Unveiling peripheral neuropathy and cognitive dysfunction in diabetes: an observational and proof-of-concept study with video games and sensor-equipped insoles.

Background: Proactive screening for cognitive dysfunction (CD) and peripheral neuropathy (PNP) in elderly patients with diabetes mellitus is essential for early intervention, yet clinical examination is time-consuming and prone to bias. Objective: We aimed to investigate PNP and CD in a diabetes cohort and explore the possibility of identifying key features linked with the respective conditions by machine learning algorithms applied to data sets obtained in playful games controlled by sensor-equipped insoles. Methods: In a cohort of patients diagnosed with diabetes (n=261) aged over 50 years PNP and CD were diagnosed based on complete physical examination (neuropathy symptom and disability scores, and Montreal Cognitive Assessment). In an observational and proof-of-concept study patients performed a 15 min lasting gaming session encompassing tutorials and four video games with 5,244 predefined features. The steering of video games was solely achieved by modulating plantar pressure values, which were measured by sensor-equipped insoles in real-time. Data sets were used to identify key features indicating game performance with correlation regarding CD and PNP findings. Thereby, machine learning models (e.g. gradient boosting and lasso and elastic-net regularized generalized linear models) were set up to distinguish patients in the different groups. Results: PNP was diagnosed in 59% (n=153), CD in 34% (n=89) of participants, and 23% (n=61) suffered from both conditions. Multivariable regression analyses suggested that PNP was positively associated with CD in patients with diabetes (adjusted odds ratio = 1.95; 95% confidence interval: 1.03-3.76; P=0.04). Predictive game features were identified that significantly correlated with CD (n=59), PNP (n=40), or both (n=59). These features allowed to set up classification models that were enriched by individual risk profiles (i.e. gender, age, weight, BMI, diabetes type, and diabetes duration). The obtained models yielded good predictive performance with the area under the receiver-operating-characteristic curves reaching 0.95 for CD without PNP, 0.83 for PNP without CD, and 0.84 for CD and PNP combined. Conclusions: The video game-based assessment was able to categorize patients with CD and/or PNP with high accuracy. Future studies with larger cohorts are needed to validate these results and potentially enhance the discriminative power of video games.

Sensory nerve conduction studies in infants, children and teenagers - An update.

Objective: Nerve conduction studies (NCS) in children remain technically challenging and depend on the cooperation of the child. Motor NCS are not compromised by analgosedation but data for sensory NCS are lacking. Here, we ask whether sensory NCS is influenced by analgosedation. We also compare the present data with NCS studies from the 1990s regarding anthropometric acceleration of the contemporary paediatric population. Methods: Sensory NCS of the median nerve and sural nerve were performed in 182 healthy subjects aged 1 to 18 years during general anaesthesia and in 47 of them without analgosedation. Results: Sensory NCS was not influenced by midazolam or propofol. The sensory nerve action potential (SNAP) amplitude and the nerve conduction velocity (NCV) of the sural nerve as well as the SNAP of the median nerve show no significant age dependence in age range 1-18 years. The sensory NCV of the median nerve increased age-dependent. Conclusions: In clinical practice, analgosedation can be used for diagnostic NCS. Sensory NCS data show no relevant secular trend over the last 30 years. Differences due to technical inconsistency predominate. Significance: Analgosedation can improve diagnostic quality of sensory NCS in children. Additionally, we provide sensory NCS values from a large pediatric cohort.

Neurological Outpatients Prefer EEG Home-Monitoring over Inpatient Monitoring-An Analysis Based on the UTAUT Model.

Home monitoring examinations offer diagnostic and economic advantages compared to inpatient monitoring. In addition, these technical solutions support the preservation of health care in rural areas in the absence of local care providers. The acceptance of patients is crucial for the implementation of home monitoring concepts. The present research assesses the preference for a health service that is to be introduced, namely an EEG home-monitoring of neurological outpatients-using a mobile, dry-electrode EEG (electroencephalography) system-in comparison to the traditional long-time EEG examination in a hospital. Results of a representative study for Germany (n = 421) reveal a preference for home monitoring. Importantly, this preference is partially driven by a video explaining the home monitoring system. We subsequently analyzed factors that influence the behavioral intention (BI) to use the new EEG system, drawing on an extended Unified Theory of Acceptance and Use of Technology (UTAUT) model. The strongest positive predictor of BI is the belief that EEG home-monitoring will improve health quality, while computer anxiety and effort expectancy represent the strongest barriers. Furthermore, we find the UTAUT model's behavioral intention construct to predict the patients' decision for or against home monitoring more strongly than any other patient's characteristic such as gender, health condition, or age, underlying the model's usefulness.

Feasibility assessment of patient-controlled EEG home-monitoring: More results from the HOMEONE study.

OBJECTIVE: The feasibility phase of the HOME (Home-Monitoing and Education) project aims to show the practical feasibility of Electroencephalography (EEG)home-monitoring using a patient-controlled mobile system. Its objective is to assess the potential diagnostic and therapeutic yields of home-monitoring compared to conventional healthcare. METHODS: 16 office-based practitioners chose 97 patients and recorded standard 20-minute EEGs using conventional recorders. After training, the same patients used a patient-controlled mobile dry electrode EEG system in their home environment. The practitioners in charge and two additional raters assessed all recordings. We conducted inter-rater and intra-rater comparisons between the diagnostic findings. RESULTS: 89 patients successfully conducted home-monitoring recordings. The intra-rater comparison results for the diagnostic findings of the conventional recordings and the patient-made recordings show a fair Cohen's kappa value (0.21). Additionally, we documented a change of patient management in 9 cases. CONCLUSIONS: The feasibility of EEG home-monitoring using a patient-controlled device is confirmed. The yield of EEG home-monitoring comprises information that can influence patient management. SIGNIFICANCE: Patient-controlled EEG home-monitoring is feasible as part of routine care for neurological outpatients as its technical efficacy and practical feasibility are shown and significantly positive effects on patient management are evidenced.

