Neurocritical Care

, Volume 29, Issue 2, pp 302–312 | Cite as

Rapid Bedside Evaluation of Seizures in the ICU by Listening to the Sound of Brainwaves: A Prospective Observational Clinical Trial of Ceribell’s Brain Stethoscope Function

  • Kyle HobbsEmail author
  • Prashanth Krishnamohan
  • Catherine Legault
  • Steve Goodman
  • Josef Parvizi
  • Kapil Gururangan
  • Michael Mlynash
Original Article



Patients suffering from non-convulsive seizures experience delays in diagnosis and treatment due to limitations in acquiring and interpreting electroencephalography (EEG) data. The Ceribell EEG System offers rapid EEG acquisition and conversion of EEG signals to sound (sonification) using a proprietary algorithm. This study was designed to test the performance of this EEG system in an intensive care unit (ICU) setting and measure its impact on clinician treatment decision.


Encephalopathic ICU patients at Stanford University Hospital were enrolled if clinical suspicion for seizures warranted EEG monitoring. Treating physicians rated suspicion for seizure and decided if the patient needed antiepileptic drug (AED) treatment at the time of bedside evaluation. After listening to 30 s of EEG from each hemisphere in each patient, they reevaluated their suspicion for seizure and decision for additional treatment. The EEG waveforms recorded with Ceribell EEG were subsequently analyzed by three blinded epileptologists to assess the presence or absence of seizures within and outside the sonification window. Study outcomes were EEG set up time, ease of use of the device, change in clinician seizure suspicion, and change in decision to treat with AED before and after sonification.


Thirty-five cases of EEG sonification were performed. Mean EEG setup time was 6 ± 3 min, and time to obtain sonified EEG was significantly faster than conventional EEG (p < 0.001). One patient had non-convulsive seizure during sonification and another had rhythmic activity that was followed by seizure shortly after sonification. Change in treatment decision after sonification occurred in approximately 40% of patients and resulted in a significant net reduction in unnecessary additional treatments (p = 0.01). Ceribell EEG System was consistently rated easy to use.


The Ceribell EEG System enabled rapid acquisition of EEG in patients at risk for non-convulsive seizures and aided clinicians in their evaluation of encephalopathic ICU patients. The ease of use and speed of EEG acquisition and interpretation by EEG-untrained individuals has the potential to improve emergent clinical decision making by quickly detecting non-convulsive seizures in the ICU.


Electroencephalography Sonification Status epilepticus Clinical trial 


Author Contributions

All authors contributed substantially to the design and conduct of the study, data acquisition and/or analysis, and revision of the manuscript.

Source of Support

This study was supported by a fund from Ceribell, Inc. (Mountain View, CA, USA) to Stanford University.

Compliance with Ethical Standards

Conflict of interest

Josef Parvizi is co-founder of Ceribell. Goodman is on the Ceribell scientific advisory board. Both were involved in the design of the study, commenting on data analysis and interpretation, and revisions of later versions of the manuscript. Other authors have no financial relationship with Ceribell.

Ethical Approval

The trial was approved by our local Institutional Review Board, unique protocol number 38555.

Human and Animal Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

Video #1

Clip of visual handheld EEG and sonification of a patient in non-convulsive status epilepticus (NCSE) (MP4 25219 kb)


