Borges Daniel Filipe, Soares Joana Isabel, Dias Daniela, Cordeiro Helena, Leal Alberto
RISE-Health, Center for Translational Health and Medical Biotechnology Research (TBIO), E2S, Polytechnic University of Porto, Porto, Portugal.
Department of Neurophysiology, E2S, Polytechnic University of Porto, Porto, Portugal.
Epilepsia Open. 2025 Feb 18. doi: 10.1002/epi4.70004.
To clinically validate the contribution of a custom-built EEG wearable device (waEEG) compared to a full 10-20 electrode array ambulatory EEG (aEEG) for screening epilepsy cases in patients with suspected temporal lobe epilepsy (TLE) but negative routine EEGs.
Patients (aged 16-91 years) with clinically suspected TLE who were referred for a 24 h aEEG were fitted with an additional 2-channel bipolar waEEG device and prospectively enrolled in the study until 20 TLE diagnoses were confirmed by aEEG. 41 patients were included and their waEEG was blindly reviewed by two experienced clinical neurophysiologists and a semi-automated spike detection software to categorize patients into TLE (spikes present) and non-TLE (no spikes) groups.
The experts achieved good sensitivity (95%-100%) and accuracy (98%-93%) with excellent interrater agreement (kappa>0.80) in patient labelling. The semi-automated software performed poorly (40% sensitivity, 68% accuracy) and failed to classify TLE in more than half the cases. Classification was not affected by restricting spike detection to the evening and night time, which reduced the average length of the analyzed EEG from 23.4 to 10.4 h. Three false-positive spike detections were thoroughly analyzed and reclassified as artifacts due to eye and body movements and electrocardiographic contamination. To better control cardiac artifacts, the addition of an ECG channel to the waEEG is recommended.
Detection of spikes with waEEG allows accurate detection of epilepsy in suspected TLE cases, with less technical and professional effort and improved acceptance. This screening tool could improve the yield of follow-up with a conventional aEEG and provide an accessible method for monitoring interictal epileptiform activity in TLE.
Epilepsy is a chronic short circuit in the brain. In adults, it most often affects the temporal lobes, resulting in temporal lobe epilepsy (TLE). Seizures are infrequent but difficult to treat. Electroencephalography (EEG) is the best method to detect the electrical disturbances and is crucial to distinguish epilepsy from other non-epileptic disorders. Developing simple, inexpensive and easily accessible portable EEG methods that complement in-hospital assessment could significantly impact patient care. Our study aims to clinically validate a wearable epilepsy screening device to aid in TLE management, reduce delays in diagnosis and enable straightforward assessment of epileptic activity.
临床验证定制的脑电图可穿戴设备（waEEG）与全10-20电极阵列动态脑电图（aEEG）相比，在筛查疑似颞叶癫痫（TLE）但常规脑电图阴性的患者癫痫病例中的作用。
将临床疑似TLE且被转诊进行24小时aEEG检查的患者（年龄16-91岁）佩戴一个额外的双通道双极waEEG设备，并前瞻性纳入研究，直至通过aEEG确诊20例TLE诊断。共纳入41例患者，其waEEG由两名经验丰富的临床神经生理学家和一个半自动尖峰检测软件进行盲法评估，以将患者分为TLE（有尖峰）和非TLE（无尖峰）组。
专家们在患者标记方面达到了良好的敏感性（95%-100%）和准确性（98%-93%），评分者间一致性极佳（kappa>0.80）。半自动软件表现不佳（敏感性40%，准确性68%），超过半数病例未能对TLE进行分类。将尖峰检测限制在傍晚和夜间对分类没有影响，这将分析的脑电图平均时长从23.4小时缩短至10.4小时。对三个假阳性尖峰检测进行了深入分析，并重新分类为由于眼球和身体运动以及心电图干扰导致的伪迹。为了更好地控制心脏伪迹，建议在waEEG中增加一个心电图通道。
使用waEEG检测尖峰能够在疑似TLE病例中准确检测癫痫，所需技术和专业工作量更少且接受度更高。这种筛查工具可以提高常规aEEG随访的效率，并为监测TLE的发作间期癫痫样活动提供一种便捷的方法。
癫痫是大脑中的一种慢性短路。在成年人中，它最常影响颞叶，导致颞叶癫痫（TLE）。发作不频繁但难以治疗。脑电图（EEG）是检测电干扰的最佳方法，对于区分癫痫与其他非癫痫性疾病至关重要。开发简单、廉价且易于使用的便携式EEG方法以补充医院内评估，可能会对患者护理产生重大影响。我们的研究旨在临床验证一种可穿戴癫痫筛查设备，以辅助TLE管理，减少诊断延迟，并能够直接评估癫痫活动。
