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- Closing the temporal blind spot: Six additional electrodes increase patient-level EEG abnormality detection by ~12%Publication . Batista, Carla; Soares, Joana Isabel; Coelho, Paulo; Ferreira, Simão; Rosenzweig, Ivana; Borges, Daniel Filipe; Borges, Daniel Filipe; Ferreira, Simão; Soares, Joana I.To quantify the additional detection yield of the 25-channel electrodearray recommended by the International Federation of Clinical Neurophysiology(IFCN), which includes six inferior-temporal electrodes beyond the conventional 10–20 International System (IS) in identifying interictal epileptiform discharges(IEDs) and focal slow activity (SA). We analyzed 258 consecutive adult EEGs (routine or sleep-deprived; mean age, 57 ± 19 years; 55% female; 61% on anti-seizure medication). Indications were suspected epilepsy (33%) and seizure follow-up (28%). Two blinded neurophysiologists harmonized IED/SA terminology and applied the validated three-item subset of the IFCN's operational IED criteria. Each EEG was reviewed twice: first with the standard 19-electrode 10–20 system and, after a ≥ 4- week washout, with the 25-channel IFCN array. Reading lists were randomized between reviewers so that the sequence of cases differed, thereby reducing recallbias. Abnormalities were classified by type and lobe. Agreement was measured using Cohen's κ; yield gain was the detection-rate difference. Agreement ranged from substantial to almost perfect (κ = .65–.88;95% CI: .48–1.00), with disagreement rates of 1.2–7.8%. Temporal IEDs were detected more frequently with IFCN (72/71 patients) than with 10–20 (63 each), corresponding to gains of 12.5% and 11.3%, respectively. Temporal SA was also higher (98 vs. 86; +12.2% for both). Gains in extratemporal SA were smaller (10.7%and 9.5%) and differences in extratemporal IEDs were minimal (≤3.6%). Pooledacross all abnormalities, IFCN detected 183 and 182 patients versus 172 and 170with 10–20, respectively, an overall gain of 11.5%. The largest relative increase was seen in temporal IEDs, with an additional 11–12% of patients identified using the IFCN array compared with 10–20. The addition of six inferior-temporal electrodes increased the relative detection yield of EEG abnormalities by 11.5%, with the largest gains fortemporal IEDs, and required only minimal extra setup time. Although the true diagnostic accuracy of these additional detections can not be determined without an external gold standard, the findings support the routine use of the IFCN25-electrode array to address a major blind spot of the 10–20 system in adult EEGpractice.
- A custom-built single-channel in-ear electroencephalography sensor for sleep phase detection: an interdependent solution for at-home sleep studiesPublication . Borges, Daniel Filipe; Soares, Joana Isabel; Silva, Heloísa; Felgueiras, João; Batista, Carla; Ferreira, Simão; Rocha, Nuno; Leal, AlbertoSleep is vital for health. It has regenerative and protective functions. Its disruption reduces the quality of life and increases susceptibility to disease. During sleep, there is a cyclicity of distinct phases that are studied for clinical purposes using polysomnography (PSG), a costly and technically demanding method that compromises the quality of natural sleep. The search for simpler devices for recording biological signals at home addresses some of these issues. We have reworked a single-channel in-ear electroencephalography (EEG) sensor grounded to a commercially available memory foam earplug with conductive tape. A total of 14 healthy volunteers underwent a full night of simultaneous PSG, in-ear EEG and actigraphy recordings. We analysed the performance of the methods in terms of sleep metrics and staging. In another group of 14 patients evaluated for sleep-related pathologies, PSG and in-ear EEG were recorded simultaneously, the latter in two different configurations (with and without a contralateral reference on the scalp). In both groups, the in-ear EEG sensor showed a strong correlation, agreement and reliability with the ‘gold standard’ of PSG and thus supported accurate sleep classification, which is not feasible with actigraphy. Single-channel in-ear EEG offers compelling prospects for simplifying sleep parameterisation in both healthy individuals and clinical patients and paves the way for reliable assessments in a broader range of clinical situations, namely by integrating Level 3 polysomnography devices. In addition, addressing the recognised overestimation of the apnea-hypopnea index, due to the lack of an EEG signal, and the sparse information on sleep metrics could prove fundamental for optimised clinical decision making.
- Response to: Does reliability benefit from superior visualization of epileptiform discharges on inferior temporal electrodes?Publication . Batista, Carla; Soares, Joana Isabel; Coelho, Paulo; Ferreira, Simão; Rosenzweig, Ivana; Borges, Daniel Filipe; Borges, Daniel Filipe; Ferreira, SimãoWe thank Dr. Kleine for his thoughtful letter regarding our study and for highlighting both the anatomical rationale and the recognized clinical relevance of inferior-temporal electrodes. We welcome the opportunity to clarify specific numerical points and to provide the inter-reviewer agreement data he requested. Our study was intentionally designed as a prospective, blinded, within-subject technical validation comparing the IFCN-recommended 25-electrode 19-channel 10–20 International System (10–20 IS) in consecutive(IFCN-25) array with the conventional 19-channel 10–20 International System (10–20 IS) in consecutive adult EEGs. Importantly, it was not framed as a diagnostic or superiority trial: no external gold standard was applied, and both montages were treated methodologically as equivalent acquisition systems. The primary endpoint was patient-level detection of any abnormality (IEDs or focal slow activity) under blinded real-world conditions. In this reply, we address exclusively the point raised by Dr. Kleine concerning inter-reviewer agreement for temporal-lobe IEDs, providing the 2 × 2 tables and κ values requested. These analyses represent a clear subset of the broader dataset already published and are provided here for transparency.