Nordli D R, Bazil C W, Scheuer M L, Pedley T A
Department of Neurology, Columbia Presbyterian Medical Center, New York, New York, USA.
Epilepsia. 1997 May;38(5):553-60. doi: 10.1111/j.1528-1157.1997.tb01140.x.
We wished to assess the reliability of the International League Against Epilepsy (ILAE) seizure classification system applied to infantile seizures and to test a proposed new classification.
We first analyzed 39 seizures in 20 infants (aged 1-26 months) recorded with simultaneous closed-circuit television and EEG (CCTV/EEG). EEGs and videotapes of all seizures were independently analyzed by two epileptologists blinded to clinical histories. Videotapes of each seizure were reviewed without simultaneous EEG (phase 1), and printouts of ictal EEGs were assessed without behavioral correlates (phase II). The observers classified seizures according to ILAE criteria. Interrater agreement was assessed by the kappa statistic.
Agreement on EEG features (phase II) was moderate (= 0.54) in identifying focal ictal onsets and substantial (= 0.79) in identifying generalized onsets. In contrast, analysis of videotapes showed substantial disagreement between observers in terms of classifying seizures as partial or generalized. Therefore, agreement between observers for partial was slight (= 0.14) and fair for generalized seizures (= 0.26). Similarly, conclusions of the observers as compared with those of a consensus panel were divergent for both partial (= 0.18) and generalized seizures (= 0.30). We therefore developed an alternative classification scheme and retested interrater agreement in a review of 50 seizures in 25 other infants. With this classification scheme, there was substantial agreement between observers (= 0.72).
With clinical observations and interictal EEGs, seizures in infants cannot be reliably classified by current ILAE criteria. In contrast, a proposed new classification scheme based solely on semiology showed substantial reliability.
我们希望评估国际抗癫痫联盟（ILAE）癫痫发作分类系统应用于婴儿癫痫发作的可靠性，并测试一种新提出的分类方法。
我们首先分析了20名婴儿（年龄1至26个月）的39次癫痫发作，这些发作通过同步闭路电视和脑电图（CCTV/EEG）进行记录。所有癫痫发作的脑电图和录像带由两名对临床病史不知情的癫痫专家独立分析。每次癫痫发作的录像带在没有同步脑电图的情况下进行审查（第一阶段），发作期脑电图打印件在没有行为关联的情况下进行评估（第二阶段）。观察者根据ILAE标准对癫痫发作进行分类。通过kappa统计量评估观察者间的一致性。
在识别局灶性发作起始方面，脑电图特征（第二阶段）的一致性为中等（κ = 0.54），在识别全身性发作起始方面一致性较高（κ = 0.79）。相比之下，录像带分析显示观察者在将癫痫发作分类为部分性或全身性方面存在很大分歧。因此，观察者间部分性发作的一致性轻微（κ = 0.14），全身性发作的一致性一般（κ = 0.26）。同样，与共识小组相比，观察者对部分性发作（κ = 0.18）和全身性发作（κ = 0.30）的结论也存在分歧。因此，我们制定了一种替代分类方案，并在对另外25名婴儿的50次癫痫发作进行审查时重新测试观察者间的一致性。采用这种分类方案，观察者间存在较高的一致性（κ = 0.72）。
基于临床观察和发作间期脑电图，目前的ILAE标准无法可靠地对婴儿癫痫发作进行分类。相比之下，一种仅基于症状学提出的新分类方案显示出较高的可靠性。
