To validate the effectiveness of Zeto EEG (zEEG) as a routine EEG by comparing the subjective quality of recordings with the hypothesis that zEEG is non-inferior to a reference system. 

EEG is a gold standard for epilepsy diagnosis. Nevertheless, bottlenecks for reaching its full potential in neurology practice include the shortage of trained technologists and the technical skills of manual electrode setup. Zeto has developed a 19-channel, wireless, zero-preparation, adjustable headset equipped with replaceable magnetic tip, dry electrodes which is the first FDA approved product of its kind. zEEG is uploaded real-time via Wi-Fi to cloud servers and data can be analyzed from any location. 

Studies were acquired by registered EEG technologists from a sample of patients at an outpatient tertiary referral epilepsy clinic. The zEEG headset was placed using the manufacturer’s recommendations. The headset was removed and then a standard EEG was acquired with a reference system (Natus) using cup electrodes and the 10-20 system. EEGs were recorded for 20-30 minutes and then exported to common review software (Persyst) and reviewed in a longitudinal bipolar montage using set viewing settings (TC 0.16s, LFF 70Hz, notch 60Hz). 4 board-eligible or -certified reviewers blinded to each other’s ratings and the machine source scored EEGs according to subjective 3 point Likert scale (3=highest quality, 2=acceptable, 1=not acceptable, 0 = n/a) in the following categories: myogenic noise, body movements, baseline wander and slow frequency artifact, electrode defect, 60 Hz artifact, waking alpha rhythm, and other waking background. Scores were averaged across reviewers and studies within each category were compared by recording system using one-sided Wilcoxon tests.

Electrode and slow frequency artifacts were significantly more apparent in the Zeto system but the overall interpretability was not inferior to that of the reference system. 

Dry electrode systems can provide clinically relevant routine EEG recordings.