Authors :
Presenting Author: Edeline Jean Baptiste, BS – Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA
Elijah Simon, BS – Boston Children's Hospital
Stephanie Dailey, BA – Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA
Lillian Voke, BS – Umass Medical School
Michele Jackson, BA – Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA
Vamshi Muvvala, MS – Epitel, Inc.
Mitchell Frankel, PhD – Epitel, Inc.
Mark lehmkuhle, PhD – Epitel Inc.
Tobias Loddenkemper, MD – Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA
Rationale:
Traditional electroencephalogram (EEG) systems are often limited by challenges in applying electrodes to certain hair textures1, which can introduce bias and reduce access to high-quality EEG monitoring for individuals with hair types less compatible with standard EEG supplies2,3. Recently developed wireless EEG systems may help mitigate these barriers. This study assessed whether two distinct EEG systems (wired and wireless) were associated with hair texture-related complications in patients undergoing EEG monitoring. Additionally, we conducted a literature review to identify additional reports of hair texture-related EEG challenges, their associated technologies, and proposed solutions.
Methods:
A comprehensive literature search was conducted via PubMed on May 1, 2025, using the search terms “Hair” AND “EEG” to identify studies reporting hair texture-related complications or accommodations in EEG application. Pediatric patients aged ≥1 year were prospectively enrolled at a Level-4 Epilepsy Center and monitored simultaneously with wired and wireless EEG systems (Figure 1). Electronic health records (EHR) were reviewed to identify documentation of hair texture-related issues reported during or after EEG monitoring.
Results:
The literature search yielded 187 papers, of which 11 met the inclusion criteria for analysis. These studies described various wired EEG systems implicated in hair texture–related barriers, including standard (10–20) systems (n=4), EEG caps (n=3), sensor nets (n=1), headsets (n=1), and other configurations (n=2). Reported accommodations included leveraging electrode adapters, braiding hair before electrode placement, and applying larger amounts of conductive gel. Notably, none of the studies mentioned wireless EEG systems as either contributing to or mitigating hair texture–related challenges.
In our prospective cohort of 400 patients, three cases of hair texture–related complications were reported, all associated with the standard (10-20) wired EEG system. These patients were described as having thick hair, which made electrode placement more difficult and required additional technical interventions. In contrast, no hair texture–related complications were reported with the wireless EEG system.
Conclusions:
In our study, the traditional wired EEG system was associated with more hair texture–related challenges than the wireless system. This finding aligns with additional reports in the literature describing similar barriers associated with wired EEG systems. Wireless, wearable EEG technologies may offer a more accessible alternative for both short- and long-term seizure monitoring in pediatric epilepsy. Ongoing work aims to further evaluate signal quality, seizure detection performance, and the feasibility of remote use with these systems.
Funding:
Supported by NIH 1U44 NS121562 and research funding by Epitel, Inc. TL is part of pending/approved patents relating to epilepsy diagnosis, seizure detection, and seizure prediction. ML and MF have a financial interest in Epitel.