be aware of, is that another pioneer, Florence Nightingale enforced general hygiene and handwashing in the army hospital during the Crimean war (1854-56) with a dramatic effect on infections and, thereby, the survival rate of the soldiers.

Nevertheless, according to this study, it seems that doctors and nurses choose to neglect the importance of proper hand washing. Again, according to Dr. Lundberg’s Medscape Evidence-Based Patient Safety Minute, six Canadian authors published a study in the Journal of Hospital Medicine in July 2016 about this. Their study reports observations of trained teams of medical students, who surreptitiously spied on their teaching physicians and on nurses, scrutinizing hand hygiene across multiple clinical services during weekly rotations. “This covert hand-hygiene behavior by physicians was compared with hand-hygiene compliance as measured by the hospital auditors during the same period. Physician hand-hygiene compliance was 84% when overtly observed and 50% when covertly observed. For nurses, compliance reached 86% when overtly observed vs 45% when covertly observed. When attending physicians cleaned their hands, 79% of physician trainees also did; when attending physicians did not, only 19% of trainees did.”

It seems like the Hawthorne effect is alive in these wards and maybe it is time not only to boost the message of proper handwashing but also to point out the critical importance of physician leadership in this area!

See Dr.Lundberg’s Patient Safety Minute here.

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How IT will change healthcare

Medical Research & Innovations | August 2016

A very interesting article by Brennan Spiegel, MD, MSHS was published recently in the American Journal of Gastroenterology (2016; 111(5):624-630). This article describes clearly the movement of healthcare from serving the hospitals towards serving the patients. 

Modern healthcare understands the needs of the patients and the more professional approach of bringing healthcare into the patient’s close environment, rather than taking him into unusual circumstances in the hospital.

The article is written with Gastroenterology in mind, but can of course be transferred to any other specialty of healthcare. It is very clear to us at Lifelines iEEG that this is exactly the way to go with many (not all) EEG monitoring recordings and is the foundation of our development in the past years. With our Cloud service we enable remote monitoring of EEG recordings from literally anywhere in the world. We enable cross country, even cross border consultations for specialists and even more importantly, we enable the patient to stay in the comfort of his close environment, while being monitored.

Below is the abstract and first part of the article ‘How Digital Health Will Transform Gastroenterology’ published in Am J Gastroenterol.2016; 111(5):624-630 and a link to the full article on Medscape.

Abstract

Our patients spend most of their lives far away from an examination room. If we are truly going to capture our patients' attention and engage them in their care, then we must reach beyond the four walls of the clinic, hospital, or endoscopy suite. This is the vision of the digital health movement—an effort to monitor patients remotely and dynamically with mobile health ("mHealth") smartphone applications, electronic health record portals, social media, and wearable biosensors to improve health care outside of the clinical trenches. This article explores how advances in digital health may improve health¬care delivery, focusing on gastroenterology and hepatology.  It describes how technology can monitor patients remotely, improve face-¬to-¬face care, drive clinical decisions, and offer value to health¬care organizations, their patients, and their staff. The article also describes pitfalls and shortcomings of digital technologies and concludes by describing a new model for how digital health can be deployed at scale to improve coordination and outcomes of care.

Reaching beyond the four walls

Take a look at the picture. This is where we deliver most of the health care in the United States and around the modern world. If you think about it, you will realize that this room is unusual. There is no other room in our lives that bears any resemblance to this room. It has a strange looking table–chair lined with tissue paper, bland walls, and a sink. It is impersonal and sterile. People do not want to come to this room.

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Could listening to music help treat epilepsy?

Medical Research & Innovations | February 2016

A new study suggests that the therapeutic potential of music could be useful for treating epilepsy.

Music appears to have a different impact on the brains of people with epilepsy, suggesting it could be used to help treat the condition.

Recently presented at the American Psychological Association's 123rd Annual Convention, the findings reveal that the brains of individuals with epilepsy respond differently to music than those of people without the condition.

As such, study co-author Christine Charyton, of The Ohio State University Wexner Medical Center, and colleagues believe music could be used in combination with existing treatments for epilepsy.

Approximately 2.9 million children and adults in the US have epilepsy - a neurological condition characterized by the occurrence of seizures.

According to Charyton, around 80% of epilepsy cases are temporal lobe epilepsy, where seizures begin in the temporal lobe of the brain. The temporal lobe is home to the auditory cortex - the part of the brain that processes sound.

With this in mind, the team set out to investigate how music impacts the brains of individuals with epilepsy.

Music triggered greater synchronization in patients with epilepsy.

As expected, participants with and without epilepsy demonstrated heightened brainwave activity when they listened to music. However, those with epilepsy showed greater synchronization with the music in the frontal and temporal lobes than participants without the disorder.

Please click on the link below for the full story

http://www.medicalnewstoday.com/articles/297864.php