Ma Brandy B, Johnson Emily L, Ritzl Eva K
Department of Neurology, School of Medicine, University of California, San Francisco, San Francisco, California, U.S.A.
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
J Clin Neurophysiol. 2018 May;35(3):256-262. doi: 10.1097/WNP.0000000000000463.
Neurocritical care units commonly implement the double-distance reduced EEG montage in postoperative neurosurgic patients who have structural barriers that hinder the placement of a standard 10-20 system array. Despite its widespread use, its sensitivity has not been adequately addressed. We evaluated the sensitivity and specificity of this montage for seizure detection.
One hundred fifty-five full-montage continuous EEGs (cEEGs) completed in the Johns Hopkins University neurocritical care unit containing unequivocal electrographic seizures, status epilepticus, or other abnormalities were selected, comprising 73 ictal and 82 nonictal EEGs. EEGs were reformatted to the reduced montage, and 2-hour clips were reviewed independently by 2 epileptologists who documented the presence of seizures, status, or background abnormalities.
The sensitivity and specificity of the reduced montage for electrographic seizure detection was 81% and 92% with substantial interrater agreement (kappa 0.71). The sensitivity for status epilepticus was lower at 69%, but specificity remained high at 97% (kappa 0.67). Several EEGs miscategorized as nonictal were labeled as rather having rhythmic activity or periodic discharges. Evaluation of background patterns on the ictal-interictal continuum resulted in sensitivities ranging from 68% to 83%.
Although the specificity of the reduced array is good, epileptologists should remain vigilant when monitoring patients using this montage, given its reduced sensitivity for epileptic activity, especially status epilepticus.
神经重症监护病房通常会对术后存在结构障碍而妨碍标准10 - 20系统电极阵列放置的神经外科患者采用双倍距离缩减脑电图导联。尽管其应用广泛，但其敏感性尚未得到充分研究。我们评估了这种导联对癫痫检测的敏感性和特异性。
选取约翰霍普金斯大学神经重症监护病房完成的155份全导联连续脑电图（cEEG），这些脑电图包含明确的脑电图癫痫发作、癫痫持续状态或其他异常，其中包括73份发作期脑电图和82份非发作期脑电图。将脑电图重新格式化为缩减导联，由2名癫痫专家独立审查2小时的片段，记录癫痫发作、状态或背景异常的存在情况。
缩减导联对脑电图癫痫发作检测的敏感性和特异性分别为81%和92%，评分者间一致性较高（kappa值为0.71）。对癫痫持续状态的敏感性较低，为69%，但特异性仍较高，为97%（kappa值为0.67）。几份被误分类为非发作期的脑电图被标记为具有节律性活动或周期性放电。对发作期 - 发作间期连续体上背景模式的评估导致敏感性范围为68%至83%。
尽管缩减电极阵列的特异性良好，但鉴于其对癫痫活动尤其是癫痫持续状态的敏感性降低，癫痫专家在使用这种导联监测患者时应保持警惕。
