NeuroEEG and NeuroCap through the Eyes of an Academic Neurologist
John Hixson, MD is an Associate Professor of Neurology at the University of California San Francisco and the San Francisco VA. Dr. Hixson’s primary clinical focus is treating epilepsy patients, while his primary research interests are to explore the use of mobile health applications in chronic neurologic disease. Dr. Hixson discusses the key issues surrounding portable EEG and MemoryMD’s NeuroEEG and NeuroCap devices, specifically.
How do you envision NeuroEEG being used in clinical practice?
Dr. Hixson: “I think that it's a very attractive device for…a situation where there's effectively no standard of care currently. So, in community hospitals, they typically don't have EEG resources and yet the question of whether a person is having a subclinical seizure or not, comes up quite frequently. In the past 10 years there’s been increased recognition of subclinical seizures happening in intensive care units. Yet, in these community hospitals, they just don't have the resources to provide that type of testing. So, I think this is a tremendous benefit. I mean it essentially allows nurses at bedside to be trained relatively quickly to apply a basic headset and then collect the signal relatively quickly.”
“At a specialty care center like where I work, we see patients who have been in another hospital for a while and they eventually get transferred to us and we suspect that they were having seizures that were not diagnosed. This [portable EEG system] would enable them to, at a relatively low cost, gain a test that they don't currently have access to.”
“Now, after that, there are a variety of benefits that you could imagine. You could envision this being very useful for your traditional long-term monitoring settings. Ambulatory monitoring is becoming a lot more frequent for just diagnostic purposes. And so if this was able to be taken home and worn, I think that would also be a pretty big value.”
Is there a role for these devices in the outpatient neurology clinical practice?
Dr. Hixson: “I don't know that it's going to be the very first use case, but I certainly think that with some evolution it could be a candidate for an ambulatory approach. So, the current standard of care for outpatient diagnosis is a routine EEG study, which is done in a lab and typically lasts 30 minutes. But the utility of a routine EEG test that's negative is relatively limited, right? And so, it's pretty common that we would prefer to get a longer period of recording, perhaps even catching some of the patients’ events in their home environment. Historically, ambulatory EEG rigs were very artifact prone. So, it made it difficult to trust the signal, but I think that with this cap, because it's so easy to apply and if there were some durability in terms of being able to provide longer monitoring, I think that the ambulatory market would be very, very interesting.”
Is there a role for these devices in telemedicine?
I think I'd say my answer would be very similar. Telemedicine is interesting because when it comes to neurology, I prefer to see the patient at least once and then I can do my follow-up visits via telemedicine just because it's so convenient for the patient. If there was a patient who lived remotely and there was a diagnostic dilemma, then I think that an ambulatory EEG approach, as I just described, would still apply whether that person was seen first in-person or in telemedicine.
Do you see EEG use increasing, decreasing, or staying the same over the next five years?
Dr. Hixson: “Overall, I see EEG use increasing. I think the ambulatory market is really what's accelerating.”
Do you anticipate any innovations that will change the use of EEG over the next five years?
Dr. Hixson: “I think that innovation in medicine is a lot slower than people realize or like to acknowledge. So, over five years, I don't know that I see a tremendous shift. But I will say a couple things. First…the quality of the recording just gets incrementally better. You'll see a moment in which there's kind of a tipping of the scales and people will become less concerned about using a portable rig or an ambulatory headset…I do think that's happening. That's why we're having this conversation.”
“Second, if you believe the trend in machine learning is going to continue, that automated algorithms for evaluating this EEG content will become more machine-based. I think that will happen…but that isn't going to happen overnight.”
“The final thing…is that I think EEG is increasingly going to be relevant to other conditions outside of epilepsy. Everybody wants to find an objective biomarker for things like autism, schizophrenia, concussion and traumatic brain injury, and I think that we're still in the research phase of that. It's not ready for clinical primetime in my opinion…but certainly we're headed in that direction. So, it would not surprise me in five years that EEG was routinely used to help diagnose those conditions as well.”
Dr. Hixson about NeuroEEG Benefits
Dr. Hixson about NeuroCap Set-Up
Dr. Hixson on NeuroCap Advantages
Do you have any specific feedback on MemoryMD’s products?
Dr. Hixson: “I think that historically the quality of EEG signal that was really possible with these types of devices was pretty limited. So, I do think that this device has a real potential to begin to deliver on the promise of a portable and disposable EEG system.”
Regarding NeuroEEG and NeuroCap devices, “I think that the quality of the signal is good. I think that on the interpretation side so far, I've been impressed with the size of the amplifier and the relative efficiency of getting a signal up and running. Some type of cloud-based system that would allow for remote monitoring of the EEG signal or incorporating some type of machine learning algorithm that would allow for even an ICU physician or an emergency room physician to quickly determine if a seizure was happening or not would also be valuable.”
“We wouldn't be having this conversation if I didn't think the product was very interesting and that it had a lot of potential.”