Objectives: Children pose challenges to obtain quality EEG data due to excessive artifact. Collodion is used in EEG electrodes due to its water resistance and strong adhesive qualities. This study was done to evaluate differences in artifacts between the collodion and paste method.
Methods: 115 subjects (children age \u3e 3 years) were randomized into paste and collodion groups and artifacts evaluated at baseline and every hour over 30s increments. Age, sleep state, and number of electrodes with artifact were also documented. T-test was performed to determine differences in the various parameters between the two groups.
Results: 61 subjects were in the paste group and 54 in the collodion group. Mean of total seconds of artifact from 0 to 24h were 41.8s in paste group versus 30.3s in collodion group (P=0.02). Children \u3e 11 years old had less artifact than younger children from 0 to 24h (24.3 versus 41.2s, P=0.03), and from 24 to 48h (33.1 versus 43.1s, P=0.03). There was a significant effect of sleep vs. awake state recordings on artifact from 0 to 24h (30.3 versus 50.2s, P=0.01).
Conclusion: Electrode problems are common with both collodion and paste in prolonged AEEG monitoring. However, for studies less than 24h, collodion may be a better alternative.
Significance: Our study provides evidence that in some cases collodion may be a better alternative to paste in terms of decreased artifacts

Brigham, Danielle

Karkare, Shefali

Kothare, Sanjeev V.

