Salzburg criteria for nonconvulsive status epilepticus: Details matter

Abstract

To the Editors:We have read with great interest the paper entitled, "The difficulty of diagnosing NCSE in clinical practice; external validation of the Salzburg criteria" by Goselink et al. 1 We agree on the importance of "careful weighing of both clinical and EEG information on an individual basis," 1 which we have also emphasized in papers describing the Salzburg criteria for nonconvulsive status epilepticus (NCSE). [2][3][4] However, we have several comments on the methods and reporting of the study, which question the conclusions of the authors. | STATISTICSThe authors found highly significant, yet moderate Spearman correlations (r s = 0.41, P < .001) between raters. Gwet AC1 coefficient might be a more appropriate method for assessment of interrater agreement, 8 as Spearman correlations could yield paradoxical results, similar to Cohen kappa. There were only four cases of disagreement in 191 EEGs, so the interrater agreement should be good.Confidence intervals were not provided. This contradicts the very basic principles of reporting (item 24, STARD criteria 9 ). Given the moderate subgroup sizes and the resulting considerable variance, the strong conclusions are questionable from a methodological point of view.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

The EEG diagnosis of NCSE: Concordance between clinical practice and Salzburg Criteria for NCSE

“…We think that this is a key consideration because the aim of the study was to evaluate the SCC on spot 30 min EEG recordings that often represent the standard of care when a first urgent EEG is requested. The high percentage of P-NCSE suggests that should be important, in these cases, to set a longer EEG duration to evaluate the EEG evolution [19,20].…”

Hemodynamic changes associated with common EEG patterns in critically ill patients: Pilot results from continuous EEG-fNIRS study

“…The American Clinical Neurophysiology Society’s (ACNS) diagnostic criteria were used for the diagnosis of electrographic and electroclinical seizures ( Hirsch et al, 2013 ). The diagnosis of NCSE was based on both EEG and clinical data following the modified Salzburg Consensus Criteria (mSCNC) ( Leitinger et al, 2019 ). Quantitative EEG analysis was performed offline for the whole EEG recording using Persyst 13 EEG software (Persyst Systems, Arizona, USA), including rhythmicity spectrogram, fast Fourier transform (FFT) spectrogram, asymmetry relative spectrogram, and amplitude EEG spectrogram (for parameters, see Table 1 ).…”

Management of Status Epilepticus, Refractory Status Epilepticus, and Super-refractory Status Epilepticus

“…A critical view and the addition of clinical and paraclinical criteria and suggestions to standardize testing and gauging of the response to antiseizure medication were provided by Leitinger and colleagues in 2015 94,100 . The Salzburg Consensus Criteria were validated retrospectively in a multicenter study with very good test performance characteristics 101-103 and can be implemented in the ICU environment with continuous EEG recordings 104-106 . The American Clinical Neurophysiology Society adopted the Salzburg Consensus Criteria into their most recent Standard Critical Care EEG Terminology 2021 ( figure 12-13 ).…”