Seizure detection using digital trend analysis: Factors affecting utility

Akman, Cigdem I.; Micic, Vesna; Thompson, Anita; Riviello, James J.

doi:10.1016/j.eplepsyres.2010.10.018

Cited by 48 publications

(52 citation statements)

References 21 publications

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“…Studies in the adult and pediatric population also evaluating individual qEEG trends (aEEG, CDSA, or envelope trend), but derived from full channel cEEGs, report higher sensitivities for seizure detection from 41% to 89% (Abend et al, 2008;Ackman et al, 2011;Stewart et al, 2010;Williamson et al, 2014). The higher sensitivities in these studies may be attributed to the fact that the qEEG data were derived from full-channel EEG montages rather than limited-channel EEG montages.…”

Section: Discussionmentioning

confidence: 74%

“…One study in the pediatric population detected an improvement in seizure detection when CDSA was combined with envelope trend analysis compared with envelope trend analysis alone (sensitivity of 66% vs. 50%, respectively), but this benefit was only seen with experienced readers, not inexperienced readers (Ackman et al, 2011). Similarly, it has been our observation that using a panel of qEEG trends seems to enhance seizure detection compared with using a single type of trend.…”

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confidence: 75%

“…Although commercial EEG software increasingly includes qEEG tools, the evidence for its diagnostic accuracy is sparse. Studies in the adult and pediatric population evaluating individual qEEG trends (envelope trend, amplitude integrated EEG [aEEG], or color density spectral array [CDSA]) derived from full-channel EEG montages report sensitivities for seizure detection from 41% to 89% (Abend et al, 2008;Ackman et al, 2011;Stewart et al, 2010;Williamson et al, 2014).…”

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confidence: 99%

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Diagnostic Accuracy of Electrographic Seizure Detection by Neurophysiologists and Non-Neurophysiologists in the Adult ICU Using a Panel of Quantitative EEG Trends

Swisher

White

Mace

et al. 2015

Journal of Clinical Neurophysiology

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Purpose: To evaluate the sensitivity and specificity of a panel of quantitative EEG (qEEG) trends for seizure detection in adult intensive care unit (ICU) patients when reviewed by neurophysiologists and non-neurophysiologists. Methods: One hour qEEG panels (n ¼ 180) were collected retrospectively from 45 ICU patients and were distributed to 5 neurophysiologists, 7 EEG technologists, and 5 Neuroscience ICU nurses for evaluation of seizures. Each panel consisted of the following qEEG tools, displayed separately for left and right hemisphere electrodes: rhythmicity spectrogram (rhythmic run detection and display; Persyst Inc), color density spectral array, EEG asymmetry index, and amplitude integrated EEG. The reviewers did not have access to the raw EEG data. Results: For the reviewer's ability to detect the presence of seizures on qEEG panels when compared with the gold standard of independent raw EEG review, the sensitivities and specificities are as follows: neurophysiologists 0.87 and 0.61, EEG technologists 0.80 and 0.80, and Neuroscience ICU nurses 0.87 and 0.61, respectively. There was no statistical difference among the three groups regarding sensitivity. Conclusions: Quantitative EEG display panels are a promising tool to aid detection of seizures by non-neurophysiologists as well as by neurophysiologists. However, even when used as a panel, qEEG trends do not appear to be adequate as the sole method for reviewing continuous EEG data.

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Section: Discussionmentioning

confidence: 74%

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confidence: 75%

mentioning

confidence: 99%

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Diagnostic Accuracy of Electrographic Seizure Detection by Neurophysiologists and Non-Neurophysiologists in the Adult ICU Using a Panel of Quantitative EEG Trends

Swisher

White

Mace

et al. 2015

Journal of Clinical Neurophysiology

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“…29 Another study applying color density spectral array and envelope trend demonstrated that sensitivity for seizure identification depends on user experience, display size, and inherent seizure characteristics such as duration. 30 We found that 38% of electrographic seizures in children in the PICU lasted less than 1 minute, indicating that a substantial proportion of seizures may be "averaged-out" by highly compressed displays. Both this study and a prior single-center study reported worse short-term outcome with electrographic status epilepticus but not electrographic seizures.…”

