ArticleAnnals of neurology2021
Automated Annotation of Epileptiform Burden and Its Association with Outcomes.
Article in Annals of neurology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers.
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Who cites it
25 citing papers in PubMed.
- Electroencephalography Monitoring for Seizure Risk Stratification in the Critically III.Current neurology and neuroscience reports · 2026Review
- Article
- Resting-state EEG for continuous prognostic monitoring and prediction of coma recovery after acute brain injury.Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology · 2026Article
- Point-of-Care EEG Artificial Intelligence Measure of Seizure Burden Associates With Clinical Outcome at Discharge.Critical care medicine · 2026Article
- Status Epilepticus Is Detected Earlier than Seizures on cEEG in Critically Ill Adults.Neurocritical care · 2026Article
- Electroencephalogram Monitoring in Critical Care: Multicenter Analysis of Timing, Duration, and Readmissions.Critical care explorations · 2026Article
- Automating Critical Care EEG: Enhancing Accuracy, Efficiency, and Patient Outcomes in Critical Care.Epilepsy currents · 2026Article
- Choosing wisely: who really benefits from critical care EEG monitoring?Intensive care medicine · 2025Article
- Harvard Electroencephalography Database: A comprehensive clinical electroencephalographic resource from four Boston hospitals.Epilepsia · 2025Article
- Using artificial intelligence to optimize anti-seizure treatment and EEG-guided decisions in severe brain injury.Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics · 2025Review
- Antiseizure Medication Use and Outcomes After Suspected or Confirmed Acute Symptomatic Seizures.JAMA neurology · 2024Article
- Utility and rationale for continuous EEG monitoring: a primer for the general intensivist.Critical care (London, England) · 2024Review
- How many patients do you need? Investigating trial designs for anti-seizure treatment in acute brain injury patients.Annals of clinical and translational neurology · 2024Article
- Article
- Review
- The Cost of After-Hour Electroencephalography.Neurology. Clinical practice · 2024Article
- It's About Time! Timing in Epilepsy Evaluation and Treatment.Epilepsy currents · 2024Review
- Association of Epileptiform Activity With Outcomes in Toxic-Metabolic Encephalopathy.Critical care explorations · 2023Article
- Development of Expert-Level Classification of Seizures and Rhythmic and Periodic Patterns During EEG Interpretation.Neurology · 2023Article
- Interrater Reliability of Expert Electroencephalographers Identifying Seizures and Rhythmic and Periodic Patterns in EEGs.Neurology · 2023Article
Corrections and comments
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Authors and funding
20 authors.
Funding
Abstract
objectiveThis study was undertaken to determine the dose-response relation between epileptiform activity burden and outcomes in acutely ill patients.
methodsA single center retrospective analysis was made of 1,967 neurologic, medical, and surgical patients who underwent >16 hours of continuous electroencephalography (EEG) between 2011 and 2017. We developed an artificial intelligence algorithm to annotate 11.02 terabytes of EEG and quantify epileptiform activity burden within 72 hours of recording. We evaluated burden (1) in the first 24 hours of recording, (2) in the 12-hours epoch with highest burden (peak burden), and (3) cumulatively through the first 72 hours of monitoring. Machine learning was applied to estimate the effect of epileptiform burden on outcome. Outcome measure was discharge modified Rankin Scale, dichotomized as good (0-4) versus poor (5-6).
resultsPeak epileptiform burden was independently associated with poor outcomes (p < 0.0001). Other independent associations included age, Acute Physiology and Chronic Health Evaluation II score, seizure on presentation, and diagnosis of hypoxic-ischemic encephalopathy. Model calibration error was calculated across 3 strata based on the time interval between last EEG measurement (up to 72 hours of monitoring) and discharge: (1) <5 days between last measurement and discharge, 0.0941 (95% confidence interval [CI] = 0.0706-0.1191); 5 to 10 days between last measurement and discharge, 0.0946 (95% CI = 0.0631-0.1290); >10 days between last measurement and discharge, 0.0998 (95% CI = 0.0698-0.1335). After adjusting for covariates, increase in peak epileptiform activity burden from 0 to 100% increased the probability of poor outcome by 35%.
interpretationAutomated measurement of peak epileptiform activity burden affords a convenient, consistent, and quantifiable target for future multicenter randomized trials investigating whether suppressing epileptiform activity improves outcomes. ANN NEUROL 2021;90:300-311.
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