Diagnostic Accuracy of the Ambulatory EEG vs. Routine EEG for First Single Unprovoked Seizures and Seizure Recurrence: The DX-Seizure Study

Abstract

Background: The DX-Seizure study aims to evaluate the diagnostic accuracy (sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratio) of the ambulatory EEG in comparison with the first routine EEG, and a second routine EEG right before the ambulatory EEG, on adult patients with first single unprovoked seizure (FSUS) and define the utility of ambulatory EEG in forecasting seizure recurrence in these patients after 1-year follow-up. Methods: The DX-Seizure study is a prospective cohort of 113 adult patients (≥18-yearold) presenting with FSUS to the Single Seizure Clinic for evaluation. These patients will be assessed by a neurologist/epileptologist with the first routine EEG (referral EEG) and undergo a second routine EEG and ambulatory EEG. The three EEG (first routine EEG as gold standard) will be compared and evaluated their diagnostic accuracy (sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratios) with respect of epileptiform activity and other abnormalities. One-year follow-up of each patient will be used to assess recurrence of seizures after a FSUS and the utility of the ambulatory EEG to forecast these recurrences. Discussion: To the best of our knowledge, this will be the first study to prospectively examine the use of ambulatory EEG for a FSUS in adults and its use for prediction of recurrence of seizures. The overarching goal is to improve diagnostic accuracy with the use of ambulatory EEG in patients with their FSUS. We anticipate that this will decrease incorrect or uncertain diagnoses with resulting psychological and financial cost to the patient. We also anticipate that an improved method to predicting the recurrence of seizures will reduce the chances of repeated seizures and their consequences.

Impact of ambulatory EEG in the management of patients with epilepsy in resource-limited Latin American populations

“…Despite this variation in the indication classification, our findings align with numerous studies where AEEG is primarily utilized for diagnostic purposes ( Faulkner et al, 2012 , Goodwin et al, 2014 , Kandler et al, 2017 , Primiani et al, 2021 , Syed et al, 2019 ). AEEG offers a higher likelihood of capturing both clinical events and interictal EDs compared to routine EEGs ( Hernández-Ronquillo et al, 2020 ). Many patients in both populations presented with clinical events characterized by inconclusive semiology and normal routine EEG findings.…”

Current state of the epilepsy drug and device pipeline

“…Diagnostic accuracy is higher with longer EEG monitoring, 62 although prolonged ambulatory monitoring is limited with conventional EEG equipment. The REMI remote EEG monitoring system by Epitel uses four, single‐patient, single‐use wireless sensors that transmit a single‐channel EEG to a mobile computing device and uses automated seizure detection with machine learning to tag events for clinician review.…”

Get Out the Door: Ambulatory EEG Trumps Routine EEG in the Detection of Interictal Epileptiform Abnormalities After a First Unprovoked Seizure

“…In this vacuum, the study by Hernandez-Ronquillo et al lands with a thunderous bang in favor of ambulatory EEG. 4 This elegant study performed prospectively over 4 years aimed to evaluate the yield of aEEG compared to a first and a repeat rEEG for detecting IEDs/seizures after FSUS. The study cohort had ages between 17 and 82 years, but racial distribution was not disclosed.…”

“…1 The true risk is what happens in actuality, and the aEEG seems more accurate in predicting the true risk. 4 It is important to note that ASM treatment does not change the long-term risk of second unprovoked seizure and epilepsy. 1…”