Midline and Parasagittal Seizures are Rare in Adult Patients

Gururangan, Kapil; Parvizi, Josef

doi:10.1007/s12028-019-00804-6

Cited by 11 publications

(7 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…First, a new medical device recently developed by Ceribell (see conflict of interest) uses this configuration, and since the device is in clinical use in some of the authors' institutions, findings of our study will help us adjust our own views of its accuracy. Second, a recent report by two of the co-authors (JP and KG) reported that seizures limited to midline and parasagittal regions are rare (occurring in less than 1% of all EEG recordings) [30,31]. Third, this rm-EEG configuration has been previously demonstrated to have high sensitivity and specificity for generalized or hemispheric seizures and high specificity for generalized or hemispheric rhythmic or periodic patterns that are frequently seen in critically ill patients [32], in which case the lateral circumferential rm-EEG configuration should incur only minimal loss in diagnostic sensitivity.…”

Section: Full and Reduced Eeg Configurationsmentioning

confidence: 99%

Diagnostic Value of Electroencephalography with Ten Electrodes in Critically Ill Patients

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background: In critical care settings, electroencephalography (EEG) with reduced number of electrodes (reduced montage EEG, rm-EEG) might be a timely alternative to the conventional full montage EEG (fm-EEG). However, past studies have reported variable accuracies for detecting seizures using rm-EEG. We hypothesized that the past studies did not distinguish between differences in sensitivity from differences in classification of EEG patterns by different readers. The goal of the present study was to revisit the diagnostic value of rm-EEG when confounding issues are accounted for. Methods: We retrospectively collected 212 adult EEGs recorded at Massachusetts General Hospital and reviewed by two epileptologists with access to clinical, trending, and video information. In Phase I of the study, we re-configured the first 4 h of the EEGs in lateral circumferential montage with ten electrodes and asked new readers to interpret the EEGs without access to any other ancillary information. We compared their rating to the reading of hospital clinicians with access to ancillary information. In Phase II, we measured the accuracy of the same raters reading representative samples of the discordant EEGs in full and reduced configurations presented randomly by comparing their performance to majority consensus as the gold standard. Results: Of the 95 EEGs without seizures in the selected fm-EEG, readers of rm-EEG identified 92 cases (97%) as having no seizure activity. Of 117 EEGs with "seizures" identified in the selected fm-EEG, none of the cases was labeled as normal on rm-EEG. Readers of rm-EEG reported pathological activity in 100% of cases, but labeled them as seizures (N = 77), rhythmic or periodic patterns (N = 24), epileptiform spikes (N = 7), or burst suppression (N = 6). When the same raters read representative epochs of the discordant EEG cases (N = 43) in both fm-EEG and rm-EEG configurations, we found high concordance (95%) and intra-rater agreement (93%) between fm-EEG and rm-EEG diagnoses. Conclusions: Reduced EEG with ten electrodes in circumferential configuration preserves key features of the traditional EEG system. Discrepancies between rm-EEG and fm-EEG as reported in some of the past studies can be in part due to methodological factors such as choice of gold standard diagnosis, asymmetric access to ancillary clinical information, and inter-rater variability rather than detection failure of rm-EEG as a result of electrode reduction per se.

show abstract

Section: Full and Reduced Eeg Configurationsmentioning

confidence: 99%

Diagnostic Value of Electroencephalography with Ten Electrodes in Critically Ill Patients

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…It is important to note that in the 164 EEG episodes included in the DECIDE trial, the cohort did not include any focal seizures strictly restricted to midline or parasagittal regions that one could argue could have been missed by Rapid-EEG as a result of reduced spatial coverage. However, as described elsewhere, midline and parasagittal seizures are rare in adult patients, especially critically ill populations, and when midline and parasagittal seizures occur, they are often reflected in the temporal chains ( 12 ). Future studies might prospectively assess Rapid-EEG 's ability to detect these focal seizures.…”

Section: Discussionmentioning

confidence: 96%

“…This device consists of a ten-electrode array arranged circumferentially at the hairline to generate an eight-channel bipolar montage (i.e., lateral channels of the International 10-20 system). This circumferential montage has been shown to provide comparable diagnostic information to the conventional EEG system, despite eliminating midline and parasagittal channels (9)(10)(11)(12). A recent multicenter prospective clinical study (Does Use of Rapid Response EEG Impact Clinical Decision Making, DECIDE) demonstrated that Rapid-EEG shortened the time to EEG acquisition, increased physicians' confidence in diagnosis and treatment plans, and improved the accuracy of physicians' diagnoses compared to clinical judgment alone (13).…”

