Optimizing seizure detection by quantitative EEG in paediatric refractory status epilepticus
- Author:
Junjie HUANG
;
Gita KRISHNASWAMY
;
Jocelyn LIM
;
Nazima Binte SAHUL HAMED
;
Simon LING
;
Terrence THOMAS
;
Derrick CHAN
- Publication Type:Journal Article
- Keywords:
Density spectral array;
continuous EEG monitoring;
seizure detection;
refractory status epilepticus;
pediatric;
critical care
- From:Neurology Asia
2020;25(1):13-23
- CountryMalaysia
- Language:English
-
Abstract:
Background & Objective: Continuous electroencephalography (cEEG) is valuable in the diagnosis
and management of refractory status epilepticus (RSE) but requires intensive skilled interpretation.
Density spectral array (DSA) is a quantitative analytic tool used to screen cEEG recordings for seizures.
This study aims to determine the optimal amplitude setting and to compare the use of single-averagetrendgraph display and eight-trendgraph display in seizure detection with DSA. Methods: Five excerpts
from pediatric cEEG recordings with RSE were identified. In Phase 1 of the study, each of 4 readers
determined the DSA amplitude setting one most preferred for each excerpt, and marked all seizures
in one excerpt using one’s preferred setting. Inter-rater agreement in seizure detection was measured.
In Phase 2, readers marked all seizures in all excerpts, first using single-average-trendgraph display,
and then using eight-trendgraph display after a wash-out period. Intra-rater agreement in seizure
detection between the two display methods was calculated. Results: In Phase 1, DSA readers’ choice
of preferred amplitude settings varied widely but inter-rater agreement in seizure detection was high.
In Phase 2, seizure detection using single- and eight-trendgraph displays showed high agreement with
each other and, where they disagreed, single-average-trendgraph was more sensitive. Additionally,
low seizure-to-background amplitude ratio in EEG recordings was associated with worse detection
sensitivity/specificity.
Conclusions: DSA amplitude settings do not affect seizure detection. Single-trendgraph display is
comparable to eight-trendgraph display in screening cEEG for seizures. Seizure detection with DSA
performs better in cEEG recordings with high seizure-to-background amplitude ratio.
- Full text:7.2020my0003.pdf
