Neurostimulation EEG artifacts: VNS, RNS, and DBS

Artefatos de neuroestimulação no EEG: VNS, RNS e DBS

Accurately recognizing artifacts on electroencephalogram (EEG) is necessary to prevent EEG misinterpretation and epilepsy misdiagnosis. EEG artifacts generated by neurostimulation devices (Figures 1 and 2) can be identified based on their unique spatial and frequency properties1.

Figure 1.
Vagus nerve stimulation (VNS) EEG artifact. Scalp EEG: sensitivity 7 µV/mm, LF 1 Hz, HF 70 Hz, notch on; invasive EEG: sensitivity 100 µV, LF 0.53 Hz, HF 600 Hz, notch off.

Figure 2.
Responsive neurostimulation (RNS) and deep brain stimulation (DBS) scalp EEG artifacts - extended longitudinal bipolar montages (with additional frontotemporal electrodes). EEG: sensitivity 7 µV/mm, LF 1 Hz, HF 70 Hz, notch on.

VNS and RNS artifacts display an electrical interference-like “spiky” morphology with a distribution that is incompatible with a cerebral source and frequencies that mirror stimulation settings. DBS artifact features diffuse electrical interference with a relatively monomorphic appearance, and its frequency can vary depending on intermittent versus continuous neurostimulation - indicated for epilepsy and movement disorders, respectively.

REFERENCES

• 1. McKay JH, Tatum WO. Artifact mimicking ictal epileptiform activity in EEG. J Clin Neurophysiol. 2019 Jul;36(4):275-88. https://doi.org/10.1097/wnp.0000000000000597
  » https://doi.org/10.1097/wnp.0000000000000597

• Statement of ethics:

  This study was conducted ethically and in compliance with the guidelines for human studies. Informed consent was not obtained because all patient data in this manuscript was de-identified.

Publication Dates

• Publication in this collection
  11 June 2021
• Date of issue
  Aug 2021

History

• Received
  23 Aug 2020
• Reviewed
  24 Oct 2020
• Accepted
  28 Oct 2020