  1. 1.
    Kaplan PW. Prognosis in nonconvulsive status epilepticus. Epileptic Disord. 2000;2(4):185–93.PubMedPubMedCentralGoogle Scholar
  2. 2.
    DeLorenzo RJ, Waterhouse EJ, Towne AR, Boggs JG, Ko D, DeLorenzo GA, Brown A, Garnett L. Persistent nonconvulsive status epilepticus after the control of convulsive status epilepticus. Epilepsia. 1998;39(8):833–40.CrossRefGoogle Scholar
  3. 3.
    Towne AR, Waterhouse EJ, Boggs JG, Garnett LK, Brown AJ, Smith JR Jr, DeLorenzo RJ. Prevalence of nonconvulsive status epilepticus in comatose patients. Neurology. 2000;54(2):340–5.CrossRefGoogle Scholar
  4. 4.
    Claassen J, Mayer SA, Kowalski RG, Emerson RG, Hirsch LJ. Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology. 2004;62(10):1743–8.CrossRefGoogle Scholar
  5. 5.
    Meierkord H, Holtkamp M. Non-convulsive status epilepticus in adults: clinical forms and treatment. Lancet Neurol. 2007;6(4):329–39.CrossRefGoogle Scholar
  6. 6.
    Vespa P, Prins M, Ronne-Engstrom E, Caron M, Shalmon E, Hovda DA, Martin NA, Becker DP. Increase in extracellular glutamate caused by reduced cerebral perfusion pressure and seizures after human traumatic brain injury: a microdialysis study. J Neurosurg. 1998;89(6):971–82.CrossRefGoogle Scholar
  7. 7.
    Vespa P, Tubi M, Claassen J, Buitrago-Blanco M, McArthur D, Velazquez AG, Tu B, Prins M, Nuwer M. Metabolic crisis occurs with seizures and periodic discharges after brain trauma. Ann Neurol. 2016;79(4):579–90.CrossRefGoogle Scholar
  8. 8.
    Vespa PM, O’Phelan K, Shah M, Mirabelli J, Starkman S, Kidwell C, Saver J, Nuwer MR, Frazee JG, McArthur DA, et al. Acute seizures after intracerebral hemorrhage: a factor in progressive midline shift and outcome. Neurology. 2003;60(9):1441–6.CrossRefGoogle Scholar
  9. 9.
    Quigg M, Shneker B, Domer P. Current practice in administration and clinical criteria of emergent EEG. J Clin Neurophysiol. 2001;18(2):162–5.CrossRefGoogle Scholar
  10. 10.
    Gururangan K, Razavi B, Parvizi J. Utility of electroencephalography: experience from a U.S. tertiary care medical center. Clin Neurophysiol. 2016;127(10):3335–40.CrossRefGoogle Scholar
  11. 11.
    Sanchez Fernandez I, Sansevere AJ, Guerriero RM, Buraniqi E, Pearl PL, Tasker RC, Loddenkemper T. Time to electroencephalography is independently associated with outcome in critically ill neonates and children. Epilepsia. 2017;58(3):420–8.CrossRefGoogle Scholar
  12. 12.
    Young GB, Doig GS. Continuous EEG monitoring in comatose intensive care patients: epileptiform activity in etiologically distinct groups. Neurocrit Care. 2005;2(1):5–10.CrossRefGoogle Scholar
  13. 13.
    Parvizi J, Gururangan K, Razavi B, Chafe C: Detectig silent seizures by their sound. Epilepsia 2018, In Press.Google Scholar
  14. 14.
    Bridgers SL, Ebersole JS. Ambulatory cassette EEG in clinical practice. Neurology. 1985;35(12):1767–8.CrossRefGoogle Scholar
  15. 15.
    Bridgers SL, Ebersole JS. The clinical utility of ambulatory cassette EEG. Neurology. 1985;35(2):166–73.CrossRefGoogle Scholar
  16. 16.
    Olivan J, Kemp B, Roessen M. Easy listening to sleep recordings: tools and examples. Sleep Med. 2004;5(6):601–3.CrossRefGoogle Scholar
  17. 17.
    Khamis H, Mohamed A, Simpson S, McEwan A. Detection of temporal lobe seizures and identification of lateralisation from audified EEG. Clin Neurophysiol. 2012;123(9):1714–20.CrossRefGoogle Scholar
  18. 18.
    Campo Ad: Toward A Data Sonification Design Space Map. 2007.Google Scholar
  19. 19.
    Hermann T, Meinicke P, Bekel H, Muller H, Weiss S, Helge R: Sonifications for EEG data analysis. Proc ICAD 2002.Google Scholar
  20. 20.
    Loui P, Koplin-Green M, Frick M, Massone M. Rapidly learned identification of epileptic seizures from sonified EEG. Front Hum Neurosci. 2014;8:820.CrossRefGoogle Scholar
  21. 21.
    Gururangan K, Razavi B, Parvizi J: Diagnostic Utility of Eight-Channel EEG for Detecting Seizures and Seizure-Like Activity. Clinical Neurophysiology Practice 2018, In Press.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2018

Authors and Affiliations

  • Kyle Hobbs
    • 1
    • 3
    Email author
  • Prashanth Krishnamohan
    • 1
  • Catherine Legault
    • 1
  • Steve Goodman
    • 2
  • Josef Parvizi
    • 1
  • Kapil Gururangan
    • 1
  • Michael Mlynash
    • 1
  1. 1.Department of Neurology and Neurological SciencesStanford University School of MedicineStanfordUSA
  2. 2.Department of Health Research and PolicyStanford University School of MedicineStanfordUSA
  3. 3.Wake Forest University School of MedicineWinston-SalemUSA

Personalised recommendations