The Past, Present, and Future of Tele-EEG

Abstract

Tele-electroencephalogram (EEG) has become more pervasive over the last 20 years due to advances in technology, both independent of and driven by personnel shortages. The professionalization of EEG services has both limited growth and controlled the quality of tele-EEG. Growing data on the conditions that benefit from brain monitoring have informed increased critical care EEG and ambulatory EEG utilization. Guidelines that marshal responsible use of still-limited resources and changes in broadband and billing practices have also shaped the tele-EEG landscape. It is helpful to characterize the drivers of tele-EEG to navigate barriers to sustainable growth and to build dynamic systems that anticipate challenges in any of the domains that expand access and enhance quality of these diagnostic services. We explore the historical factors and current trends in tele-EEG in the United States in this review.

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“…52 53 Additionally, EEG monitors and teleconsultation services can bridge geographical gaps and enhance access to epilepsy and status epilepticus care. 54 55 A study utilizing pre-assembled EEG montage caps and a smartphone-based EEG platform for diagnosing seizures in Bhutan provides an example of the implementation of relatively low-cost and low-tech hardware for managing epilepsy in a resource-limited setting. 56…”

“…52,53 Additionally, EEG monitors and teleconsultation services can bridge geographical gaps and enhance access to epilepsy and status epilepticus care. 54,55 A study utilizing pre-assembled EEG montage caps and a smartphone-based EEG platform for diagnosing seizures in Bhutan provides an example of the implementation of relatively low-cost and low-tech hardware for managing epilepsy in a resource-limited setting. 56 Establishing Systems of Care for Traumatic Brain Injury TBI management in LMICs faces significant challenges due to the absence of efficient prehospital care systems and emergency medical services, causing delays in initial care and transportation.…”

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“…The dearth of well-trained EEG technologists was apparent during the pandemic, with the subsequent reduction in staffing of clinical EEG services to support the response to the COVID-19 pandemic (6,20,33). Prior studies before the pandemic noted a demand for nearly 40,000 jobs for neurodiagnostic technicians in the future and a lack of sufficient training programs to meet this need (34), and the pandemic exacerbated this problem. Given the toll taken on technologists as the stress of the pandemic worsened, these staff shortages were intensified and likely will continue into the future (35).…”

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“…Despite these challenges, telehealth offers a wide variety of advantages and can be applied to many clinical settings including outpatient ambulatory settings 4 and acute and inpatient applications such as telestroke, 5 teleneuro-intensive care, 6 general neurology, and EEG 7 . This article reviews current and future clinical applications of teleneurology, including emerging artificial intelligence (AI) technologies that will expand the neurologist’s ability to integrate this modality into routine practice ( Box 1 8 ).…”