Criteria for defining interictal epileptiform discharges in EEG
Top Cited Papers
Open Access
- 19 May 2020
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Neurology
- Vol. 94 (20), e2139-e2147
- https://doi.org/10.1212/wnl.0000000000009439
Abstract
Objective To define and validate criteria for accurate identification of EEG interictal epileptiform discharges (IEDs) using (1) the 6 sensor space criteria proposed by the International Federation of Clinical Neurophysiology (IFCN) and (2) a novel source space method. Criteria yielding high specificity are needed because EEG over-reading is a common cause of epilepsy misdiagnosis. Methods Seven raters reviewed EEG sharp transients from 100 patients with and without epilepsy (diagnosed definitively by video-EEG recording of habitual events). Raters reviewed the transients, randomized, and classified them as epileptiform or nonepileptiform in 3 separate rounds: in 2, EEG was reviewed in sensor space (scoring the presence/absence of each IFCN criterion for each transient or classifying unrestricted by criteria [expert scoring]); in the other, review and classification were performed in source space. Results Cutoff values of 4 and 5 criteria in sensor space and analysis in source space provided high accuracy (91%, 88%, and 90%, respectively), similar to expert scoring (92%). Two methods had specificity exceeding the desired threshold of 95%: using 5 IFCN criteria as cutoff and analysis in source space (both 95.65%); the sensitivity of these methods was 81.48% and 85.19%, respectively. Conclusions The presence of 5 IFCN criteria in sensor space and analysis in source space are optimal for clinical implementation. By extracting these objective features, diagnostic accuracy similar to expert scorings is achieved. Classification of evidence This study provides Class III evidence that IFCN criteria in sensor space and analysis in source space have high specificity (>95%) and sensitivity (81%–85%) for identification of IEDs.Keywords
This publication has 40 references indexed in Scilit:
- Fast evaluation of interictal spikes in long‐term EEG by hyper‐clusteringEpilepsia, 2012
- Errors in EEG Interpretation and Misdiagnosis of EpilepsyEuropean Neurology, 2008
- Normal Adult EEG and Patterns of Uncertain SignificanceJournal of Clinical Neurophysiology, 2006
- The misdiagnosis of epilepsy in children admitted to a tertiary epilepsy centre with paroxysmal eventsArchives of Disease in Childhood, 2006
- Preventing misdiagnosis of epilepsyArchives of Disease in Childhood, 2006
- The misdiagnosis of epilepsyBMJ, 2002
- Avoiding the Pitfalls of EEG Interpretation in Childhood EpilepsyEpilepsia, 1996
- Diagnosis of epilepsyThe Lancet, 1990
- DOES THE INTERICTAL EEG HAVE A ROLE IN THE DIAGNOSIS OF EPILEPSY?The Lancet, 1984
- A Practical Guide for Routine EEG Studies in EpilepsyJournal of Clinical Neurophysiology, 1984