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Light electroencephalography cost-effective for hepatic encephalopathy diagnosis

The use of a light electroencephalography wireless headset to diagnose and grade hepatic encephalopathy is both reliable and cost-effective compared with standard electroencephalography.

“Electroencephalography is useful to objectively diagnose and grade hepatic encephalopathy, a common and severe brain complication of liver disease. However, EEG recording requires expensive equipment, and hepato-gastroenterologists are generally unfamiliar with its acquisition and interpretation,” Sara Montagnese, MD, PhD, of the department of medicine, University of Padova, Italy, told Healio.com/Hepatology. “Recent technological advances have led to the development of low-cost, user-friendly EEG systems, allowing EEG acquisition also in settings with limited neurophysiological experience.”

Sara Montagnese

Montagnese and colleagues enrolled 72 consecutive patients with cirrhosis and varying degrees of HE in the study and each underwent clinical evaluation, the Psychometric Hepatic Encephalopathy Score measurement and EEG recordings with both a light EEG system — EPOC 16-electrobe cap (Emotiv, Australia) — and standard system, Brain-quick 3200 digital EEG. The goal was to assess the relationship between electroencephalography parameters with the two different systems.

“The EEG is not commonly used in clinical practice as it requires costly equipment (approximately $30,000) and a certain degree of expertise. … Over the last few years, technological advances in the field of brain–computer interface have led to the development of novel EEG recording tools which are considerably cheaper (approximately $1,000) and more user-friendly,” the researchers wrote.

The researchers observed strong correlations between all automated parameters from the two EEG systems. The mean dominant frequency from light EEG correlated with MELD score (r = −0.39; P < .05), fasting venous ammonia levels (r = −0.41; P < .01) and Psychometric Hepatic Encephalopathy Score (r = −0.49; P < .001).

Bland and Altman analysis showed the two systems had not only comparable automated parameters, but had good classification of normal vs. abnormal electroencephalography (0.6 < κ < 0.8). The analysis also showed “acceptable average differences and acceptable ranges of oscillation” between the two systems.

Significant differences in light EEG parameters were observed in patients with varying degrees of HE, according to the research.

“We show that reliable EEG parameters for purposes of hepatic encephalopathy diagnosis and grading can be obtained from a cheap, commercial, wireless headset,” Montagnese said. “This may lead to more widespread use of this patient-independent tool both in routine liver practice and in the research setting.”– by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.