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      A short study of abbreviated EEG

      editorial
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      Clinical Neurophysiology Practice
      Elsevier

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          Abstract

          The use of an abbreviated number of electrodes and channels for EEG recordings, principally in intensive care unit patients, has been explored by a number of investigators (Bridgers and Ebersole, 1988; Kolls and Husain, 2007, Young et al., 2009, Karakis et al., 2010, Tanner et al., 2014, Herta et al., 2017, Jordan, 2017). The incentive has been, presumably, the ease of application (especially for placement below the hairline/subhairline montages) and the perceived ease of interpretation by nonneurologists, e.g., nurses, residents or intensivists, by preventing “information overload”. The sensitivity for the use of reduced montages for seizure detection has been explored mainly using electroencephalographers (EEGers) and has been shown to be inferior to standard recordings for a mix of seizure types (Kolls and Husain, 2007, Young et al., 2009, Tanner et al., 2014). However, there has not until now been an examination of a reduced montage for generalized events with persons of different levels of EEG training or exposure. Gururangan and colleagues (Gururangan et al., 2018) in this issue of the Journal present a study involving a reduced montage (bipolar anterior-posterior through the frontal, temporal and occipital regions) compared with a simultaneous standard full montage recording (bipolar anterior-posterior montage with the full 10–20 system). The performances of 20 experienced neurologists with extensive EEG experience, 20 residents with some EEG exposure and 43 medical students without EEG experience (but only a brief training session for each group) were compared for the sensitivity and specificity for detecting seizures (7 generalized, 1 focal), and rhythmic and periodic patterns (RPPs). The EEGs classifications were previously agreed upon by 3 experienced EEGers and served as the “gold standard”. As expected, the neurologists performed better than the residents who outshone the students for sensitivity for detecting seizures or RRPs, but within each group there was no significant difference in performances comparing reduced and full montages. However, the specificity was significantly greater for the reduced montage compared to the full montage for each group. It is not surprising that the performance within each group was equivalent for the reduced and full montages, considering the heavy weighting for generalized phenomena, which should show equally well with both montages. It is unexpected that the specificity should be greater for the reduced montage, since the material of the reduced montage was already contained in the full montage. It is likely to be the result of the study design: 15 s epochs were presented with each sample; it may be easier psychologically to interpret and mentally extrapolate the evolutionary changes from an abbreviated sample from an already reduced montage. Although the paper gives some justification for the use of an abbreviated montage for detecting generalized events, it has some limitations: numbers of seizures were small; the study does not allow for conclusions regarding focal/regional phenomena; there was no opportunity to examine the use of a referential montage, which is often superior for demonstrating generalized phenomena (Young and Mantia, 2017); the seizure samples may well have been too short for adequate assessments. Also, it would be worth exploring whether other abbreviated montages are better than temporal montage utilized in this study, as might well be the case (Kolls and Husain, 2007). Limitations aside, the authors are to be congratulated in conducting an original, carefully controlled study, testing groups of individuals with different levels of experience, showing that even naïve subjects can show a credible performance and demonstrating the usefulness of a limited EEG montage in detecting various generalized phenomena that may well not be apparent clinically. Conflict of interest I declare no conflict of interest and no funding, personal or technical assistance.

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          Most cited references7

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          Seizure detection with a commercially available bedside EEG monitor and the subhairline montage.

          Availability of standard, continuous electroencephalography (cEEG) monitoring in ICU is very limited, although commercially available 4-channel modules are present in many ICUs. We investigated the sensitivity of such modules compared with the more complete monitoring with a standard EEG system. Seventy patients at high risk of seizures in the medical-surgical intensive care unit and Epilepsy Monitoring Unit were recorded simultaneously for at least 24 h with a 4-channel commercial ICU bedside monitoring system (Datex-Ohmeda) with a subhairline montage and a standard EEG machine (XLTEK) using the international 10-20 system of electrode placement. Recordings were interpreted independently from each other. The 4-channel recordings demonstrated a sensitivity of 68 and 98% specificity for seizure detection, and a sensitivity of 39% and a specificity of 92% for detection of spikes and PLEDs. The 4-channel EEG module has limited but practical usefulness for seizure detection when standard cEEG monitoring is not available.
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            Application of subhairline EEG montage in intensive care unit: comparison with full montage.

            Problems with the availability of standard EEG monitoring in the intensive care unit have led to the use of recordings that have limited spatial coverage. We studied the performance of limited coverage EEG compared with more traditional full-montage EEG.
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              Assessment of Hairline EEG as a Screening Tool for Nonconvulsive Status Epilepticus

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                Author and article information

                Contributors
                Journal
                Clin Neurophysiol Pract
                Clin Neurophysiol Pract
                Clinical Neurophysiology Practice
                Elsevier
                2467-981X
                16 April 2018
                2018
                16 April 2018
                : 3
                : 177-178
                Affiliations
                Western University, London, Ontario, Canada
                Author notes
                [* ]Address: 1800-8th Street East, Owen Sound, Ontario N4K6M9, Canada. gyoung@ 123456gbhs.on.ca
                Article
                S2467-981X(18)30016-7
                10.1016/j.cnp.2018.03.005
                6288661
                934a32c3-c8a6-4aa8-ba23-c2b20b093b93
                © 2018 International Federation of Clinical Neurophysiology. Published by Elsevier B.V.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 27 March 2018
                : 30 March 2018
                Categories
                Editorial

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