Ayham Alkhachroum1,2,3, Saptharishi Lalgudi Ganesan4,5, Johannes P Koren6, Julie Kromm7,8, Nina Massad1, Renz A Reyes1, Michael R Miller4,5, David Roh1, Sachin Agarwal1, Soojin Park1, Jan Claassen9. 1. Department of Neurology, Columbia University and NewYork Presbyterian Hospital, New York, NY, USA. 2. Department of Neurology, University of Miami, Miami, FL, USA. 3. Department of Neurology, Jackson Memorial Hospital, Miami, FL, USA. 4. Children's Hospital of Western Ontario, London Health Sciences Centre, London, ON, Canada. 5. Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. 6. Department of Neurology, Clinic Hietzing, Vienna, Austria. 7. Departments of Critical Care Medicine and Clinical Neurosciences, University of Calgary, Calgary, AB, Canada. 8. Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada. 9. Department of Neurology, Columbia University and NewYork Presbyterian Hospital, New York, NY, USA. jc1439@columbia.edu.
Abstract
BACKGROUND: The objective of this study was to evaluate the accuracy of seizure burden in patients with super-refractory status epilepticus (SRSE) by using quantitative electroencephalography (qEEG). METHODS: EEG recordings from 69 patients with SRSE (2009-2019) were reviewed and annotated for seizures by three groups of reviewers: two board-certified neurophysiologists using only raw EEG (gold standard), two neurocritical care providers with substantial experience in qEEG analysis (qEEG experts), and two inexperienced qEEG readers (qEEG novices) using only a qEEG trend panel. RESULTS: Raw EEG experts identified 35 (51%) patients with seizures, accounting for 2950 seizures (3,126 min). qEEG experts had a sensitivity of 93%, a specificity of 61%, a false positive rate of 6.5 per day, and good agreement (κ = 0.64) between both qEEG experts. qEEG novices had a sensitivity of 98.5%, a specificity of 13%, a false positive rate of 15 per day, and fair agreement (κ = 0.4) between both qEEG novices. Seizure burden was not different between the qEEG experts and the gold standard (3,257 vs. 3,126 min), whereas qEEG novices reported higher burden (6066 vs. 3126 min). CONCLUSIONS: Both qEEG experts and novices had a high sensitivity but a low specificity for seizure detection in patients with SRSE. qEEG could be a useful tool for qEEG experts to estimate seizure burden in patients with SRSE.
BACKGROUND: The objective of this study was to evaluate the accuracy of seizure burden in patients with super-refractory status epilepticus (SRSE) by using quantitative electroencephalography (qEEG). METHODS: EEG recordings from 69 patients with SRSE (2009-2019) were reviewed and annotated for seizures by three groups of reviewers: two board-certified neurophysiologists using only raw EEG (gold standard), two neurocritical care providers with substantial experience in qEEG analysis (qEEG experts), and two inexperienced qEEG readers (qEEG novices) using only a qEEG trend panel. RESULTS: Raw EEG experts identified 35 (51%) patients with seizures, accounting for 2950 seizures (3,126 min). qEEG experts had a sensitivity of 93%, a specificity of 61%, a false positive rate of 6.5 per day, and good agreement (κ = 0.64) between both qEEG experts. qEEG novices had a sensitivity of 98.5%, a specificity of 13%, a false positive rate of 15 per day, and fair agreement (κ = 0.4) between both qEEG novices. Seizure burden was not different between the qEEG experts and the gold standard (3,257 vs. 3,126 min), whereas qEEG novices reported higher burden (6066 vs. 3126 min). CONCLUSIONS: Both qEEG experts and novices had a high sensitivity but a low specificity for seizure detection in patients with SRSE. qEEG could be a useful tool for qEEG experts to estimate seizure burden in patients with SRSE.
Authors: Susan T Herman; Nicholas S Abend; Thomas P Bleck; Kevin E Chapman; Frank W Drislane; Ronald G Emerson; Elizabeth E Gerard; Cecil D Hahn; Aatif M Husain; Peter W Kaplan; Suzette M LaRoche; Marc R Nuwer; Mark Quigg; James J Riviello; Sarah E Schmitt; Liberty A Simmons; Tammy N Tsuchida; Lawrence J Hirsch Journal: J Clin Neurophysiol Date: 2015-04 Impact factor: 2.177
Authors: P M Vespa; D L McArthur; Y Xu; M Eliseo; M Etchepare; I Dinov; J Alger; T P Glenn; D Hovda Journal: Neurology Date: 2010-08-31 Impact factor: 9.910
Authors: Paul M Vespa; W John Boscardin; David A Hovda; David L McArthur; Marc R Nuwer; Neil A Martin; Valeriy Nenov; Thomas C Glenn; Marvin Bergsneider; Daniel F Kelly; Donald P Becker Journal: J Neurosurg Date: 2002-07 Impact factor: 5.115
Authors: P M Vespa; K O'Phelan; M Shah; J Mirabelli; S Starkman; C Kidwell; J Saver; M R Nuwer; J G Frazee; D A McArthur; N A Martin Journal: Neurology Date: 2003-05-13 Impact factor: 9.910
Authors: Jan Claassen; Adler Perotte; David Albers; Samantha Kleinberg; J Michael Schmidt; Bin Tu; Neeraj Badjatia; Hector Lantigua; Lawrence J Hirsch; Stephan A Mayer; E Sander Connolly; George Hripcsak Journal: Ann Neurol Date: 2013-06-27 Impact factor: 10.422
Authors: Gian Marco De Marchis; Deborah Pugin; Emma Meyers; Angela Velasquez; Sureerat Suwatcharangkoon; Soojin Park; M Cristina Falo; Sachin Agarwal; Stephan Mayer; J Michael Schmidt; E Sander Connolly; Jan Claassen Journal: Neurology Date: 2015-12-23 Impact factor: 9.910
Authors: Ayham Alkhachroum; Saptharishi Lalgudi Ganesan; Johannes P Koren; Julie Kromm; Nina Massad; Renz A Reyes; Michael R Miller; David Roh; Sachin Agarwal; Soojin Park; Jan Claassen Journal: Neurocrit Care Date: 2021-11-17 Impact factor: 3.210