Pavkovic, Ivan

Shah, Yash

Singh, Kanwaljit

English

eScholarship@UMMS

University of Massachusetts Medical School eScholarship@UMMS Open Access Articles Open Access Publications by UMMS Authors 2019-11-30 Comparison of artifacts between paste and collodion method of electrode application in pediatric EEG Danielle Brigham Cohen Children's Medical Center Et al. Let us know how access to this document benefits you. Follow this and additional works at: https://escholarship.umassmed.edu/oapubs  Part of the Biomaterials Commons, Biomedical Devices and Instrumentation Commons, Diagnosis Commons, Health Services Administration Commons, and the Pediatrics Commons Repository Citation Brigham D, Shah Y, Singh K, Pavkovic I, Karkare S, Kothare SV. (2019). Comparison of artifacts between paste and collodion method of electrode application in pediatric EEG. Open Access Articles. https://doi.org/10.1016/j.cnp.2019.11.002. Retrieved from https://escholarship.umassmed.edu/oapubs/4111 Creative Commons License This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License. This material is brought to you by eScholarship@UMMS. It has been accepted for inclusion in Open Access Articles by an authorized administrator of eScholarship@UMMS. For more information, please contact Lisa.Palmer@umassmed.edu. Comparison of artifacts between paste and collodion method ofelectrode application in pediatric EEGDanielle Brigham a, Yash Shah a, Kanwaljit Singh b, Ivan Pavkovic a, Shefali Karkare a, Sanjeev V. Kothare a,⇑aDepartment of Pediatrics, Cohen Children’s Medical Center, NY, USAbDepartment of Pediatrics, University of Massachusetts Medical School, MA, USAa r t i c l e i n f oArticle history:Received 31 July 2019Received in revised form 7 November 2019Accepted 8 November 2019Available online 30 November 2019Keywords:CollodionPasteEEG artifactsa b s t r a c tObjectives: Children pose challenges to obtain quality EEG data due to excessive artifact. Collodion is usedin EEG electrodes due to its water resistance and strong adhesive qualities. This study was done to eval-uate differences in artifacts between the collodion and paste method.Methods: 115 subjects (children age >3 years) were randomized into paste and collodion groups and arti-facts evaluated at baseline and every hour over 30 s increments. Age, sleep state, and number of elec-trodes with artifact were also documented. T-test was performed to determine differences in thevarious parameters between the two groups.Results: 61 subjects were in the paste group and 54 in the collodion group. Mean of total seconds of arti-fact from 0 to 24 h were 41.8 s in paste group versus 30.3 s in collodion group (P = 0.02). Children>11 years old had less artifact than younger children from 0 to 24 h (24.3 versus 41.2 s, P = 0.03), andfrom 24 to 48 h (33.1 versus 43.1 s, P = 0.03). There was a significant effect of sleep vs. awake staterecordings on artifact from 0 to 24 h (30.3 versus 50.2 s, P = 0.01).Conclusion: Electrode problems are common with both collodion and paste in prolonged AEEG monitor-ing. However, for studies less than 24 h, collodion may be a better alternative.Significance: Our study provides evidence that in some cases collodion may be a better alternative topaste in terms of decreased artifacts. 2019 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. This is an openaccess article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).1. IntroductionThe EEG is an invaluable tool in neurology, especially in theevaluation for seizure and epilepsy. Long-term recordings, in theform of video EEG (VEEG) or ambulatory EEG (AEEG), are gold stan-dard and extremely helpful in diagnosis and treatment. Eitherstudy can be difficult to perform in the pediatric age group, wherethe record is marred with significant artifact. It is easier to performEEGs in an inpatient setting, when the patient is monitored, andthe EEG technicians can reapply electrodes if removed. However,VEEG is not cost effective, as the AEEG costs 51–65% less than a24-hour inpatient VEEG (Foley et al., 2000) and is often deniedby insurance. Plus, it needs hospital resources which might notbe present at smaller centers. Thus, the AEEG may be the onlyoption available. Unfortunately, this may be problematic in chil-dren as the electrode connection degrades with time and may givesignificant artifact.This artifact can be caused by various reasons; however majorcontributors in the pediatric population include difficulty keepingpediatric patients motionless while applying the leads, and keep-ing the electrodes secured on the patient’s head. Pediatric patientstend to have co-morbidities of intellectual disability and behav-ioral problems as well; this can make it even more difficult toget an accurate EEG study. As excessive artifact can limit the over-all quality of the study, could the usage of a particular adhesive forEEG lead placement reduce the amount of artifact?According to the American Clinical Neurophysiology SocietyGuidelines, EEG electrodes can be applied with paste or collodion.Kuratani et al. (2016) Collodion is water resistance and has strongadhesive qualities. It works while drying due to the evaporation ofethyl ether; the nitrocellulose forms a secure film bonding theelectrode to the skin and hair. These properties make it ideal forapplying electrodes in EEG studies. Unfortunately, a common com-plaint about collodion usage is the smell of ethyl ether (MavidonInc., 2009), and as per US OSHA guidelines, a specialized fumeextraction apparatus is needed to decrease the amount of ethylhttps://doi.org/10.1016/j.cnp.2019.11.0022467-981X/ 2019 International Federation of Clinical Neurophysiology. Published by Elsevier B.V.This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).