Automated Seizure Detection in Patients with Cardiac Arrest: A Retrospective Review of Ceribell™ Rapid-EEG Recordings

Villamar, Mauricio F.; Ayub, Neishay; Koenig, Seth

doi:10.1007/s12028-023-01681-w

Cited by 5 publications

(5 citation statements)

References 41 publications

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“…Despite the considerable benefits these point-of-care EEG systems offer, limitations regarding automated software embedded in these systems require consideration. For instance, in a study of 21 patients with coma after cardiac arrest, embedded software for automated detection of seizures [ 73 ] failed to detect four individuals (19.0%) experiencing multiple electrographic seizures, 2 of which additionally had electrographic SE within the initial 24-h period of rapid-EEG observation. This highlights the need for cautious interpretation of automated results and, where possible, review by experienced neurophysiologists.…”

Section: Continuous Eeg For Seizure and Status Epilepticus Detectionmentioning

confidence: 99%

Utility and rationale for continuous EEG monitoring: a primer for the general intensivist

Bitar,

Khan,

Rosenthal

2024

Crit Care

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This review offers a comprehensive guide for general intensivists on the utility of continuous EEG (cEEG) monitoring for critically ill patients. Beyond the primary role of EEG in detecting seizures, this review explores its utility in neuroprognostication, monitoring neurological deterioration, assessing treatment responses, and aiding rehabilitation in patients with encephalopathy, coma, or other consciousness disorders. Most seizures and status epilepticus (SE) events in the intensive care unit (ICU) setting are nonconvulsive or subtle, making cEEG essential for identifying these otherwise silent events. Imaging and invasive approaches can add to the diagnosis of seizures for specific populations, given that scalp electrodes may fail to identify seizures that may be detected by depth electrodes or electroradiologic findings. When cEEG identifies SE, the risk of secondary neuronal injury related to the time-intensity “burden” often prompts treatment with anti-seizure medications. Similarly, treatment may be administered for seizure-spectrum activity, such as periodic discharges or lateralized rhythmic delta slowing on the ictal-interictal continuum (IIC), even when frank seizures are not evident on the scalp. In this setting, cEEG is utilized empirically to monitor treatment response. Separately, cEEG has other versatile uses for neurotelemetry, including identifying the level of sedation or consciousness. Specific conditions such as sepsis, traumatic brain injury, subarachnoid hemorrhage, and cardiac arrest may each be associated with a unique application of cEEG; for example, predicting impending events of delayed cerebral ischemia, a feared complication in the first two weeks after subarachnoid hemorrhage. After brief training, non-neurophysiologists can learn to interpret quantitative EEG trends that summarize elements of EEG activity, enhancing clinical responsiveness in collaboration with clinical neurophysiologists. Intensivists and other healthcare professionals also play crucial roles in facilitating timely cEEG setup, preventing electrode-related skin injuries, and maintaining patient mobility during monitoring.

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Section: Continuous Eeg For Seizure and Status Epilepticus Detectionmentioning

confidence: 99%

Utility and rationale for continuous EEG monitoring: a primer for the general intensivist

Bitar,

Khan,

Rosenthal

2024

Crit Care

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“…We read the report by Dr. Villamar and his colleagues [ 1 ] with great interest, and we congratulate the authors on presenting a well-balanced evaluation of Ceribell’s Claritɣ seizure burden algorithm [ 2 ]. We do fully agree with the authors’ conclusion that artificial intelligence is not ready to replace neurologists.…”

mentioning

confidence: 99%

“…In this regard, it is important to acknowledge the hundreds of cases at Dr. Villamar’s institution where the algorithm had performed correctly. Furthermore, exceptional cases presented in the study by Villamar et al [ 1 ] should not be freely extrapolated to all patients in need of point-of-care EEG monitoring. While the authors highlight a few cases in which Claritɣ missed seizure activity, they also point out that the performance of this algorithm was satisfactory in the majority of EEGs performed at their institution.…”

mentioning

confidence: 99%

“…Our team, similar to many others who have developed algorithms for clinical use, regularly works with users to retrain the algorithm to improve accuracy for missed cases in version upgrades approximately twice a year. Since the initial cases reported by Villamar et al [ 1 ], two new versions of Claritɣ have been released with clear improvements. The latest release (version 6.0 released November 2022) already shows improvement regarding two of the cases reported in this study (Fig.…”

mentioning

confidence: 99%

“…1 Performance of updated Claritɣ algorithm v6.0. a Two-minute segment of ictal EEG from patient 4 from Villamar et al [ 1 ] with original seizure burden trend showing 0% seizure burden throughout the recording (displayed as a green horizontal line in trend bar below EEG montage). The patient had fragmented seizures.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Gaining Clarity on the Claritɣ Algorithm

Parvizi,

Gururangan,

Knickerbocker

et al. 2023

Neurocrit Care

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Sources of supportThis report was funded by Ceribell Inc. Conflicts of interestJP is an inventor of Ceribell Point-of-Care EEG System and co-founder of Ceribell Inc., a start-up company that is commercializing this electroencephalography system for clinical use. KG has served as a clinical and scientific advisor to Ceribell Inc. since its inception and has received compensation for his contributions to research. DK, BK, and RW are employees of Ceribell.

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