Sub-scalp electroencephalography: A next-generation technique to study human neurophysiology

Zulfi Haneef; Kaiyuan Yang; Sameer A Sheth; Fuad Z Aloor; Behnaam Aazhang; Vaishnav Krishnan; Cemal Karakas

doi:10.1016/j.clinph.2022.07.003

Sub-scalp electroencephalography: A next-generation technique to study human neurophysiology

Clin Neurophysiol. 2022 Sep:141:77-87. doi: 10.1016/j.clinph.2022.07.003. Epub 2022 Jul 18.

Authors

Zulfi Haneef¹, Kaiyuan Yang², Sameer A Sheth³, Fuad Z Aloor⁴, Behnaam Aazhang⁵, Vaishnav Krishnan⁶, Cemal Karakas⁷

Affiliations

¹ Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA. Electronic address: [email protected].
² Department of Electrical and Computer Engineering, Rice University, Houston, TX 77005, USA. Electronic address: [email protected].
³ Department of Neurosurgery, Baylor College of Medicine, Houston, TX 77030, USA.
⁴ Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA.
⁵ Department of Electrical and Computer Engineering, Rice University, Houston, TX 77005, USA.
⁶ Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA; Department of Electrical and Computer Engineering, Rice University, Houston, TX 77005, USA.
⁷ Division of Pediatric Neurology, Department of Neurology, University of Louisville, Louisville, KY 40202, USA; Norton Children's Neuroscience Institute, Louisville, KY 40241, USA.

PMID: 35907381
DOI: 10.1016/j.clinph.2022.07.003

Abstract

Sub-scalp electroencephalography (ssEEG) is emerging as a promising technology in ultra-long-term electroencephalography (EEG) recordings. Given the diversity of devices available in this nascent field, uncertainty persists about its utility in epilepsy evaluation. This review critically dissects the many proposed utilities of ssEEG devices including (1) seizure quantification, (2) seizure characterization, (3) seizure lateralization, (4) seizure localization, (5) seizure alarms, (6) seizure forecasting, (7) biomarker discovery, (8) sleep medicine, and (9) responsive stimulation. The different ssEEG devices in development have individual design philosophies with unique strengths and limitations. There are devices offering primarily unilateral recordings (24/7 EEG^TM SubQ, Neuroview^TM, Soenia® UltimateEEG™), bilateral recordings (Minder™, Epios™), and even those with responsive stimulation capability (EASEE®). We synthesize the current knowledge of these ssEEG systems. We review the (1) ssEEG devices, (2) use case scenarios, (3) challenges and (4) suggest a roadmap for ideal ssEEG designs.

Keywords: EEG; Epilepsy monitoring; Seizure detection; Subscalp; Wearable.

Published by Elsevier B.V.

Publication types

Review
Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

Electroencephalography / methods
Humans
Neurophysiology*
Scalp*
Seizures

Grants and funding

K08 NS110924/NS/NINDS NIH HHS/United States