Section for Clinical Neurophysiology, Department of Neurology, Oslo University Hospital, Oslo, Norway.
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Ann Clin Transl Neurol. 2024 Oct;11(10):2685-2695. doi: 10.1002/acn3.52184. Epub 2024 Aug 26.
The Salzburg EEG criteria for nonconvulsive status epilepticus (NCSE) have been proposed as consensus criteria for NCSE. We aimed to perform an independent study of their diagnostic accuracy.
A prospective study was carried out at Oslo University Hospital, including all consecutive patients ≥15 years old who were referred for an EEG with an explicit or implicit question of NCSE from February 2020 to February 2022. Two independent EEG readers scored the included EEGs according to the Salzburg criteria and blinded to the clinical data. The reference standard was defined as the clinical diagnosis the patient received based on all available clinical and paraclinical data. Diagnostic accuracy in identifying "certain/possible NCSE" was assessed by calculating sensitivity, specificity, positive predictive value, and negative predictive value with their 95% confidence intervals.
In total, 469 patients/EEGs were included in the study. The prevalence of NCSE according to the reference standard was 11% (n = 53). The criteria showed a sensitivity of 94% (95% CI: 92-96%), a specificity of 77% (95% CI: 73-81%), a positive predictive value of 34% (95% CI: 30-39%), and a negative predictive value of 99% (95% CI: 98-100%). False positives for "certain NCSE" (n = 16) included many serial seizures and stimulus-induced rhythmic and periodic discharges (SIRPIDs), as well as a focal cortical dysplasia. False positives for "possible NCSE" (n = 79) were mainly represented by different encephalopathies and postictality.
The low specificity of the Salzburg criteria calls for refinement before implementation into daily clinical practice.
萨尔茨堡非惊厥性癫痫持续状态（NCSE）脑电图标准已被提出作为 NCSE 的共识标准。我们旨在对其诊断准确性进行独立研究。
一项前瞻性研究在奥斯陆大学医院进行，纳入了 2020 年 2 月至 2022 年 2 月期间因明确或隐含 NCSE 问题而接受脑电图检查的所有年龄≥15 岁的连续患者。两名独立的脑电图读者根据萨尔茨堡标准对纳入的脑电图进行评分，并对临床数据进行盲法。参考标准定义为根据所有可用的临床和辅助检查数据，患者接受的临床诊断。通过计算敏感性、特异性、阳性预测值和阴性预测值及其 95%置信区间来评估识别“确定/可能 NCSE”的诊断准确性。
共有 469 名患者/脑电图纳入研究。根据参考标准，NCSE 的患病率为 11%（n=53）。该标准的敏感性为 94%（95%CI：92-96%），特异性为 77%（95%CI：73-81%），阳性预测值为 34%（95%CI：30-39%），阴性预测值为 99%（95%CI：98-100%）。“确定 NCSE”的假阳性（n=16）包括许多连续发作和刺激诱导的节律和周期性放电（SIRPIDs），以及局灶性皮质发育不良。“可能 NCSE”的假阳性（n=79）主要代表不同的脑病和发作后状态。
萨尔茨堡标准的特异性较低，在将其纳入日常临床实践之前需要进行改进。