⇑ Corresponding author at: Department of Pediatrics, Cohen Children’s MedicalCenter, Pediatric Neurology Service Line for Northwell Health, Zucker School ofMedicine at Hofstra/Northwell, 2001 Marcus Avenue, Suite W290, Lake Success, NY11042, USA.E-mail address: skothare@northwell.edu (S.V. Kothare).Clinical Neurophysiology Practice 5 (2020) 12–15Contents lists available at ScienceDirectClinical Neurophysiology Practicejournal homepage: www.elsevier .com/locate /cnpether exposure (Young et al., 1993). Additionally, collodion is flam-mable and needs to be properly stored and managed appropriatelyfor any spillage (Mavidon Inc., 2009). Although collodion is aneffective adhesive material, the strong odor and need for cautionin its usage makes it not universally used for EEG electrodeconnection.The objective of this study was to compare the usage of collo-dion versus traditional conductive paste in adhering AEEG elec-trodes. We hypothesized that the use of collodion woulddecrease the amount of artifact seen in the AEEG studies. Anotherhypothesis was that older children would be less likely to interferein eeg equipment and thus have less artifacts.2. MethodsThis was a prospective study, evaluating artifact on AEEG stud-ies obtained in an ambulatory (outpatient) setting in the pediatricpopulation from November 2017 until March 2018. Data wasobtained by review of AEEG studies after Institutional ReviewBoard approval. 115 subjects who completed an AEEG at an urbantertiary care children’s hospital were evaluated.The subjects were randomized into a traditional paste group(Elefix Conductive EEG paste by Nippon Coviden) or a collodiongroup in a 1:1 ratio. A block randomizationmethod was used. Stan-dard application of EEG using the international 10–20 system wasperformed in both groups. There were a total of 19 electrodesapplied, and they were kept in place using a net. EEG technicianswere not aware of the purpose of the study and why they wereasked to used paste or collodion in different patients.Inclusion criteria included pediatric subjects scheduled for a24–48 h AEEG study and impedance at hook up within acceptablerange (1–5 KX). Exclusion criteria included subjects with extremebehavioral issues or aggressive behavior Children <3 years oldwere also excluded from the study, as it has been the EEG techni-cian’s experience that these children have more skin breakdownand ulceration from the collodion.EEGs were analyzed by 2 blinded epileptologists, using a refer-ential montage. Three 10 s epochs were assessed at baseline andevery 1 h of the study subsequently. The total number of secondsof artifact was documented at every time point. The number ofelectrodes affected by artifact, and sleep-wake state were also doc-umented as well as age of the subjects.Data analysis was performed to compare amount of artifactseen with the paste group compared to the collodion group. Sec-ondary analysis was performed to determine impact of both age,sleep/wake state, and duration of study on amount of artifact. T-test was performed to detect any difference between number ofelectrodes involved and seconds of artifact at each point of timebetween paste and collodion group. Kappa analysis using interclasscorrelation coefficient was performed to assess differencesbetween the two blinded EEG reviewers.3. Results61 subjects were in the traditional paste group and 54 subjectsin the collodion group. The mean age in the paste group was10 years old versus 11 years old in the collodion group. Fifty-fourpercent (31/61) of subjects in paste group were male, vs. 48% incollodion group (26/54).The mean of total electrodes with artifact from 0 to 24 h was 8.2electrodes in the paste group versus 7.1 electrodes in the collodiongroup (P = 0.012), and 5.5 electrodes vs. 6.2 electrodes from 24 to48 h (P = 0.52; Table 1). Mean of total seconds of artifact from 0 to24 h was 41.8 s in paste group versus 30.3 s in collodion group(P = 0.02), and 57.7 s versus 52.5 s from 24 to 48 h (P = 0.69).There was a significant effect of age on seconds of artifact, at alltime-points. Older children (age >11 years old) had less artifactthan young children (age <11 years old) from 0 to 24 h (24.3 s ver-sus 41.2 s, P = 0.026), and from 24 to 48 h (33.1 s versus 43.1 s,P = 0.03; Fig. 1). There was also a significant effect of sleep on sec-onds of artifact from 0 to 24 h (30.3 s during sleep versus 50.2 sduring awake state, P = 0.01; Fig. 1). Seconds of artifact did not dif-fer significantly between sleep and awake state from 24 to 48 h(53.3 s versus 66.2 s, P = 0.07). (Table 1).Average measure Interclass Correlation Coefficient (ICC) was0.835 with a 95% confidence interval from 0.369 to 0.938,p < 0.001 to indicate that the findings from the two EEG reviewerswere statistically similar.4. DiscussionThe results of the study have shown that electrode problems arecommon with both collodion and traditional conductive paste inprolonged AEEG monitoring. After 24 h of recording, both the pasteand collodion groups had similar amounts of artifact measured inseconds and equivalent number of electrodes involved (Fig. 1).But in subjects with less than 24 h of AEEG monitoring, the collo-dion group had fewer seconds of artifact and decreased numberof electrodes involved, both statistically significant.Artifacts were observed less in older children (>11 year old)from 0 to 24 h, and from 24 to 48 h. Similarly, decreased artifactwas observed during sleep state from 0 to 24 h but not in subjectswith over 24 h of recording.There are limited studies available to assess the degree of arti-fact present during EEG monitoring using different electrode appli-cations, especially in the pediatric population.Young et al. (2006) compared collodion-applied electrodes ver-sus subdermal wire electrodes for 10 comatose Intensive Care Unit(ICU) subjects. Artifacts were measured (60 Hz and other types)between both groups, and impedance at the end of the studywas also noted. The collodion group had more artifact comparedto the subdermal wire electrode group. The collodion group alsohad worsened impedance (Young et al., 2006). However, it isimportant to note that the American Clinical NeurophysiologySociety advises against the use of wire electrodes (Kuratani et al.,2016).Another study by Falco et al. (2005) monitored 40 adult subjectswith drug-resistant epilepsy for long-term video