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Closing the temporal blind spot: Six additional electrodes increase patient-level EEG abnormality detection by ~12%

dc.contributor.authorBatista, Carla
dc.contributor.authorSoares, Joana Isabel
dc.contributor.authorCoelho, Paulo
dc.contributor.authorFerreira, Simão
dc.contributor.authorRosenzweig, Ivana
dc.contributor.authorBorges, Daniel Filipe
dc.contributor.authorBorges, Daniel Filipe
dc.contributor.authorFerreira, Simão
dc.contributor.authorSoares, Joana I.
dc.date.accessioned2025-10-08T09:07:50Z
dc.date.available2025-10-08T09:07:50Z
dc.date.issued2025-10-07
dc.description.abstractTo 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.por
dc.identifier.citationBatista, C., Soares, J. I., Coelho, P., Ferreira, S., Rosenzweig, I., & Borges, D. F. (2025). Closing the temporal blind spot: Six additional electrodes increase patient-level EEG abnormality detection by 12%. Epileptic Disorders, n/a(n/a). https://doi.org/10.1002/epd2.70114
dc.identifier.doi10.1002/epd2.70114
dc.identifier.eissn1950-6945
dc.identifier.issn1294-9361
dc.identifier.urihttp://hdl.handle.net/10400.22/30581
dc.language.isoeng
dc.peerreviewedyes
dc.publisherWiley
dc.relation.hasversionhttps://onlinelibrary.wiley.com/doi/10.1002/epd2.70114
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/
dc.subject10–20 International System
dc.subjectElectrodes
dc.subjectElectroencephalography
dc.subjectEpilepsy
dc.subjectIFCN 25-channelEEG
dc.subjectInterictal epileptiform discharges
dc.subjectSensitivity and specificity
dc.titleClosing the temporal blind spot: Six additional electrodes increase patient-level EEG abnormality detection by ~12%por
dc.typeresearch article
dspace.entity.typePublication
oaire.citation.titleEpileptic Disorders
oaire.versionhttp://purl.org/coar/version/c_970fb48d4fbd8a85
person.familyNameBorges
person.familyNameFerreira
person.familyNameSoares
person.givenNameDaniel Filipe
person.givenNameSimão
person.givenNameJoana I.
person.identifier3235598
person.identifier2680796
person.identifier.ciencia-id0217-87F9-58DF
person.identifier.ciencia-idB11E-1BD3-5F34
person.identifier.ciencia-idB81F-1A58-0242
person.identifier.orcid0000-0003-0189-7908
person.identifier.orcid0000-0001-8233-2217
person.identifier.orcid0000-0002-3549-6873
person.identifier.ridJVO-1831-2024
person.identifier.scopus-author-id57912703700
person.identifier.scopus-author-id57359736400
relation.isAuthorOfPublicationf67e814a-8ad9-4440-820a-deaccea87bb8
relation.isAuthorOfPublication0bd5b0fc-6849-4f36-b751-87e7f4c81eff
relation.isAuthorOfPublication60b3d8c2-513c-4fcf-9b0d-0c85bd34ea1b
relation.isAuthorOfPublication.latestForDiscoveryf67e814a-8ad9-4440-820a-deaccea87bb8

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