Spectrogram screening of adult EEGs is sensitive and efficient

Neurology. 2014 Jul 1;83(1):56-64. doi: 10.1212/WNL.0000000000000537. Epub 2014 May 23.


Objective: Quantitatively evaluate whether screening with compressed spectral arrays (CSAs) is a practical and time-effective protocol for assisting expert review of continuous EEG (cEEG) studies in hospitalized adults.

Methods: Three neurophysiologists reviewed the reported findings of the first 30 minutes of 118 cEEGs, then used CSA to guide subsequent review ("CSA-guided review" protocol). Reviewers viewed 120 seconds of raw EEG data surrounding suspicious CSA segments. The same neurophysiologists performed independent page-by-page visual interpretation ("conventional review") of all cEEGs. Independent conventional review by 2 additional, more experienced neurophysiologists served as a gold standard. We compared review times and detection rates for seizures and other pathologic patterns relative to conventional review.

Results: A total of 2,092 hours of cEEG data were reviewed. Average times to review 24 hours of cEEG data were 8 (±4) minutes for CSA-guided review vs 38 (±17) minutes for conventional review (p < 0.005). Studies containing seizures required longer review: 10 (±4) minutes for CSA-guided review vs 44 (±20) minutes for conventional review (p < 0.005). CSA-guided review was sensitive for seizures (87.3%), periodic epileptiform discharges (100%), rhythmic delta activity (97.1%), focal slowing (98.7%), generalized slowing (100%), and epileptiform discharges (88.5%).

Conclusions: CSA-guided review reduces cEEG review time by 78% with minimal loss of sensitivity compared with conventional review.

Classification of evidence: This study provides Class IV evidence that screening of cEEG with CSAs efficiently and accurately identifies seizures and other EEG abnormalities as compared with standard cEEG visual interpretation.

MeSH terms

  • Adult
  • Aged
  • Brain Waves / physiology*
  • Electroencephalography*
  • Female
  • Humans
  • Male
  • Mass Screening / methods*
  • Middle Aged
  • Retrospective Studies
  • Seizures / diagnosis*
  • Spectrum Analysis
  • Young Adult