Inter-rater agreement on identification of electrographic seizures and periodic discharges in ICU EEG recordings.

OBJECTIVE: This study investigated inter-rater agreement (IRA) among EEG experts for the identification of electrographic seizures and periodic discharges (PDs) in continuous ICU EEG recordings. METHODS: Eight board-certified EEG experts independently identified seizures and PDs in thirty 1-h EEG segments which were selected from ICU EEG recordings collected from three medical centers. IRA was compared between seizure and PD identifications, as well as among rater groups that have passed an ICU EEG Certification Test, developed by the Critical Care EEG Monitoring Research Consortium (CCEMRC). RESULTS: Both kappa and event-based IRA statistics showed higher mean values in identification of seizures compared to PDs (k=0.58 vs. 0.38; p<0.001). The group of rater pairs who had both passed the ICU EEG Certification Test had a significantly higher mean IRA in comparison to rater pairs in which neither had passed the test. CONCLUSIONS: IRA among experts is significantly higher for identification of electrographic seizures compared to PDs. Additional instruction, such as the training module and certification test developed by the CCEMRC, could enhance this IRA. SIGNIFICANCE: This study demonstrates more disagreement in the labeling of PDs in comparison to seizures. This may be improved by education about standard EEG nomenclature.

Increased spontaneous unit activity and appearance of spontaneous negative potentials in the goldfish tectum during refinement of the optic projection.

Spontaneous (not retinally driven) postsynaptic activity was examined during activity-dependent refinement of optic fibers in the goldfish tectum. Unit recordings in vivo and in vitro demonstrated that spontaneous tectal activity increased to 150% of normal during refinement at 1-2 months after optic nerve crush and subsequently returned to baseline over the next month. This increase was not mimicked by long-term denervation indicating an effect specifically influenced by regenerating fibers. Loss of optic input was also found to induce spontaneous negative potentials (SNPs) rapidly in the tectum. SNPs were negative, monophasic potentials of 70-120 msec duration and -0.15 to -1.5 mV amplitude. SNPs occurred with no apparent periodicity at a frequency of approximately 0.3-0.6 Hz. Multiple electrode recordings and depth analysis showed that SNPs were localized events occurring in columnar domains of tectum a few hundred micrometers wide. Cross-correlation analysis revealed that SNPs were strongly correlated with local unit bursting, suggesting SNPs are generated by the summed synaptic and spike currents of coactive cells in small regions of the tectum. SNPs were suppressed by a low concentration of APV indicating they were regulated by NMDA receptors. During regeneration, the number and size of SNPs reached a peak during refinement and subsequently decreased, eventually disappearing. This temporal association with refinement suggests that these patterns of postsynaptic activity may have functional relevance. It is hypothesized that SNPs or the underlying activity that produces them increases the excitability of target cells, allowing the weak, less-convergent input from regenerating axons to drive target groups of cells in the tectum during refinement.