Photo Credit: YAKOBCHUK VIACHESLAV

The following is a summary of “Accuracy of a Rapid-Response EEG’s Automated Seizure-Burden Estimator: AccuRASE Study,” published in the December 2024 issue of Neurology by Sheikh et al.    

The use of rapid-response electroencephalography (rr-EEG) has expanded in limited-resource settings to detect and treat nonconvulsive status epilepticus (NCSE), supporting people experiencing seizures.  

Researchers conducted a retrospective study to assess the accuracy of the rr-EEG automated seizure-burden estimator (ASBE) in detecting electrographic status epilepticus (ESE) and possible ESE (ESE/pESE).  

They included all consecutive rr-EEG procedures performed (November 2019 and February 2021) at Yale New Haven Hospital, 1 affiliated community hospital, and 1 affiliated inner-city regional hospital, 3 blinded reviewers analyzed the EEG data, with 2/3 agreement as the reference standard. The negative predictive value (NPV) and positive predictive value (PPV) of the ASBE were evaluated for detecting ESE or possible ESE (ESE/pESE) using various seizure burden cutoffs (>1%, >10%, >20%, >50%, and >90%).  

The results showed that, during the first 2 hours, a >10% seizure burden cutoff detected 86% (95% CI 42%-100%) of studies with ESE and 88% (68%-97%) with ESE/pESE. This threshold had an NPV of 99% (97%-100%) for ESE and 98% (95%-100%) for ESE/pESE. Specificity, the threshold was 79% (73%-84%) for ESE and 84% (79%-89%) for ESE/pESE, but the PPV was low at 11% (4%-23%) for ESE and 39% (26%-53%) for ESE/pESE. A >90% seizure burden cutoff showed 97% (94%-99%) specificity for detecting ESE (PPV 33% [7%-70%]) and 99% (97%-100%) for detecting ESE/pESE (PPV 78% [40%-97%]), but sensitivity dropped significantly to 29% (13%-51%) for ESE/pESE and 43% (10%-82%) for ESE.  

They concluded that the ASBE has high specificity at a >90% seizure burden threshold for detecting ESE and ESE/pESE, with good PPV for ESE/pESE, although sensitivity was moderate to low. A >10% threshold can be used for screening to exclude ESE with high NPV.  

Source: neurology.org/doi/10.1212/WNL.0000000000210234