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 NEMO Workpackages

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Workpackage 06

Workpackage lead and partners

Academic Lead: Dr. Sampsa Vanhatalo (HUS)

WP partners: UCC

Workpackage objectives

  • To establish a network of EEG experts ("EEG expert group") from each centre that enrols patients
  • To develop EEG standards for monitoring seizures bedside and online
  • To validate these EEG recording standards (including electrodes/caps, online analysis, inter-observer reliability, and automated EEG detection)

Workpackage description

Monitoring of brain with EEG is necessary to both accurate seizure diagnosis and the objective (also offline) assessment of treatment responses. The primary aim of NEMO is to evaluate seizure treatments; hence the reliability of NEMO results will critically depend on the success of WP 06. The participants within this NEMO WP06 are international leaders in the field of Neonatal EEG monitoring, and the established EEG expert group takes full advantage of their collective experience.

This WP will set the standards of recording procedures and protocols, which may be challenging and can only be overcome by arranging a peer-support network between the centres.

Task 1: Establish the EEG expert group (EEGEG)
This group has been formed from members of the consortium all of whom are eminent experts in this field globally. The aim of EEGEG is to provide protocols, guidelines, minimal standards, criteria for seizure detection, as well as to provide help with EEG analysis where required (using web technology). Members will be participants from P1-UCL, P2-Cork, P6-UU, P9-UMCU and P10-AP-HP.

Task 2: Development of common protocols for EEG recording and seizure diagnoses using both multichannel EEG and aEEG.
Standard operational procedures (SOPs) will be written with input from WP 01, WP 02 and the EEGEG.

Task 3: Research and development of long term EEG recording electrode systems and electrode caps for neonates.
Babies recruited for NEMO will need EEG monitoring for up to 72 hours. A minimum of 8 EEG recording electrodes will be used. Therefore, the aim of this task in the WP will be to assess the long term performance of a number of electrode systems, as well as develop new solutions suitable for babies and to provide recommendations to the consortium on the most efficient and accurate system suitable for the trial.

Task 4: Validation of an internet-based network for real-time links between centres and monitors.
NEMO participant 2 (UCC) have already developed a web-based real time EEG reporting system in Ireland, which includes an EEG transmission protocol extendable to the NEMO consortium in all countries. This will allow remote analysis of the EEG should the local neurophysiologist not be available to report on the EEG for the trial. The consortium is aware of the fact that babies may be born at any time and that a 24 hour reporting service is needed. In addition, this platform will mean that an EEG archive can be developed that will serve as a useful educational tool for all participating centres and for the greater scientific community.

Task 5. Designing robust protocols for a real-time assessment of drug effects on seizures.
The NEMO trial is based on drug treatments that are modified according to the effects on EEG seizures in the time scale of hours. Protocols will be designed that are easy to perform in every participating centre, at all times of day, and by all potential personnel taking part in the treatment decisions.

Task 6. EEG analysis for prognosis.
A further aim of this WP will be to assess the ability of certain ictal and interictal EEG features to determine longer term prognosis in babies with seizures by comparison with long-term outcomes established by WP 07. These will be analysed and published by the EEG expert group (EEGEG). The effect of different seizure aetiology on the EEG features, and the implications for early prognosis will be examined and guidelines will be disseminated widely.

WP06 - Outcome analysis: EEG