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confidence: 99%

Electrographic seizures in pediatric ICU patients

et al. 2013

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Objectives: We aimed to determine the incidence of electrographic seizures in children in the pediatric intensive care unit who underwent EEG monitoring, risk factors for electrographic seizures, and whether electrographic seizures were associated with increased odds of mortality.Methods: Eleven sites in North America retrospectively reviewed a total of 550 consecutive children in pediatric intensive care units who underwent EEG monitoring. We collected data on demographics, diagnoses, clinical seizures, mental status at EEG onset, EEG background, interictal epileptiform discharges, electrographic seizures, intensive care unit length of stay, and in-hospital mortality.Results: Electrographic seizures occurred in 162 of 550 subjects (30%), of which 61 subjects (38%) had electrographic status epilepticus. Electrographic seizures were exclusively subclinical in 59 of 162 subjects (36%). A multivariable logistic regression model showed that independent risk factors for electrographic seizures included younger age, clinical seizures prior to EEG monitoring, an abnormal initial EEG background, interictal epileptiform discharges, and a diagnosis of epilepsy. Subjects with electrographic status epilepticus had greater odds of in-hospital death, even after adjusting for EEG background and neurologic diagnosis category.Conclusions: Electrographic seizures are common among children in the pediatric intensive care unit, particularly those with specific risk factors. Electrographic status epilepticus occurs in more than one-third of children with electrographic seizures and is associated with higher in-hospital mortality. Neurology â 2013;81:383-391 GLOSSARY CEEG 5 continuous EEG; CI 5 confidence interval; IQR 5 interquartile range; OR 5 odds ratio; PICU 5 pediatric intensive care unit.

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“…Neurol Clin Pract 2017;7:15-25 C ontinuous EEG monitoring (cEEG) in acutely hospitalized patients has increased dramatically throughout the last decade. [1][2][3][4][5][6] cEEG has been particularly helpful in acutely ill patients at risk for nonconvulsive seizures, 4,7,8 and has been reported to contribute to reduced inpatient mortality without additional charges to hospital stay. 9 In addition, cEEG is increasingly used to detect cerebral ischemia in patients at high risk, 5,[9][10][11] with ischemia monitoring protocols often involving monitoring at-risk patients for as long as 10 or more days.…”

Section: Introductionmentioning

confidence: 99%

cEEG electrode-related pressure ulcers in acutely hospitalized patients

Moura

Carneiro²,

Kwasnik

et al. 2017

Neur Clin Pract

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Background: Pressure ulcers resulting from continuous EEG (cEEG) monitoring in hospitalized patients have gained attention as a preventable medical complication. We measured their incidence and risk factors. Methods: We performed an observational investigation of cEEG-electrode-related pressure ulcers (EERPU) among acutely ill patients over a 22-month period. Variables analyzed included age, sex, monitoring duration, hospital location, application methods, vasopressor usage, nutritional status, skin allergies, fever, and presence/severity of EERPU. We examined risk for pressure ulcers vs monitoring duration using Kaplan-Meyer survival analysis, and performed multivariate risk assessment using Cox proportional hazard model. Results:Among 1,519 patients, EERPU occurred in 118 (7.8%). Most (n 5 109, 92.3%) consisted of hyperemia only without skin breakdown. A major predictor was monitoring duration, with 3-, 5-, and 10-day risks of 16%, 32%, and 60%, respectively. Risk factors included older age (mean age 60.65 vs 50.3, p , 0.01), care in an intensive care unit (9.37% vs 5.32%, p , 0.01), lack of a head wrap (8.31% vs 27.3%, p 5 0.02), use of vasopressors (16.7% vs 9.64%, p , 0.01), enteral feeding (11.7% vs 5.45%, p 5 0.04), and fever (18.4% vs 9.3%, p , 0.01). Elderly patients (71-80 years) were at higher risk (hazard ratio 6.84 [1.95-24], p , 0.01), even after accounting for monitoring time and other pertinent variables in multivariate analysis. Conclusions: EERPU are uncommon and generally mild. Elderly patients and those with more severe illness have higher risk of developing EERPU, and the risk increases as a function of monitoring duration. Neurol Clin Pract 2017;7:15-25

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Seizure detection using digital trend analysis: Factors affecting utility

Cited by 48 publications

References 21 publications

Diagnostic Accuracy of Electrographic Seizure Detection by Neurophysiologists and Non-Neurophysiologists in the Adult ICU Using a Panel of Quantitative EEG Trends

Diagnostic Accuracy of Electrographic Seizure Detection by Neurophysiologists and Non-Neurophysiologists in the Adult ICU Using a Panel of Quantitative EEG Trends

Electrographic seizures in pediatric ICU patients

cEEG electrode-related pressure ulcers in acutely hospitalized patients

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