Bennis Frank C, Geertsema Evelien E, Velis Demetrios N, Reus Elise Em, Visser Gerhard H
Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, University of Twente, MIRA-Institute for Biomedical Technology and Technical Medicine, Enschede, Present address: Department of Biomedical Engineering, Maastricht University, Maastricht.
Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede.
Epileptic Disord. 2017 Sep 1;19(3):307-314. doi: 10.1684/epd.2017.0926.
Epilepsy is difficult to diagnose using routine EEG recordings of short duration in patients who have low seizure frequency. Long-term EEG may be useful but is impractical in an out-of-hospital setting. We investigated whether single-channel scalp EEG placed behind the earlobe is suitable for seizure identification during prolonged EEG monitoring. Scalp EEG samples were selected from subjects over 15 years of age, and comprised two segments of either background followed by seizure or background followed by background. Bipolar EEG derivations in three directions (F8-T8, C4-T8 and T8-P8) were evaluated for the presence of a seizure by two experienced reviewers. For each EEG segment containing a seizure, one pair of electrodes was oriented towards the suspected region of seizure onset, while two pairs of electrodes were oriented elsewhere. The EEG data contained five frontally localized seizures, five parietal, five temporal, two occipital, and four primary or secondary generalized seizures. The sensitivity and specificity for recognition of seizures was 86% and 95% for Reviewer 1, and 79% and 99% for Reviewer 2, respectively. When identifying a seizure with the lead orientation towards the region of seizure onset, both reviewers identified 20 out of 21 seizures (95%). When the lead was not oriented towards the region of seizure onset, the reviewers identified 34 and 30 out of 42 ictal records correctly, respectively. These results suggest that it is possible to identify epileptic seizures by bipolar EEG derivation using only two scalp electrodes. Lead orientation towards the suspected region of seizure onset is important for optimal detection sensitivity.
对于癫痫发作频率较低的患者，使用常规的短程脑电图记录很难进行诊断。长期脑电图监测可能有用，但在院外环境中并不实际。我们研究了置于耳垂后方的单通道头皮脑电图是否适用于长时间脑电图监测期间的癫痫发作识别。头皮脑电图样本选自15岁以上的受试者，包括两段，一段是背景脑电图后接癫痫发作，另一段是背景脑电图后接背景脑电图。由两名经验丰富的评估人员对三个方向（F8-T8、C4-T8和T8-P8）的双极脑电图导联进行癫痫发作评估。对于每一段包含癫痫发作的脑电图，一对电极指向癫痫发作的疑似起始区域，而另外两对电极指向其他位置。脑电图数据包含5次额叶局部性癫痫发作、5次顶叶癫痫发作、5次颞叶癫痫发作、2次枕叶癫痫发作以及4次原发性或继发性全身性癫痫发作。评估人员1识别癫痫发作的敏感性和特异性分别为86%和95%，评估人员2分别为79%和99%。当导联指向癫痫发作区域来识别癫痫发作时，两名评估人员在21次癫痫发作中均识别出20次（95%）。当导联未指向癫痫发作区域时，评估人员分别从42次发作期记录中正确识别出34次和30次。这些结果表明，仅使用两个头皮电极通过双极脑电图导联来识别癫痫发作是可行的。导联指向癫痫发作的疑似起始区域对于获得最佳检测敏感性很重要。
