Optimized set of criteria for defining interictal epileptiform EEG discharges |
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| Affiliation: | 1. Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark;2. Section for Biostatistics, Department of Public Health, Aarhus University, Denmark;3. Krembil Brain Institute, Toronto Western Hospital, University of Toronto, Toronto, Canada;4. Department of Neurosurgery, University Hospital Erlangen, Germany and Department of Neurosurgery, University Hospital Halle (Saale), Germany;5. Department of Neurosurgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway;6. Epilepsy Center Bethel, Mara Hospital, Bielefeld, Germany;7. Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark;8. Department of Clinical Medicine, Aarhus University, Denmark;1. Department of Neurology, Kyoto University Graduate School of Medicine, 54, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan;2. Department of Pediatric Neurology, Child and Adolescent Epilepsy Center, Osaka City General Hospital, 2-13-22, Miyakojimahondori, Miyakojima-ku, Osaka 534-0021, Japan;3. Division of Neurology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan;4. Department of Respiratory Care and Sleep Control Medicine, Kyoto University Graduate School of Medicine, 54, Shogoin, Sakyo-ku, Kyoto, Japan;5. Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine, 54, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan;6. Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan;7. Department of Human Health Sciences, Kyoto University Graduate School of Medicine, 53, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan;8. Department of Neurosurgery, Ehime University Graduate School of Medicine, Shitsukawa Toon City, Ehime 791-0295, Japan;1. Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria;2. Centre for Cognitive Neuroscience Salzburg, Austria;3. Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark;4. Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark;5. Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark;1. Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark (member of the European Reference Network EpiCare);2. University of Southern Denmark, Denmark;3. Section for Clinical Neurophysiology, Department of Neurology, Haukeland University Hospital, Bergen, Norway;4. Department of Clinical Neurophysiology, Aarhus University Hospital, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark;1. Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark;2. Department of Neurology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania;3. Research Department, BESA GmbH, Graefelfing, Germany;4. Department of Clinical Neurophysiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark;5. Department of Neurology, Danish Epilepsy Centre, Dianalund, Denmark;6. Department of Neurology, Aarhus University Hospital, Aarhus, Denmark;1. Dept of Neurology and Clinical Neurophysiology, Medisch Spectrum Twente, Enschede, The Netherlands;2. Clinical Neurophysiology (CNPH), MIRA-Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands |
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| Abstract: | ObjectiveTo find and validate the optimal combination of criteria that define interictal epileptiform EEG discharges (IEDs). Our target was a specificity over 95%, to avoid over-reading in clinical EEG.MethodsWe constructed 63 combinations of the six criteria from the operational definition of IEDs, recently issued in the EEG-glossary of the International Federation of Clinical Neurophysiology (IFCN). The diagnostic gold standard was derived from video-EEG recordings. In a testing EEG dataset from 100 patients, we selected the best performing combinations of criteria and then we validated them in an independent dataset from 70 patients. We compared their performance with subjective, expert-scorings and we determined inter-rater agreement (IRA).ResultsWithout using criteria, the specificity of expert-scorings was lower than the pre-defined threshold (86%). The best performing combination of criteria was the following: waves with spiky morphology, followed by a slow-afterwave and voltage map suggesting a source in the brain. In the validation dataset this achieved a specificity of 97% and a sensitivity of 89%. IRA was substantial.ConclusionsThe optimized set of criteria for defining IEDs has high accuracy and IRA.SignificanceUsing these criteria will contribute to decreasing over-reading of EEG and avoid misdiagnosis of epilepsy. |
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| Keywords: | Criteria Definition Diagnostic accuracy EEG Interictal epileptiform discharges |
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