Criteria for defining interictal epileptiform discharges in EEG: A clinical validation study

Mustafa Aykut Kural; Lene Duez; Vibeke Sejer Hansen; Pål G. Larsson; Stefan Rampp; Reinhard Schulz; Hatice Tankisi; Richard Wennberg; Bo M. Bibby; Michael Scherg; Sándor Beniczky

doi:10.1212/WNL.0000000000009439

Criteria for defining interictal epileptiform discharges in EEG: A clinical validation study

Mustafa Aykut Kural, Lene Duez, Vibeke Sejer Hansen, Pål G. Larsson, Stefan Rampp, Reinhard Schulz, Hatice Tankisi, Richard Wennberg, Bo M. Bibby, Michael Scherg, Sándor Beniczky

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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.

Original language	English
Journal	Neurology
Volume	94
Issue	20
Pages (from-to)	e2139-e2147
Number of pages	9
ISSN	0028-3878
DOIs	https://doi.org/10.1212/WNL.0000000000009439
Publication status	Published - May 2020

Keywords

ACCURACY
CHILDREN
DIAGNOSIS
EPILEPSY
ERRORS
MISDIAGNOSIS
PATTERNS
PITFALLS

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e2139.fullFinal published version, 547 KBLicence: CC BY-NC-ND

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@article{3060459e9e8f4fde825ad11399108b81,

title = "Criteria for defining interictal epileptiform discharges in EEG: A clinical validation study",

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 = "ACCURACY, CHILDREN, DIAGNOSIS, EPILEPSY, ERRORS, MISDIAGNOSIS, PATTERNS, PITFALLS",

author = "Kural, {Mustafa Aykut} and Lene Duez and {Sejer Hansen}, Vibeke and Larsson, {P{\aa}l G.} and Stefan Rampp and Reinhard Schulz and Hatice Tankisi and Richard Wennberg and Bibby, {Bo M.} and Michael Scherg and S{\'a}ndor Beniczky",

year = "2020",

month = may,

doi = "10.1212/WNL.0000000000009439",

language = "English",

volume = "94",

pages = "e2139--e2147",

journal = "Neurology",

issn = "0028-3878",

publisher = "Lippincott Williams and Wilkins",

number = "20",

}

TY - JOUR

T1 - Criteria for defining interictal epileptiform discharges in EEG

T2 - A clinical validation study

AU - Kural, Mustafa Aykut

AU - Duez, Lene

AU - Sejer Hansen, Vibeke

AU - Larsson, Pål G.

AU - Rampp, Stefan

AU - Schulz, Reinhard

AU - Tankisi, Hatice

AU - Wennberg, Richard

AU - Bibby, Bo M.

AU - Scherg, Michael

AU - Beniczky, Sándor

PY - 2020/5

Y1 - 2020/5

N2 - 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.

AB - 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.

KW - ACCURACY

KW - CHILDREN

KW - DIAGNOSIS

KW - EPILEPSY

KW - ERRORS

KW - MISDIAGNOSIS

KW - PATTERNS

KW - PITFALLS

UR - http://www.scopus.com/inward/record.url?scp=85084877523&partnerID=8YFLogxK

U2 - 10.1212/WNL.0000000000009439

DO - 10.1212/WNL.0000000000009439

M3 - Journal article

C2 - 32321764

AN - SCOPUS:85084877523

SN - 0028-3878

VL - 94

SP - e2139-e2147

JO - Neurology

JF - Neurology

IS - 20

ER -

Criteria for defining interictal epileptiform discharges in EEG: A clinical validation study

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