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Hernandez-Ronquillo L, Thorpe L, Feng C, Hunter G, Dash D, Hussein T, Dolinsky C, Waterhouse K, Roy PL, Jette N. Diagnostic Accuracy of Ambulatory EEG vs Routine EEG in Patients With First Single Unprovoked Seizure. Neurol Clin Pract 2023; 13:e200160. [PMID: 37197370 PMCID: PMC10184557 DOI: 10.1212/cpj.0000000000200160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 02/27/2023] [Indexed: 05/19/2023]
Abstract
Background and Objective To evaluate the diagnostic accuracy of the ambulatory EEG (aEEG) at detecting interictal epileptiform discharges (IEDs)/seizures compared with routine EEG (rEEG) and repetitive/second rEEG in patients with a first single unprovoked seizure (FSUS). We also evaluated the association between IED/seizures on aEEG and seizure recurrence within 1 year of follow-up. Methods We prospectively evaluated 100 consecutive patients with FSUS at the provincial Single Seizure Clinic. They underwent 3 sequential EEG modalities: first rEEG, second rEEG, and aEEG. Clinical epilepsy diagnosis was ascertained based on the 2014 International League Against Epilepsy definition by a neurologist/epileptologist at the clinic. An EEG-certified epileptologist/neurologist interpreted all 3 EEGs. All patients were followed up for 52 weeks until they had either second unprovoked seizure or maintained single seizure status. Accuracy measures (sensitivity, specificity, negative and positive predictive values, and likelihood ratios), receiver operating characteristic (ROC) analysis, and area under the curve (AUC) were used to evaluate the diagnostic accuracy of each EEG modality. Life tables and the Cox proportional hazard model were used to estimate the probability and association of seizure recurrence. Results Ambulatory EEG captured IED/seizures with a sensitivity of 72%, compared with 11% for the first rEEG and 22% for the second rEEG. The diagnostic performance of the aEEG was statistically better (AUC: 0.85) compared with the first rEEG (AUC: 0.56) and second rEEG (AUC: 0.60). There were no statistically significant differences between the 3 EEG modalities regarding specificity and positive predictive value. Finally, IED/seizure on the aEEG was associated with more than 3 times the hazard of seizure recurrence. Discussion The overall diagnostic accuracy of aEEG at capturing IED/seizures in people presenting with FSUS was higher than the first and second rEEGs. We also found that IED/seizures on the aEEG were associated with an increased risk of seizure recurrence. Classification of Evidence This study provides Class I evidence supporting that, in adults with First Single Unprovoked Seizure (FSUS), 24-h ambulatory EEG has increased sensitivity when compared with routine and repeated EEG.
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Affiliation(s)
- Lizbeth Hernandez-Ronquillo
- Community Health and Epidemiology (LH-R, LT), Saskatoon, SK; Division of Neurology, Department of Medicine (LH-R, GH.), Saskatoon, SK; Department of Community Health and Epidemiology (CF), Halifax, NS; Neurophysiology Laboratory (DD, CD), Royal University Hospital, Saskatoon, SK; Neurophysiology Laboratory (TH), BC Children's Hospital, Vancouver, BC; Neuromodulation/Epilepsy Programs (KW), Royal University Hospital, Saskatoon, SK; Division of Neurology, Department of Medicine (PLR), Lakeridge Health Oshawa, Oshawa, ON; Department of Neurology and Population Health Science & Policy (NJ), NY
| | - Lilian Thorpe
- Community Health and Epidemiology (LH-R, LT), Saskatoon, SK; Division of Neurology, Department of Medicine (LH-R, GH.), Saskatoon, SK; Department of Community Health and Epidemiology (CF), Halifax, NS; Neurophysiology Laboratory (DD, CD), Royal University Hospital, Saskatoon, SK; Neurophysiology Laboratory (TH), BC Children's Hospital, Vancouver, BC; Neuromodulation/Epilepsy Programs (KW), Royal University Hospital, Saskatoon, SK; Division of Neurology, Department of Medicine (PLR), Lakeridge Health Oshawa, Oshawa, ON; Department of Neurology and Population Health Science & Policy (NJ), NY
