Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin, Germany.
Department of Neurology, Epilepsy-Center Berlin-Brandenburg, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Epilepsia Open. 2023 Sep;8(3):877-887. doi: 10.1002/epi4.12754. Epub 2023 May 19.
To investigate cost in working hours for initial integration of interictal EEG source localization (ESL) into clinical practice of a tertiary epilepsy center, and to examine concordance of results obtained with three different ESL pipelines.
This prospective study covered the first year of using ESL in the Epilepsy-Center Berlin-Brandenburg. Patients aged ≥14 years with drug-resistant focal epilepsy referred for noninvasive presurgical evaluation were included. Interictal ESL was based on low-density EEG and individual head models. Source maxima were obtained from two freely available software packages and one commercial provider. One physician and computer scientist documented their working hours for setting up and processing ESL. Additionally, a survey was conducted among epilepsy centers in Germany to assess the current role of ESL in presurgical evaluation.
Of 40 patients included, 22 (55%) had enough interictal spikes for ESL. The physician's working times decreased from median 4.7 hours [interquartile range 3.9-6.4] in the first third of cases to 2.0 hours [1.9-2.4] in the remaining two thirds; P < 0.01. In addition, computer scientist and physician spent a total of 35.5 and 33.0 working hours on setting up the digital infrastructure, and on training and testing. Sublobar agreement between all three pipelines was 20%, mean measurement of agreement (kappa) 0.13. Finally, the survey revealed that 53% of epilepsy centers in Germany currently use ESL for presurgical evaluation.
This study provides information regarding expected effort and costs for integration of ESL into an epilepsy surgery program. Low result agreement across different ESL pipelines calls for further standardization.
研究将间期脑电图源定位（ESL）初始整合到三级癫痫中心临床实践中的工作时间成本，并检验三种不同 ESL 管道的结果一致性。
这项前瞻性研究涵盖了在柏林-勃兰登堡癫痫中心使用 ESL 的第一年。纳入了年龄≥14 岁、患有耐药性局灶性癫痫、接受非侵入性术前评估的患者。间期 ESL 基于低密度 EEG 和个体头部模型。源最大值是从两个免费的软件包和一个商业供应商获得的。一名医生和计算机科学家记录了他们设置和处理 ESL 的工作时间。此外，还对德国的癫痫中心进行了一项调查，以评估 ESL 在术前评估中的当前作用。
40 名纳入患者中，22 名（55%）有足够的间期棘波进行 ESL。医生的工作时间从最初三分之一病例的中位数 4.7 小时（四分位距 3.9-6.4）减少到剩余三分之二病例的 2.0 小时（1.9-2.4）；P<0.01。此外，计算机科学家和医生总共花费了 35.5 和 33.0 个工作小时来设置数字基础设施，并进行培训和测试。所有三种管道之间的亚叶间一致性为 20%，平均一致性测量（kappa）为 0.13。最后，调查显示，德国 53%的癫痫中心目前将 ESL 用于术前评估。
这项研究提供了有关将 ESL 整合到癫痫手术项目中所需的预期工作和成本的信息。不同 ESL 管道之间的结果一致性较低，需要进一步标准化。
