Photo Credit: Artemis Diana

The following is a summary of “Seizure Assessment and Forecasting With Efficient Rapid-EEG: A Retrospective Multicenter Comparative Effectiveness Study,” published in the June 2024 issue of Neurology by Kalkach-Aparicio, et al.

Patients with critical illness have a high risk of non-convulsive seizures and limited Conventional-EEG (cEEG) resources, and the need for rapid seizure detection necessitates exploring alternative methods like risk-stratification with rapid response-EEG (rrEEG) systems.

Researchers conducted a retrospective study to assess whether the 2HELPS2B score derived from a 1-hour rrEEG was non-inferior to the score obtained from cEEG for predicting seizure risk.

They conducted an EEG diagnostic accuracy study (October 1, 2021, to July 31, 2022). Chart and EEG reviews, using consecutive sampling at four tertiary care centers, included patient records (≥18 years old) from January 1, 2018, to June 20, 2022. Monte Carlo simulation power analysis determined a sample size of n = 500 for rrEEG, and secondary outcomes and n = 500 for cEEG with planned propensity-score covariate matching. The primary outcome, the noninferiority of rrEEG for seizure risk prediction, was evaluated using the area under the receiver operator characteristic curve (AUC), with a noninferiority margin of 0.05 based on the 2HELPS2B validation study.

The results showed 240 rapid-response EEG (rrEEG) with follow-on continuous EEG (cEEG). The median age was 64 years (IQRi 22); 42% were female. The 2HELPS2B score on 1-hour rrEEG demonstrated noninferiority to cEEG (AUC 0.85, 95% CI 0.78–0.90, P=0.001). Secondary comparisons with matched contemporaneous cEEG revealed no significant difference in AUC (0.89, 95% CI 0.83–0.94, P=0.31), false negative rates for the 2HELPS2B = 0 group (P=1.0) were rrEEG (0.021, 95% CI 0–0.062) and cEEG (0.016, 95% CI 0–0.048), and no differences were found in survival analyses.

Investigators found the 2HELPS2B score obtained from a 1-hour rrEEG to be non-inferior to cEEG for seizure prediction, suggesting low-risk patients with potential for shorter monitoring (2HELPS2B = 0) and improved resource allocation.

Source: neurology.org/doi/10.1212/WNL.0000000000209621