Neurologists have been urged not to underestimate the high burden of skin injury and discomfort for patients undergoing ambulatory EEG monitoring.
A study at a Sydney epilepsy clinic found that the EEG electrodes caused a significant level of skin irritation, inflammation and mechanical injury for patients, particularly when used for longer than 48 hours.
Nurses at the Royal Prince Alfred Hospital’s Comprehensive Epilepsy Service said that clinicians should not view skin injury is an inevitable and necessary aspect of ambulatory EEG, as there were several ways to minimise irritation through the use of alternative adhesives, creams and placement of electrodes.
In a study involving 251 patients undergoing ambulatory EEG at the clinic they assessed the level of skin injuries in one group monitored for 2–3 days ( n = 92) and a second group who were monitored for 4–5 day (n= 179).
The electrodes were applied by trained neurophysiology nurses with extensive experience working as EEG technologists.
Inflammation scores reached significant levels (2 out of a range of 4.5) for frontal electrodes by Day 2. After Day 2 irritation scores increased to over 4 for the frontal electrodes by day 4/5 and also increased markedly for temporal and midline electrodes to average levels of over 1.6.
Patient characteristics such as increasing age, fair skin colour, dry skin texture and fine hair texture were the most notable risk factors for greater inflammation scores.
Patient reported outcomes showed the degree of discomfort experienced was significant, with nearly half of the participants expressed a high level of discomfort on multiple questions canvased. Embarrassment was also an important factor, for one in five participants during the course of EEG recording.
Study investigator Sumika Ouchida said the findings suggested it was time for EEG clinic staff to investigate alternative skin products with similar properties to collodion glue, such as EC/EC2 conductive cream.
Other possible ways to reduce irritation could include the use of water-based products instead of acetone solution during electrode removal, and the use of tubular elastic bandage or tubular elastic net bandage, to provide equal and consistent pressure on the scalp of patients.
“Making small changes to the position of the placement of the electrodes at the time of reassessment may also help,” the authors wrote.
“When placing T3/T4 electrodes, for example, we can attach these electrodes 5 mm above the eyeglass frames to prevent skin irritation at the temporal regions.”