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Point-of-Care Electroencephalography for Seizure Detection: Comparison of Electrode Placement in Two-Channel
Chantal Gammenthaler-Zaugg1, Tatiani Soultana Ilia1, Robin Münger2
1Division of Neuropediatrics, Development and Rehabilitation, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Background:
The use of few-electrode electroencephalography (EEG) for seizure detection in pediatric emergency departments is developing rapidly and is emerging to an important point-of-care bedside test. The aim of this study was to investigate if frontotemporal (FT) electrode placement (F7-T5 and F8-T6) is superior to the usual centroparietal (CP) electrode placement (C3-P3 and C4-P4) in seizure detection, when point-of-care two-channel EEG (tcEEG) is applied.
Method:
We reviewed a sample of 38 prerecorded long-term EEGs (gold standard, international 10-20 EEG system) with prior detected electrographic epileptic seizures in children (38 participants, median age, 10.11 years). The EEG parameters were retrospectively converted into two tcEEGs (F7-T5 and F8-T6 vs C3-P3 and C4-P4) and were independently analyzed by two epileptologists who were unaware of the gold-standard EEG findings.
Results:
Our primary outcome showed that there was no significant difference in seizure detection in FT electrode placement compared with CP placement (sensitivity 69.9% vs 72.9%). Furthermore, we found significantly higher false-positive rates with FT electrode placement in samples with high interictal spike frequency. CP electrode placement showed significantly lower false-negative rates for seizures with bilateral onset and seizures without side difference during propagation. No significant correlation of FT and CP electrode placement was found with other EEG parameters.
Conclusions:
FT or CP tcEEG electrode placement does not differ in seizure detection. Both reduced electrode montages can be used with similar sensitivities for point-of-care EEG bedside testing in pediatric emergency settings. However, the CP electrode placement shows minor advantages compared with FT electrode placement.
