Learn how to interpret and use intracranial EEG findings
B. Frauscher, D. Mansilla, C. Abdallah, A. Astner-Rohracher, S. Beniczky, M. Brazdil, V. Gnatkovsky, J. Jacobs, G. Kalamangalam, P. Perucca, P. Ryvlin, S. Schuele, J. Tao, Y. Wang, M. Zijlmans, A. McGonigal
Epileptic Disorders
Volume 26, Issue1
February 2024
Pages 1-59
https://doi.org/10.1002/epd2.20190
Abstract
Epilepsy surgery is the therapy of choice for many patients with drug-resistant focal epilepsy. Recognizing and describing ictal and interictal patterns with intracranial electroencephalography (EEG) recordings is important in order to most efficiently leverage advantages of this technique to accurately delineate the seizure-onset zone before undergoing surgery. In this seminar in epileptology, we address learning objective “1.4.11 Recognize and describe ictal and interictal patterns with intracranial recordings” of the International League against Epilepsy curriculum for epileptologists. We will review principal considerations of the implantation planning, summarize the literature for the most relevant ictal and interictal EEG patterns within and beyond the Berger frequency spectrum, review invasive stimulation for seizure and functional mapping, discuss caveats in the interpretation of intracranial EEG findings, provide an overview on special considerations in children and in subdural grids/strips, and review available quantitative/signal analysis approaches. To be as practically oriented as possible, we will provide a mini atlas of the most frequent EEG patterns, highlight pearls for its not infrequently challenging interpretation, and conclude with two illustrative case examples. This article shall serve as a useful learning resource for trainees in clinical neurophysiology/epileptology by providing a basic understanding on the concepts of invasive intracranial EEG
“RVUS”: A Structured Framework for Residents to Approach Bias in Clinical Practice
Crystal Yu, Aisha Elfasi, Lorena Figueredo-Rivas, Claudia Hernandez, and Maria Bruzzone
Neurology
April 25, 2023
100 (17_supplement_2) 4276
https://doi.org/10.1212/WNL.0000000000203861
Abstract
Objective: To enhance resident education on racism and all forms of discrimination in the healthcare setting using a case-based curriculum.
Background: The level of interest in addressing racism and ethnic inequality in medicine has risen dramatically in recent decades, with increasing awareness of the close relationship between racial injustice and healthcare disparities. Despite the acknowledged importance of addressing racism and topics of diversity, equity, and inclusion at large, implementation of formal education around these topics has been mixed or absent, with no universal requirements for such training at residency/fellowship levels.
Design/Methods: We developed a year-long curriculum consisting of 12 case-based monthly discussions between residents and faculty. The cases are designed to be interactive sessions, 15–20 minutes long, each covering a different type of bias, from macroaggressions to the varieties of microaggressions. Each encounter focuses on a different topic regarding diversity, equity and inclusion. The series is presented by residents to co-residents. A novel learning tool “RVUS” was devised to systematically approach each case with R standing for recognizing the problem, V for validating the feelings of the person(s) experiencing prejudice, U for unpacking the underlying elements leading to the situation, and S for solutions or suggestions to resolve the matter.
Results: We finished our pilot year (2021–2022) and started our first formal year in July 2022. Preliminary results from anonymous survey suggests that outside of developing skills, having formal, safe, educational sessions dedicated to diversity and discrimination has helped participants feel more comfortable discussing and addressing these scenarios, creating an environment where they are able to learn from each other and share their own experiences in the process.
Conclusions: Dedicated resident education to help combat discrimination, address microaggressions, and foster health equity, diversity, and inclusion can be achieved through a case-based curriculum especially when combined with a systematic approach such as RVUS.
Development of a structured process for the Spanish translation of the 2021 ACNS standardized critical care EEG terminology
Maria Bruzzone, Clio Rubinos, Andrea Lowden, Juan Appendino, Jorge Vidaurre, Daniel Sanjuan, Naiara Garcia Losarcos, and Andres Fernandez
Neurology
April 25, 2023
100 (17_supplement_2) 3854
https://doi.org/10.1212/WNL.0000000000203572
Abstract
Objective: To develop a Spanish translation of the 2021 critical care EEG terminology through a structured consensus of an interdisciplinary group with representation from Latin America and Spain.
Background: Aiming for a common language for the classification of electroencephalogram (EEG) findings in critical care (ICU), the American Clinical Neurophysiology Society (ACNS) published the ICU-EEG terminology in 2013, which was updated in 2021. Since this nomenclature has not been published in Spanish, the potential use of the ICU-EEG terminology can be variable when translated into daily practice in Spanish-speaking countries.
Design/Methods: The initial translation of the terminology was done in parallel by three subgroups of Spanish-speaking neurophysiologists and neurointensivists representing different regions of Latin America and Spain. Each subgroup worked iteratively on one section of the terminology. Scheduled meetings were carried out with the entire team to discuss translation differences and alternatives, which were recorded for discussion in future planned consensus groups. We have recruited 25 participants from Latin America and Spain to explore their impressions on the applicability, implementation, and regional differences of the translation in different Spanish-speaking countries. Using qualitative methodology, the consensus groups will follow nominal group technique methods.
Results: The process, common discussion points, and consensus agreements and disagreements of the different terms chosen in the translation will be presented.
Conclusions: The Spanish language is diverse, and the terms used to describe electroencephalographic findings vary in different countries. It is essential to consider these variations when translating guidelines into other languages. Translations need to be structured, iterative, and consensus-based with representations of different countries with the same language to encourage widespread use and a more homogeneous communication, which can in turn facilitate and encourage future research.
Interictal Epileptiform Discharge Detection in EEG in Different Practice Settings
Halford, Jonathan J; Westover, M. Brandon; LaRoche, Suzette M; Macken, Micheal P; Kutluay, Ekrem; Edwards, Jonathan C; Bonilha, Leonardo; Kalamangalam, Giridhar P; Ding, Kan; Hopp, Jennifer L; Arain, Amir; Dawson, Rachael A; Martz, Gabriel U; Wolf, Bethany J; Waters, Chad G; Dean, Brian C
Journal of Clinical Neurophysiology
35(5):p 375-380, September 2018.
DOI: 10.1097/WNP.0000000000000492
Abstract
Objective: The goal of the study was to measure the performance of academic and private practice (PP) neurologists in detecting interictal epileptiform discharges in routine scalp EEG recordings.
Methods: Thirty-five EEG scorers (EEGers) participated (19 academic and 16 PP) and marked the location of ETs in 200 30-second EEG segments using a web-based EEG annotation system. All participants provided board certification status, years of Epilepsy Fellowship Training (EFT), and years in practice. The Persyst P13 automated IED detection algorithm was also run on the EEG segments for comparison.
Results: Academic EEGers had an average of 1.66 years of EFT versus 0.50 years of EFT for PP EEGers (P < 0.0001) and had higher rates of board certification. Inter-rater agreement for the 35 EEGers was fair. There was higher performance for EEGers in academics, with at least 1.5 years of EFT, and with American Board of Clinical Neurophysiology and American Board of Psychiatry and Neurology-E specialty board certification. The Persyst P13 algorithm at its default setting (perception value = 0.4) did not perform as well at the EEGers, but at substantially higher perception value settings, the algorithm performed almost as well human experts.
Conclusions: Inter-rater agreement among EEGers in both academic and PP settings varies considerably. Practice location, years of EFT, and board certification are associated with significantly higher performance for IED detection in routine scalp EEG. Continued medical education of PP neurologists and neurologists without EFT is needed to improve routine scalp EEG interpretation skills. The performance of automated detection algorithms is approaching that of human experts.