Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska, U.S.A.
Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska, U.S.A.; and.
J Clin Neurophysiol. 2022 Jan 1;39(1):85-91. doi: 10.1097/WNP.0000000000000742.
Prefabricated arrays with a limited number of electrodes offer an opportunity to hasten the diagnosis of seizures; however, their accuracy to detect seizures is unknown. We examined the utility of two limited-montage EEG setups for the detection of nonconvulsive seizures.
Thirty previously interpreted EEG segments with nonconvulsive seizures from 30 patients and 60 segments with background slowing or normal EEG from 60 patients were rendered in a bipolar "double banana" montage, a double distance "neonatal" montage, and a circumferential "hatband" montage. Experts reviewed 60 to 180 seconds long segments to determine whether seizures were present and if the EEG data provided were sufficient to make a decision on escalation of clinical care by ordering an additional EEG or prescribing anticonvulsants. The periodic patterns on the ictal-interictal continuum were specifically excluded for this analysis to keep the focus on definite electrographic seizures.
The sensitivities for seizure of the neonatal and hatband montages were 0.96 and 0.84, respectively, when compared with full montage EEG, whereas the specificities were 0.94 and 0.98, respectively. Appropriate escalation of care was suggested for 96% and 92% of occurrences of seizure patterns in neonatal and hatband montages, respectively. When compared with clinical EEG, the sensitivities of the neonatal and hatband montages for seizure diagnosis were 0.85 and 0.69, respectively.
Nonconvulsive seizures were detected with high accuracy using the limited electrode array configuration in the neonatal and hatband montages. The sensitivity of the neonatal montage EEG in detecting seizures was superior to that of a hatband montage. These findings suggest that in some patients with nonconvulsive seizures, limited-montage EEG may allow to differentiate ictal and slow patterns.
具有有限电极数的预制阵列提供了加速癫痫诊断的机会；然而，其检测癫痫的准确性尚不清楚。我们研究了两种有限电极脑电图设置在检测非惊厥性癫痫中的效用。
从 30 名患者的 30 个先前解释的脑电图片段中提取非惊厥性癫痫片段和 60 个背景减慢或正常脑电图片段，并以双极“双香蕉”导联、双距离“新生儿”导联和环形“帽带”导联呈现。专家审查了 60 至 180 秒长的片段，以确定是否存在癫痫发作，以及脑电图数据是否足以决定通过额外的脑电图或开处方抗癫痫药来升级临床护理。为了保持对明确的脑电图癫痫的关注，在分析中专门排除了发作-发作间连续体上的周期性模式。
与全导联脑电图相比，新生儿和帽带导联的癫痫发作灵敏度分别为 0.96 和 0.84，而特异性分别为 0.94 和 0.98。新生儿和帽带导联分别提示 96%和 92%的癫痫发作模式发生时适当升级护理。与临床脑电图相比，新生儿和帽带导联检测癫痫的灵敏度分别为 0.85 和 0.69。
使用新生儿和帽带导联的有限电极阵列配置，可以高精度地检测非惊厥性癫痫。新生儿导联脑电图检测癫痫的灵敏度优于帽带导联。这些发现表明，在一些非惊厥性癫痫患者中，有限导联脑电图可能允许区分发作和缓慢模式。
