Automated detection of interictal epileptiform discharges with few electroencephalographic channels

Interictal epileptiform discharges (IEDs) are crucial for epilepsy diagnosis and management. New electroencephalographic (EEG) devices with fewer electrodes are more accessible, but their ability to detect IEDs is uncertain. The aim of this study is to determine whether IEDs can be reliably detected in reduced-channel EEG data, enabling broader epilepsy diagnosis. Using EEG samples from 3378 patients and an external validation set of 51 patients, we trained Cyclops, a deep neural network designed to function across various channel configurations. Performance was evaluated using area under the receiver operating characteristic curve (AUROC) and other clinically relevant metrics, including IED source location sensitivity. Cyclops demonstrated strong performance even with minimal channels. AUROC for one channel was .876 (95% confidence interval [CI] = .854-.897); best configuration based on a clinically available product was .950 (95% CI = .936-.962); for the detection of focal IEDs with two local channels, AUROC values ranged from .701 (95% CI = .656-.745) to .930 (95% CI = .902-.955), with a median AUROC of .809. On the external validation set, performance ranged from .692 (95% CI = .593-.782) to .949 (95% CI = .922-.972), with a median AUROC of .846. Thus, Cyclops demonstrates that effective IED detection is possible with reduced EEG setups, enhancing accessibility and expanding epilepsy diagnosis to broader patient populations.