EEG monitoring.Patients were divided into 2 groups: collodion versus an EC2paste. Impedance was measured initially and at 24 h into thestudy. The collodion group had greater impedance values at boththe beginning and end. Paste time was also less in the EC2 pastegroup (Falco et al., 2005). They recommended that EC2 paste maysubstitute collodion in electrode placement for long-term videoEEG monitoring.Finally, another study analyzed how the impedance changedover time with two commonly used gels (EC2 paste versus Ten-20 paste) using tripolar concentric ring electrodes (Wigton andBesio, 2009). Electrodes were attached to a signal generator anda 30 Hz signal with amplitude of 500 mV was applied to the circuit.Ten experiments were run to acquire ten sets of data for eachpaste. The Ten-20 paste had a higher impedance, but remainedat a fairly consistent impedance throughout the test. The EC2paste had lower impedance, and showed a decrease in impedanceover time. They concluded that the EC2 paste made the mostsense as an experimental paste; as it created lower impedance val-ues, however further work needs to be performed to validate theresults on humans.There are also limited studies regarding the best technique forprolonged EEG studies. One study by Lau et al. (2011) performedD. Brigham et al. / Clinical Neurophysiology Practice 5 (2020) 12–15 13a prospective study evaluating 100 adult inpatient subjects receiv-ing prolonged EEG (Lau et al., 2011). They were randomized into 4different groups: collodion-Ten20 (electrode paste), collodion-Elefix (electrode paste), Hypafix (medical tape)-Ten20, andHypafix-Elefix. Collodion-Ten20 had the longest hook up time,but lowest number of electrode repairs. Hypafix-Ten20 had theshortest hook up time; Hypafix-Elefix had the highest numberof patients needing electrode repairs. They concluded thatcollodion-Ten20 should be used for studies>24 h, while Hypafixwould be more suitable for routine EEG studies.There are no studies available comparing amounts of artifact orbest technique in children in the ambulatory setting.4.1. Future workThe data must be interpreted in the appropriate clinical context.The cause of artifact could not be determined due to lack of simul-taneous video recording.EC2 paste is another option used for electrode application andprior studies have shown EC2 superior to collodion in impedanceand time to hook up (Falco et al., 2005). This could be furtherassessed, comparing EC2 paste, traditional paste, and collodionin a larger study in the future.5. ConclusionWe have shown that electrode problems are common with bothcollodion and traditional paste in prolonged AEEG monitoring inthe pediatric population, particularly as the study durationincreases. However, for shorter AEEG monitoring (less than 24 h),collodion may be a better alternative over conductive paste toreduce artifact in this age group and obtain better quality record-ing. More artifact was also observed in younger children (<11 yearold) and during the awake state. It remains to be determined ifEC2 paste is better than collodion in reducing artifact in studies>24 h in pediatric AEEGs.Declaration of Competing InterestThe authors declare that they have no known competing finan-cial interests or personal relationships that could have appearedto influence the work reported in this paper.ReferencesFalco, C., Sebastiano, F., Cacciola, L., Orabona, F., Ponticelli, R., Stirpe, P., et al., 2005.Scalp electrode placement by EC2 adhesive paste in long-term video-EEGmonitoring. Clin. Neurophysiol. 116 (8), 1771–1773.Table 1Artifact in collodion and paste groups.Collodion Paste p-valueMean Total Electrodes Involved 0–48 h (SD) 10.4 (4.1) 61 9.8 (4.8) 54 0.434Mean Total Electrodes Involved 0–24 h (SD) 8.2 (1.9) 61 7.1 (2.4) 54 0.012Mean Total Electrodes Involved 24–48 h (SD) 5.5 (3.7) 25 6.2 (3.7) 23 0.522Mean Total Seconds of Artifact from 0 to 48 h (SD) 61.1 (57.4) 61 57.5 (41.9) 54 0.717Mean Total Seconds of Artifact from 0 to 24 h (SD) 30.3 (27.9) 61 41.8 (32.8) 54 0.02Mean Total Seconds of Artifact from 24 to 48 h (SD) 57.7 (44.3) 25 52.5 (36.2) 23 0.698Bold values indicate statistically significant values (<0.05).Fig. 1. Bar charts showing artifacts in collodion and paste groups.14 D. Brigham et al. / Clinical Neurophysiology Practice 5 (2020) 12–15Foley, C.M., Legido, A., Miles, D.K., Chandler, D.A., Grover, W.D., 2000. Long-termcomputer-assisted outpatient electroencephalogram monitoring in childrenand adolescents. J. Child Neurol. 15 (1), 49–55.Kuratani, J., Pearl, P.L., Sullivan, L., Riel-Romero, R.M., Cheek, J., Stecker, M., et al.,2016. American Clinical Neurophysiology Society guideline 5: minimumtechnical standards for pediatric electroencephalography. J. Clin.Neurophysiol. 33 (4), 320–323.Lau, R.R., Powell, M.K., Terry, C., Jahnke, D., 2011. Neurotelemetry electrodeapplication techniques compared. Am. J. Electroneurodiagnostic Technol. 51 (3),165–182.Mavidon Inc., Collodion Safety Guideline; 2009. Available from: https://www.mvapmed.com/MSDS_Forms/CollodionSafety.pdf. [Accessed 26 July 2019].Wigton, R.L., Besio, W.G., 2009. Differential impedance testing of EC2 and Ten-20adhesive paste for tripolar concentric electrodes. In: IEEE 35th AnnualNortheast Bioengineering Conference. Cambridge, MA, pp. 1–2.Young, B., Blais, R., Campbell, V., Covacich, D., Demelo, J., Leitch, G., et al., 1993.Vapors from collodion and acetone in an EEG laboratory. J. Clin. Neurophysiol.10 (1), 108–110.Young, G.B., Ives, J.R., Chapman, M.G., Mirsattari, S.M., 2006. A comparison ofsubdermal wire electrodes with collodion-applied disk electrodes in long-termEEG recordings in ICU. Clin. Neurophysiol. 117 (6), 1376–1379.D. Brigham et al. / Clinical Neurophysiology Practice 5 (2020) 12–15 15

Comparison of artifacts between paste and collodion method of electrode application in pediatric EEG

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Comparison of artifacts between paste and collodion method of electrode application in pediatric EEG

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