Elsevier

The Lancet

Volume 336, Issue 8710, 4 August 1990, Pages 291-295
The Lancet

EPILEPSY OCTET
Diagnosis of epilepsy

https://doi.org/10.1016/0140-6736(90)91815-RGet rights and content

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  • The influence of the abundance and morphology of epileptiform discharges on diagnostic accuracy: How many spikes you need to spot in an EEG

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    Over-reading EEG is the most common cause of epilepsy-misdiagnosis (Benbadis and Tatum, 2003; Benbadis, 2007; Benbadis and Lin, 2008). Several studies demonstrated that roughly 30% of patients seen at epilepsy centers for drug-resistant seizures do not have epilepsy (Chadwick, 1990; Uldall et al., 2006; Asano et al., 2005; McBride et al., 2002). People misdiagnosed with epilepsy are affected by numerous, detrimental consequences, including restrictions on driving, career choice, and unnecessary exposure to side effects of antiepileptic drugs (Ferrie, 2006; Lafrance and Benbadis, 2006).

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    Nearly 30% of patients presenting to an epilepsy center for drug-resistant seizures in fact do not have seizures and are misdiagnosed [126]. An “abnormal” EEG may serve as the rationale, even though their clinical history may suggest otherwise [122,127–132]. The underlying reason for overinterpretation of EEGs is a lack of training, inexperience, and not applying strict criteria when interpreting waveforms [120].

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    Comparison between accuracies of training, validation and test data achieved in MATLAB and FPGA. Diagnosis of particular epileptic seizure requires monitoring of EEG recordings to identify seizure type in the frequency spectrum of the signal [10]. Furthermore, a detailed description of events occurring before, during and after the seizure is necessary for a clinical presumptive epilepsy diagnosis.

  • Optimized set of criteria for defining interictal epileptiform EEG discharges

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    Therefore, we pre-defined a threshold of 95% specificity, and we aimed at finding the optimal set of criteria achieving that in an independent testing dataset. There is broad consensus in the field that EEG over-reading is potentially more harmful to the patient than under-reading (Engel, 1984; Chadwick, 1990; Benbadis, 2007). It is well documented that EEG over-reading is a common error, and it is the major contributor to the misdiagnosis of epilepsy (Benbadis and Tatum, 2003; Benbadis, 2007; Benbadis and Lin, 2008).

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