Abstract Details

Title Utility of Operational Criteria for Identifying Interictal Epileptiform Discharges on EEG: A Decision Hygiene Approach

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P11 - Poster Session 11 (5:30 PM-6:30 PM)

Poster/Presentation
Number 1-003

Objective To determine if implementing the operational definition of interictal epileptiform discharges (IEDs) proposed by the International Federation of Clinical Neurophysiology (IFCN) improves expert diagnostic performance and interrater reliability (IRR).

Background Accurate and reliable EEG interpretation is critical for the diagnosis and management of epilepsy. However, variability exists even among experts, which may largely be due to differences in IED identification thresholds. Standardized criteria such as those proposed by the IFCN may minimize this unwanted variability and improve diagnostic performance.

Design/Methods In a 2-part prospective analysis, 9 EEG experts classified 200 candidate IEDs (100 expert-validated [Series A], 100 epilepsy monitoring unit-validated [Series B]) as epileptiform or non-epileptiform, in random order. In Part I, raters performed binary classification only. In Part II, raters selected the applicable IFCN criteria for each candidate IED in addition to classifying it as epileptiform vs not. Parts I and II were separated by at least 30 days to reduce the effect of visual recall. Finally, we compared aggregate performance and IRR between both parts, and we separately assessed IRR for each of the six IFCN criteria.

Results Overall, there were no major differences in performance (AUC; 0.81 vs 0.82) or IRR (Gwet’s AC1; 0.48 vs. 0.47) between Parts I and II. Similarly, there were no major differences in performance or IRR for Series A (0.81 vs. 0.79; 0.34 vs. 0.31) and Series B (0.95 vs. 0.95; 0.62 vs. 0.63). IRR was fair for criteria 2, 3, 5 and 6, and moderate for criteria 1 and 4.

Conclusions The findings of this study suggest that the IFCN criteria to define IEDs may not significantly improve performance or IRR among experts. Increasing expert IRR for each criterion separately may enhance the utility of the IFCN criteria in clinical practice.

Authors/Disclosures
Doyle Yuan, MD (Dallas VA Medical Center) PRESENTER	Dr. Yuan has nothing to disclose.
Roohi Katyal, MD (Louisiana State University Health Sciences Center)	Dr. Katyal has nothing to disclose.
Irfan S. Sheikh, MD (UT Southwestern)	Dr. Sheikh has nothing to disclose.
Adam S. Greenblatt, MD (Washington University in St. Louis)	Dr. Greenblatt has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Beacon Biosignals.
Niravkumar Barot, MD (University of PIttsburgh)	Dr. Barot has nothing to disclose.
Ushtar Amin, MD (University of South Florida - JAHVAH)	Dr. Amin has nothing to disclose.
Daniel Weber, DO (St. Louis University)	Dr. Weber has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for SK Life Science.
Ioannis Karakis, MD, FAAN (Emory University)	Dr. Karakis has received personal compensation for serving as an employee of Emory University School of Medicine. Dr. Karakis has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB. Dr. Karakis has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for GSK. Dr. Karakis has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Epitel. Dr. Karakis has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Karakis has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Hill Ward Henderson.
Vinayan KP (AIMS)	No disclosure on file
Selim R. Benbadis, MD, FAAN (University of South Florida)	Dr. Benbadis has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Stratus. Dr. Benbadis has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for SK Lifesciences. Dr. Benbadis has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Jazz. Dr. Benbadis has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Catalyst. Dr. Benbadis has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Neurelis. Dr. Benbadis has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Sunovion. Dr. Benbadis has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Livanova. Dr. Benbadis has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for UCB.
Sandor Beniczky, MD, PhD (Aarhus University & Danish Epilepsy Center)	Prof. Beniczky has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Eisai. Prof. Beniczky has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for UCB. Prof. Beniczky has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Lundbeck. Prof. Beniczky has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for GW. The institution of Prof. Beniczky has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for ILAE.
M. B. Westover, MD, PhD (MGH)	Dr. Westover has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Beacon Biosignals. Dr. Westover has stock in Beacon Biosignals. The institution of Dr. Westover has received research support from NIH. Dr. Westover has received publishing royalties from a publication relating to health care. Dr. Westover has a non-compensated relationship as a cofounder with Beacon Biosignals that is relevant to AAN interests or activities.
Fabio Nascimento, MD (Washington University Medical School)	Dr. Nascimento has received publishing royalties from a publication relating to health care.

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