PMID- 34723711
OWN - NLM
STAT- MEDLINE
DCOM- 20230410
LR  - 20230412
IS  - 2169-5202 (Electronic)
IS  - 1550-0594 (Print)
IS  - 1550-0594 (Linking)
VI  - 54
IP  - 3
DP  - 2023 May
TI  - Pitfalls in EEG Analysis in Patients With Nonconvulsive Status Epilepticus: A 
      Preliminary Study.
PG  - 255-264
LID - 10.1177/15500594211050492 [doi]
AB  - Objective: Electroencephalography (EEG) interpretations through visual (by human 
      raters) and automated (by computer technology) analysis were still not reliable 
      for the diagnosis of nonconvulsive status epilepticus (NCSE). This study aimed to 
      identify typical pitfalls in the EEG analysis and make suggestions as to how 
      those pitfalls might be avoided. Methods: We analyzed the EEG recordings of 
      individuals who had clinically confirmed or suspected NCSE. Epileptiform EEG 
      activity during seizures (ictal discharges) was visually analyzed by 2 
      independent raters. We investigated whether unreliable EEG visual interpretations 
      quantified by low interrater agreement can be predicted by the characteristics of 
      ictal discharges and individuals' clinical data. In addition, the EEG recordings 
      were automatically analyzed by in-house algorithms. To further explore the causes 
      of unreliable EEG interpretations, 2 epileptologists analyzed EEG patterns most 
      likely misinterpreted as ictal discharges based on the differences between the 
      EEG interpretations through the visual and automated analysis. Results: Short 
      ictal discharges with a gradual onset (developing over 3 s in length) were liable 
      to be misinterpreted. An extra 2 min of ictal discharges contributed to an 
      increase in the kappa statistics of >0.1. Other problems were the 
      misinterpretation of abnormal background activity (slow-wave activities, other 
      abnormal brain activity, and the ictal-like movement artifacts), continuous 
      interictal discharges, and continuous short ictal discharges. Conclusion: A 
      longer duration criterion for NCSE-EEGs than 10 s that is commonly used in NCSE 
      working criteria is recommended. Using knowledge of historical EEGs, 
      individualized algorithms, and context-dependent alarm thresholds may also avoid 
      the pitfalls.
FAU - Wang, Ying
AU  - Wang Y
AUID- ORCID: 0000-0003-4385-9117
AD  - 534522Eindhoven University of Technology, Eindhoven, the Netherlands.
AD  - 98810Radboud University, Nijmegen, the Netherlands.
AD  - 3804Academic Center for Epileptology Kempenhaeghe, Heeze, the Netherlands.
FAU - Zibrandtsen, Ivan C
AU  - Zibrandtsen IC
AUID- ORCID: 0000-0002-0529-0110
AD  - 53140Zealand University Hospital, Roskilde, Denmark.
FAU - Lazeron, Richard H C
AU  - Lazeron RHC
AUID- ORCID: 0000-0001-5570-8872
AD  - 534522Eindhoven University of Technology, Eindhoven, the Netherlands.
AD  - 3804Academic Center for Epileptology Kempenhaeghe, Heeze, the Netherlands.
FAU - van Dijk, Johannes P
AU  - van Dijk JP
AD  - 534522Eindhoven University of Technology, Eindhoven, the Netherlands.
AD  - 3804Academic Center for Epileptology Kempenhaeghe, Heeze, the Netherlands.
FAU - Long, Xi
AU  - Long X
AD  - 534522Eindhoven University of Technology, Eindhoven, the Netherlands.
AD  - 35491Philips Research, Eindhoven, the Netherlands.
FAU - Aarts, Ronald M
AU  - Aarts RM
AD  - 534522Eindhoven University of Technology, Eindhoven, the Netherlands.
FAU - Wang, Lei
AU  - Wang L
AD  - 534522Eindhoven University of Technology, Eindhoven, the Netherlands.
FAU - Arends, Johan B A M
AU  - Arends JBAM
AD  - 534522Eindhoven University of Technology, Eindhoven, the Netherlands.
AD  - 3804Academic Center for Epileptology Kempenhaeghe, Heeze, the Netherlands.
LA  - eng
PT  - Journal Article
DEP - 20211101
PL  - United States
TA  - Clin EEG Neurosci
JT  - Clinical EEG and neuroscience
JID - 101213033
SB  - IM
MH  - Humans
MH  - *Electroencephalography
MH  - *Status Epilepticus/diagnosis
MH  - Seizures/diagnosis
MH  - Time Factors
MH  - Algorithms
PMC - PMC10084519
OTO - NOTNLM
OT  - NCSE
OT  - interrater agreement
OT  - misinterpretation
OT  - reliability
OT  - seizure
COIS- The authors declared no potential conflicts of interest with respect to the 
      research, authorship, and/or publication of this article.
EDAT- 2021/11/02 06:00
MHDA- 2023/04/10 06:42
PMCR- 2023/04/10
CRDT- 2021/11/01 16:35
PHST- 2023/04/10 06:42 [medline]
PHST- 2021/11/02 06:00 [pubmed]
PHST- 2021/11/01 16:35 [entrez]
PHST- 2023/04/10 00:00 [pmc-release]
AID - 10.1177_15500594211050492 [pii]
AID - 10.1177/15500594211050492 [doi]
PST - ppublish
SO  - Clin EEG Neurosci. 2023 May;54(3):255-264. doi: 10.1177/15500594211050492. Epub 
      2021 Nov 1.