Abstracts

Rationale: Traditional ambulatory electroencephalogram (EEG) can result in skin-related adverse events, including discomfort, skin irritation and breakdown. Skin injury risk often increases with the duration of EEG recordings[1]. A wireless EEG system with patient-managed application may offer a unique avenue to reduce skin injury. We aimed to reduce the occurrence of skin-related irritation in a wireless EEG system study.


Methods: We enrolled patients, neonates to adults, during EEG monitoring with suspected seizures from May 2018 to 2024 at a pediatric epilepsy center. Patients were screened for skin sensitivity or allergies in the electronic medical records. Those with known allergies to adhesives or rubber, recent history of skin sensitivity, or visible lesions near application were excluded. Patients wore a four or eight-electrode wireless EEG system on the forehead/behind the ear in conjunction with a regular 10-20 EEG for one to three days in the outpatient setting and for one to seven days in the inpatient setting. The area was cleaned with an alcohol wipe to improve adhesion and EEG sensors were placed with either an acrylic-based (used from May 2018 to April 2024) or a hydrocolloid-based adhesive (used from Feb 2022 to May 2024). We evaluated skin reaction irritation during removal directly from patients, via clinical staff, or survey data. We used quality improvement to enact three plan-do-study-act (PDSA) cycles to reduce skin irritation. The first intervention in January 2020 excluded patients with a history of skin irritation related to EEG materials, the second in April 2022 required adhesives to be changed after 72 hours and skin checks, and the third increased the rigor of skin sensitivity screening in July 2022 for patients five years and younger.


Results: Enrolled patients (n=318, 53.3% female, median age: 11, IQR: 2) wore sensors for a mean duration of 1.8 days (IQR: 1). Of the 318 patients enrolled, 2.8% (n = 9) experienced skin-related reactions reported to researchers and the IRB from May 2018 to May 2024. The largest number of reported skin reactions peaked in 2022, with 33.33% of all reactions occurring this year, and the percentage of enrolled patients experiencing skin reactions also peaked after intervention 2 from April to July 2022 (10.00%, n =20). After intervention 3 was implemented in July 2022, 1.65% (n = 121) of patients reported skin irritation. No further events occurred after January 2023.

Conclusions: Our data suggests that quality improvement interventions and more rigorous skin sensitivity screening may be able to increase awareness, detect skin adverse effects early, and ultimately reduce skin-related irritation over time. A crucial element allowing further improvements is patient self-management of adhesive patch screening and replacements. Further data collection will enable us to better understand the incidence of skin-related reactions longitudinally.


Funding: Supported by NIH 1U44 NS121562 and research funding by Epitel, Inc.

1. Drees C, Makic MB, Case K, Mancuso MP, Hill A, Walczak P, Limon S, Biesecker K, Frey L. Skin Irritation during Video-EEG Monitoring. Neurodiagn J. 2016;56(3):139-150. doi: 10.1080/21646821.2016.1202032. PMID: 28436772.