| | - Cindy Feng
- Community Health and Epidemiology (LH-R, LT), Saskatoon, SK; Division of Neurology, Department of Medicine (LH-R, GH.), Saskatoon, SK; Department of Community Health and Epidemiology (CF), Halifax, NS; Neurophysiology Laboratory (DD, CD), Royal University Hospital, Saskatoon, SK; Neurophysiology Laboratory (TH), BC Children's Hospital, Vancouver, BC; Neuromodulation/Epilepsy Programs (KW), Royal University Hospital, Saskatoon, SK; Division of Neurology, Department of Medicine (PLR), Lakeridge Health Oshawa, Oshawa, ON; Department of Neurology and Population Health Science & Policy (NJ), NY
| | - Gary Hunter
- Community Health and Epidemiology (LH-R, LT), Saskatoon, SK; Division of Neurology, Department of Medicine (LH-R, GH.), Saskatoon, SK; Department of Community Health and Epidemiology (CF), Halifax, NS; Neurophysiology Laboratory (DD, CD), Royal University Hospital, Saskatoon, SK; Neurophysiology Laboratory (TH), BC Children's Hospital, Vancouver, BC; Neuromodulation/Epilepsy Programs (KW), Royal University Hospital, Saskatoon, SK; Division of Neurology, Department of Medicine (PLR), Lakeridge Health Oshawa, Oshawa, ON; Department of Neurology and Population Health Science & Policy (NJ), NY
| | - Dianne Dash
- Community Health and Epidemiology (LH-R, LT), Saskatoon, SK; Division of Neurology, Department of Medicine (LH-R, GH.), Saskatoon, SK; Department of Community Health and Epidemiology (CF), Halifax, NS; Neurophysiology Laboratory (DD, CD), Royal University Hospital, Saskatoon, SK; Neurophysiology Laboratory (TH), BC Children's Hospital, Vancouver, BC; Neuromodulation/Epilepsy Programs (KW), Royal University Hospital, Saskatoon, SK; Division of Neurology, Department of Medicine (PLR), Lakeridge Health Oshawa, Oshawa, ON; Department of Neurology and Population Health Science & Policy (NJ), NY
| | - Tabrez Hussein
- Community Health and Epidemiology (LH-R, LT), Saskatoon, SK; Division of Neurology, Department of Medicine (LH-R, GH.), Saskatoon, SK; Department of Community Health and Epidemiology (CF), Halifax, NS; Neurophysiology Laboratory (DD, CD), Royal University Hospital, Saskatoon, SK; Neurophysiology Laboratory (TH), BC Children's Hospital, Vancouver, BC; Neuromodulation/Epilepsy Programs (KW), Royal University Hospital, Saskatoon, SK; Division of Neurology, Department of Medicine (PLR), Lakeridge Health Oshawa, Oshawa, ON; Department of Neurology and Population Health Science & Policy (NJ), NY
| | - Chelsea Dolinsky
- Community Health and Epidemiology (LH-R, LT), Saskatoon, SK; Division of Neurology, Department of Medicine (LH-R, GH.), Saskatoon, SK; Department of Community Health and Epidemiology (CF), Halifax, NS; Neurophysiology Laboratory (DD, CD), Royal University Hospital, Saskatoon, SK; Neurophysiology Laboratory (TH), BC Children's Hospital, Vancouver, BC; Neuromodulation/Epilepsy Programs (KW), Royal University Hospital, Saskatoon, SK; Division of Neurology, Department of Medicine (PLR), Lakeridge Health Oshawa, Oshawa, ON; Department of Neurology and Population Health Science & Policy (NJ), NY
| | - Karen Waterhouse
- Community Health and Epidemiology (LH-R, LT), Saskatoon, SK; Division of Neurology, Department of Medicine (LH-R, GH.), Saskatoon, SK; Department of Community Health and Epidemiology (CF), Halifax, NS; Neurophysiology Laboratory (DD, CD), Royal University Hospital, Saskatoon, SK; Neurophysiology Laboratory (TH), BC Children's Hospital, Vancouver, BC; Neuromodulation/Epilepsy Programs (KW), Royal University Hospital, Saskatoon, SK; Division of Neurology, Department of Medicine (PLR), Lakeridge Health Oshawa, Oshawa, ON; Department of Neurology and Population Health Science & Policy (NJ), NY
| | - Pragma Laboni Roy
- Community Health and Epidemiology (LH-R, LT), Saskatoon, SK; Division of Neurology, Department of Medicine (LH-R, GH.), Saskatoon, SK; Department of Community Health and Epidemiology (CF), Halifax, NS; Neurophysiology Laboratory (DD, CD), Royal University Hospital, Saskatoon, SK; Neurophysiology Laboratory (TH), BC Children's Hospital, Vancouver, BC; Neuromodulation/Epilepsy Programs (KW), Royal University Hospital, Saskatoon, SK; Division of Neurology, Department of Medicine (PLR), Lakeridge Health Oshawa, Oshawa, ON; Department of Neurology and Population Health Science & Policy (NJ), NY