Section: Introductionmentioning

confidence: 99%

Comparing Seizures Captured by Rapid Response EEG and Conventional EEG Recordings in a Multicenter Clinical Study

et al. 2022

Self Cite

View full text Add to dashboard Cite

ObjectiveA recent multicenter prospective study (DECIDE trial) examined the use of Ceribell Rapid Response EEG (Rapid-EEG) in the emergent evaluation and management of critically ill patients suspected to have non-convulsive seizures. We present a detailed, patient-level examination of seizures detected either on initial Rapid-EEG or subsequent conventional EEG within 24 h to investigate whether seizures were missed on Rapid-EEG due to the exclusion of midline/parasagittal coverage.MethodsWe identified from 164 patients studied in the DECIDE trial those who had seizures detected on Rapid-EEG but not conventional EEG (n = 6), conventional EEG but not Rapid-EEG (n = 4), or both Rapid-EEG and conventional EEG (n = 9). We examined the electrographic characteristics of ictal and interictal findings on both devices, especially their detection in lateral or midline/parasagittal chains, and patient clinical histories to identify contributors toward discordant seizure detection.ResultsSeizures detected on both EEG systems had similar electrographic appearance and laterality. Seizures detected only on conventional EEG (within 24 h following Rapid-EEG) were visible in the temporal chains, and external clinical factors (e.g., treatment with anti-seizure medications, sedation, and duration of recordings) explained the delayed presentation of seizures. Patients with seizures detected only by Rapid-EEG were treated with anti-seizure medications, and subsequent conventional EEG detected interictal highly epileptiform patterns with similar laterality.ConclusionsOur case series demonstrates that electrographic data obtained from initial Rapid-EEG and subsequent conventional EEG monitoring are largely concordant relative to morphology and laterality. These findings are valuable to inform future investigation of abbreviated EEG systems to optimize management of suspected non-convulsive seizures and status epilepticus. Future, larger studies could further investigate the value of Rapid-EEG findings for forecasting and predicting seizures in long-term EEG recordings.

show abstract

“…11 This method should theoretically offer better sensitivity for nonconvulsive seizures, detecting not only tonic-clonic seizures but most focal impaired awareness seizures and spatially restricted seizures that involve the temporal lobe. 14…”

Section: In-ear Eegmentioning

confidence: 99%

Long-Term Home EEG Recording: Wearable and Implantable Devices

Rehman,

Higdon,

Sperling

2023

Journal of Clinical Neurophysiology

View full text Add to dashboard Cite

Summary: Electroencephalography (EEG) monitoring has served as a cornerstone in the diagnostic and therapeutic evaluation of epilepsy since its development. This has been accomplished with short-term inpatient video-EEG hospitalization enabling observation of both the semiological and the electrographic features of seizures or with short-term home ambulatory EEG or video-EEG. The advantages of inpatient video-EEG monitoring are limited by high cost, inconvenience, and inability to monitor patients for long periods (weeks or months) as might be done in the outpatient setting. This limitation has impelled the development of wearable EEG devices, which aim to capture high-quality long-term EEG data in a user-friendly and unobtrusive manner. This review article aims to summarize three broad categories of wearable EEG devices, including scalp, subcutaneous, and intracranial EEG. In this review, we will discuss the features of each type of device and the implications for the management of epilepsy. This review does not aim to describe every wearable EEG device on the market but instead seeks to provide a broad overview of the various categories of device that are available, giving examples of each and those in development (with no intention to recommend or advocate for any particular product).

show abstract

Midline and Parasagittal Seizures are Rare in Adult Patients

Cited by 11 publications

References 27 publications

Diagnostic Value of Electroencephalography with Ten Electrodes in Critically Ill Patients

Diagnostic Value of Electroencephalography with Ten Electrodes in Critically Ill Patients

Comparing Seizures Captured by Rapid Response EEG and Conventional EEG Recordings in a Multicenter Clinical Study

Long-Term Home EEG Recording: Wearable and Implantable Devices

Contact Info

Product

Resources

About