Comparison between a wireless dry electrode EEG system with a conventional wired wet electrode EEG system for clinical applications.

Dry electrode electroencephalogram (EEG) recording combined with wireless data transmission offers an alternative tool to conventional wet electrode EEG systems. However, the question remains whether the signal quality of dry electrode recordings is comparable to wet electrode recordings in the clinical context. We recorded the resting state EEG (rsEEG), the visual evoked potentials (VEP) and the visual P300 (P3) from 16 healthy subjects (age range: 26-79 years) and 16 neurological patients who reported subjective memory impairment (age range: 50-83 years). Each subject took part in two recordings on different days, one with 19 dry electrodes and another with 19 wet electrodes. They reported their preferred EEG system. Comparisons of the rsEEG recordings were conducted qualitatively by independent visual evaluation by two neurologists blinded to the EEG system used and quantitatively by spectral analysis of the rsEEG. The P100 visual evoked potential (VEP) and P3 event-related potential (ERP) were compared in terms of latency, amplitude and pre-stimulus noise. The majority of subjects preferred the dry electrode headset. Both neurologists reported that all rsEEG traces were comparable between the wet and dry electrode headsets. Absolute Alpha and Beta power during rest did not statistically differ between the two EEG systems (p > 0.05 in all cases). However, Theta and Delta power was slightly higher with the dry electrodes (p = 0.0004 for Theta and p < 0.0001 for Delta). For ERPs, the mean latencies and amplitudes of the P100 VEP and P3 ERP showed comparable values (p > 0.10 in all cases) with a similar spatial distribution for both wet and dry electrode systems. These results suggest that the signal quality, ease of set-up and portability of the dry electrode EEG headset used in our study comply with the needs of clinical applications.

Assessment of the technical usability and efficacy of a new portable dry-electrode EEG recorder: First results of the HOMEONE study.

OBJECTIVES: The HOME project is intended to provide evidence of diagnostic and therapeutic yield of a patient-controlled EEG home-monitoring for neurological outpatients. METHODS: This study evaluated the technical and practical usability and efficacy of a new portable dry-electrode EEG recorder in comparison to conventional EEG devices based on technical assessments and inter-rater comparisons of EEG record examinations of office-based practitioners and two experienced neurologists. RESULTS: The technical assessment was based on channel-wise comparisons of band power values derived from power spectra as observed in two recording modalities. Slight yet significant differences were observed only in the Delta-frequency band (1.5-4 Hz). The fraction of automatically detected artifact segments was larger in the new portable recordings than in conventional recordings (20% vs. 11%, median). Overall, 93% of raters' stated diagnostic findings gathered from conventional devices were concordant with stated diagnostic findings gathered from the new portable device. CONCLUSION: The new EEG device was shown to have technical comparability to and a high concordance rate of diagnostic findings with conventional EEG devices. SIGNIFICANCE: The new portable dry-electrode EEG device is suitable to meet the HOME projects' goal of establishing a patient-controlled EEG home-monitoring in the routine care of neurological outpatients. TRIAL REGISTRATION: DRKS DRKS00012685. Registered 09 August 2017, retrospectively registered.

Diagnostic and therapeutic yield of a patient-controlled portable EEG device with dry electrodes for home-monitoring neurological outpatients-rationale and protocol of the HOMEONE pilot study.

BACKGROUND: The HOMEONE study is part of the larger HOME project, which aims to provide evidence of diagnostic and therapeutic yield ("change of management") of a patient-controlled portable EEG device with dry electrodes for the purposes of EEG home-monitoring neurological outpatients. METHODS: The HOMEONE study is the first step in the process of investigating whether outpatient EEG home-monitoring changes the diagnosis and treatment of patients in comparison to conventional EEG ("change of management"). Both EEG devices (conventional and portable) will be systematically compared via a two-phase intra-individual assessment.In the first phase (pilot study phase), both EEG devices will be used within neurologist practices (all other things being equal). This pilot study (involving 130 patients) will evaluate the technical usability and efficacy of the new portable dry electrode EEG recorder in comparison to conventional EEG devices. Judgements will be based on technical assessments and EEG record examinations of private practitioners and two experienced neurologists (percent of concordant readings and kappa values).The second phase (feasibility study phase) aims to assess patients' acceptability and feasibility of the EEG home-monitoring and will provide insights into the extent diagnostic and therapeutic yields can be expected.For this purpose, a conventional EEG will be recorded in neurologist practices. Thereafter, the practice staff will instruct the patients on how the portable EEG device functions. The patients will subsequently use the devices in their home environment.The evaluation will compare the before and after documented diagnostic findings and the therapeutic consequences of the private practitioners with those of two experienced neurologists. DISCUSSION: To the best of our knowledge, this will be the first study of its kind to examine new approaches to diagnosing unclear consciousness disorders or other disorders of the CNS or the cardiovascular system through the use of a patient-controlled portable EEG device with dry electrodes for the purpose of home-monitoring neurological outpatients. If the two phases of the HOMEONE study provide sufficient evidence of diagnostic and therapeutic yields, this would justify (indication-specific) full-scale randomized controlled trials or observational studies. TRIAL REGISTRATION: DRKS DRKS00012685. Registered 9 August 2017, retrospectively registered.