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Postictal EEG changes following focal seizures: Interrater agreement and comparison to frequency analysis
Affiliation:1. Department of Neurophysiology, Zealand University Hospital, Roskilde, Denmark;2. Department of Clinical Medicine, University of Copenhagen, Denmark;3. Department of Neuroscience, University of Copenhagen, Denmark;4. Department of Clinical Neurophysiology, Danish Epilepsy Centre and Aarhus University Hospital, Denmark;1. University of California, Irvine, Biomedical Engineering, 3120 Natural Sciences II, University of California, Irvine, CA 92697, USA;2. University of California Irvine Medical Center, Neurology, 101 The City Drive South, Pavilion 1, Orange, CA 92868, USA;3. University of California, Irvine, Neurology, 101 The City Drive South, Building 22C, 2nd Floor, RT13, Orange, CA 92602, USA;4. University of California, Irvine, Biomedical Engineering, 3120 Natural Sciences II, University of California, Irvine, CA 92697, USA;1. Département de médecine Oncologique, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France;2. Département d''Imagerie, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France;3. UMR 8081 imagerie par résonance magnétique médicale et multimodalités (IR4M), université Paris-Sud, 4, place du Général-Leclerc, 91401 Orsay cedex, France;4. CNRS UMR 8081, 4, place du Général-Leclerc, 91401 Orsay cedex, France;1. Neurological Department, Zealand University Hospital, Roskilde, Denmark;2. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark;1. Massachusetts General Hospital, Department of Neurology, Boston, MA, USA;2. University of California, Department of Neurology, San Francisco, CA, USA;3. University of Michigan, Department of Neurosurgery and Neurology, Ann Arbor, MI, USA;4. Yale School of Medicine, Department of Neurology, New Haven, CT, USA;5. Emory University School of Medicine, Department of Neurology, Atlanta, GA, USA;6. Duke University School of Medicine, Department of Neurology, Durham, NC, USA;7. University of Wisconsin, Department of Neurology, Madison, WI, USA;8. University of Manitoba, Winnipeg, Canada, USA;9. University of South Carolina, Department of Neurology, Charleston, SC, USA;10. Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
Abstract:ObjectivesTo compare frequency analysis to human raters and determine the interrater agreement of postictal EEG changes after focal seizures.Methods24 focal seizures with and without impaired awareness recorded with scalp-EEG in the epilepsy monitoring unit were selected. Five board-certified neurophysiologists annotated seizure termination and end of postictal changes for all seizures. We assessed agreement using intraclass correlation, described the band-power changes by time-frequency analysis, and correlated these measures with the rater annotations.ResultsInterrater agreement on the duration of the postictal changes was moderate (0.64, 95% confidence interval: 0.36–0.82). The interrater agreement for seizure termination was excellent (1.00). Median duration of the postictal interval of seizures with impaired awareness was significantly shorter than for seizures with retained awareness (p = 0.0004). Mean postictal duration was 16.4 min. Seizure duration did not predict duration of the postictal changes. We found a strong correlation of 0.8 between the median human rater and the duration of the decrease in spectral edge frequency.ConclusionsThe agreement of neurophysiologists is moderate for duration of postictal changes and high for seizure termination. Rater determination of postictal duration is correlated with measures of EEG slowing.SignificanceDisagreement between neurophysiologists on postictal duration need to be considered.
Keywords:Epilepsy  Focal seizures  EEG  Interrater agreement  Time-frequency analysis  Clinical neurophysiologist
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