| | - Nathalie Jette
- Community Health and Epidemiology (LH-R, LT), Saskatoon, SK; Division of Neurology, Department of Medicine (LH-R, GH.), Saskatoon, SK; Department of Community Health and Epidemiology (CF), Halifax, NS; Neurophysiology Laboratory (DD, CD), Royal University Hospital, Saskatoon, SK; Neurophysiology Laboratory (TH), BC Children's Hospital, Vancouver, BC; Neuromodulation/Epilepsy Programs (KW), Royal University Hospital, Saskatoon, SK; Division of Neurology, Department of Medicine (PLR), Lakeridge Health Oshawa, Oshawa, ON; Department of Neurology and Population Health Science & Policy (NJ), NY
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Hernández-Ronquillo L, Thorpe L, Dash D, Hussein T, Hunter G, Waterhouse K, Laboni Roy P, Téllez-Zenteno JF. Diagnostic Accuracy of the Ambulatory EEG vs. Routine EEG for First Single Unprovoked Seizures and Seizure Recurrence: The DX-Seizure Study. Front Neurol 2020; 11:223. [PMID: 32328023 PMCID: PMC7160330 DOI: 10.3389/fneur.2020.00223] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 03/10/2020] [Indexed: 11/18/2022] Open
Abstract
Background: The DX-Seizure study aims to evaluate the diagnostic accuracy (sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratio) of the ambulatory EEG in comparison with the first routine EEG, and a second routine EEG right before the ambulatory EEG, on adult patients with first single unprovoked seizure (FSUS) and define the utility of ambulatory EEG in forecasting seizure recurrence in these patients after 1-year follow-up. Methods: The DX-Seizure study is a prospective cohort of 113 adult patients (≥18-year-old) presenting with FSUS to the Single Seizure Clinic for evaluation. These patients will be assessed by a neurologist/epileptologist with the first routine EEG (referral EEG) and undergo a second routine EEG and ambulatory EEG. The three EEG (first routine EEG as gold standard) will be compared and evaluated their diagnostic accuracy (sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratios) with respect of epileptiform activity and other abnormalities. One-year follow-up of each patient will be used to assess recurrence of seizures after a FSUS and the utility of the ambulatory EEG to forecast these recurrences. Discussion: To the best of our knowledge, this will be the first study to prospectively examine the use of ambulatory EEG for a FSUS in adults and its use for prediction of recurrence of seizures. The overarching goal is to improve diagnostic accuracy with the use of ambulatory EEG in patients with their FSUS. We anticipate that this will decrease incorrect or uncertain diagnoses with resulting psychological and financial cost to the patient. We also anticipate that an improved method to predicting the recurrence of seizures will reduce the chances of repeated seizures and their consequences.
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Affiliation(s)
- Lizbeth Hernández-Ronquillo
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada.,Division of Neurology, Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Lilian Thorpe
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Dianne Dash
- Neurophysiology Laboratory, Royal University Hospital, Saskatoon, SK, Canada
| | - Tabrez Hussein
- Neurophysiology Laboratory, BC Children's Hospital, Simon Fraser University, Vancouver, BC, Canada
| | - Gary Hunter
- Division of Neurology, Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.,Saskatchewan Health Authority, Saskatoon, SK, Canada
| | | | - Pragma Laboni Roy
- Division of Neurology, Department of Medicine, Lakeridge Health Oshawa, Oshawa, ON, Canada
| | - Jose F Téllez-Zenteno
- Division of Neurology, Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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