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Related Experiment Video

Updated: Mar 8, 2026

Interictal High Frequency Oscillations Detected with Simultaneous Magnetoencephalography and Electroencephalography as Biomarker of Pediatric Epilepsy
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Interrater reliability of visually evaluated high frequency oscillations.

Aaron M Spring1, Daniel J Pittman2, Yahya Aghakhani3

  • 1Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; Seaman Family MR Research Centre, Foothills Medical Centre, Calgary, AB, Canada.

Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology
|February 5, 2017
PubMed
Summary

Identifying high frequency oscillations (HFOs) and interictal epileptiform discharges (IEDs) lacks consistency. Poor interrater reliability in visual review of HFOs and IEDs suggests current practices may introduce bias, impacting study validity.

Keywords:
High frequency oscillationsInterictal epileptiform dischargesInterrater reliabilityInterrater variabilityIntracranial electroencephalographySpikes

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Area of Science:

  • Neuroscience
  • Clinical Neurology
  • Biomedical Engineering

Background:

  • High frequency oscillations (HFOs) and interictal epileptiform discharges (IEDs) are established biomarkers for identifying epileptogenic zones.
  • A significant limitation in current research is the absence of a standardized, validated method for HFO detection.

Purpose of the Study:

  • To quantitatively assess the interrater reliability of visual HFO and IED marking.
  • To validate current practices in identifying HFOs and IEDs by electroencephalographers.

Main Methods:

  • A morphology detector identified candidate events from intracranial EEG (iEEG) recordings of ten epilepsy patients.
  • Six electroencephalographers independently reviewed these events, classifying them as HFOs and/or IEDs.
  • Interrater reliability was measured using Cohen's Kappa (κ) and intraclass correlation coefficients (ICC).

Main Results:

  • Significant differences in HFO evaluation were observed between most reviewer pairs (p<0.05).
  • Interrater reliability for HFOs alone was poor (mean κ=0.403, ICC=0.401).
  • Reliability for combined HFOs and IEDs was also suboptimal (mean κ=0.568, ICC=0.570).

Conclusions:

  • The current standard of using two visual reviewers for HFO identification is susceptible to reviewer bias due to poor agreement.
  • This variability limits the external validity and generalizability of findings from studies relying on these markers.
  • Developing a standardized framework is crucial for reconciling existing research and advancing the field of epilepsy biomarkers.