A specially designed EEG-cap can be used for prehospital stroke screening in the ambulance, allowing a patient to get the right stroke treatment faster. The specialized dry electrode EEG-cap emerged from a study by Amsterdam UMC together with Ambulance Amsterdam and Witte Kruis Noord-Holland Noord. To further develop the EEG-cap, the researchers of Amsterdam UMC and the German Neuromotion founded the company Trianect this month.

Neurologist Jonathan Coutinho, technical physician Wouter Potters and professor of radiology Henk Marquering of Amsterdam UMC are the inventors of the cap, which can be used to make an EEG in people with a stroke as early as in the ambulance. Dry electrode EEG-caps allow reliable EEG-measurement in less than five minutes by unexperienced users. The EEG measurements show whether there has been a stroke and whether the closed brain blood vessel is large or small. That distinction determines the treatment: for a small infarct, the patient receives a certain type of blood thinner; for a large infarct, the clot must be removed in a specialized hospital.

Coutinho: " When it comes to effectively treating a stroke, time is of the essence. The earlier we start the right treatment, the better the outcome. If the diagnosis can already be performed in the ambulance, the patient can be directly located at the right hospital, which saves precious time."

Development of EEG-cap

In October 2018, Coutinho and Potters started their close collaboration with a study called ELECTRA-STROKE. Thanks to a crowdfunding innovation grant from Dutch Heart Foundation, as well as having won the 2018 Amsterdam Science & Innovation Award, they had enough of a budget to start developing and testing the prototype. Between 2018 and 2022, the EEG-cap was tested in practice: twelve ambulances used the device and collected data from about 400 patients.

Potters: "The results show that the EEG-cap functions well in an ambulance. For example, we can accurately measure differences in brain activity on the left and right sides of the brain. Which is important to know concerning differences in blood flow. Currently, it is still a simple set of measurements, which we will continue to refine.”

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Data improvement

Coutinho, Potters and Marquering encountered some practical obstacles to its use in the ambulance. "In 60% of the patients it functions completely well," says Potters. "In 40% it could be improved. For example, while placing the EEG-cap on the head, to time pressure or in situations with lots of hair, the EEG-cap is not positioned properly, and the electrodes do not make sufficient contact with the scalp. We now want to further refine and improve the technique so that we can improve the measurements even under suboptimal conditions."

The company Trianect will focus on upgrading the hardware and the development of the algorithm so that the computer attached to the EEG-cap can already indicate sufficient treatment directly in the ambulance.