title: Do false predictions of seizures depend on the state of vigilance? A report from two seizure-prediction methods and proposed remedies.
abstract: OBJECTIVE
  Available seizure-prediction algorithms are accompanied by high numbers of false predictions to achieve high sensitivity. Little is known about the extent to which changes in EEG dynamics contribute to false predictions. This study addresses potential causes and the circadian distribution of false predictions as well as their relation to the sleep-wake cycle.
  
  
  METHODS
  In 21 patients, each with 24 h of interictal invasive EEG recordings, two methods, the dynamic similarity index and the mean phase coherence, were assessed with respect to time points of false predictions. Visual inspection of the invasive EEG data and additional scalp electroencephalogram data was performed at times of false predictions to identify possible correlates of changes in the EEG dynamics.
  
  
  RESULTS
  A dependency of false predictions on the time of day is shown. Renormalized to the duration of the period patients are asleep and awake, 86% of all false predictions occurred during sleep for the dynamic similarity index and 68% for the mean phase coherence, respectively. Combining two reference intervals, one during sleep and one in an awake state, the dynamic similarity index increases its performance by reducing the number of false predictions by almost 50% without major changes in sensitivity. No obvious dependence of false predictions was noted on visible epileptic activity, such as spikes, sharp waves, or subclinical ictal patterns.
  
  
  CONCLUSIONS
  Changes in the EEG dynamics related to the sleep-wake cycle contribute to limits of specificity of both seizure-prediction methods investigated. This may provide a clue for improving prediction methods in general. The combination of reference states yields promising results and may offer opportunities to increase further the performance of prediction methods.
authors.affiliation: FDM, Freiburg Center for Data Analysis and Modeling, University of Freiburg, and Epilepsy Center, University Hospital of Freiburg, Germany. schelter@fdm.uni-freiburg.de
authors.forename: Björn
authors.initials: B
authors.lastname: Schelter
authors.forename: Matthias
authors.initials: M
authors.lastname: Winterhalder
authors.forename: Thomas
authors.initials: T
authors.lastname: Maiwald
authors.forename: Armin
authors.initials: A
authors.lastname: Brandt
authors.forename: Ariane
authors.initials: A
authors.lastname: Schad
authors.forename: Jens
authors.initials: J
authors.lastname: Timmer
authors.forename: Andreas
authors.initials: A
authors.lastname: Schulze-Bonhage
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D001143:Arousal / Q000502:physiology*; D002540:Cerebral Cortex / Q000503:physiopathology*; D002940:Circadian Rhythm / Q000502:physiology; D003344:Cortical Synchronization / Q000706:statistics & numerical data; D004567:Electrodes, Implanted / Q000706:statistics & numerical data; D004569:Electroencephalography / Q000379:methods / Q000706:statistics & numerical data*; D004827:Epilepsy / Q000175:diagnosis* / Q000503:physiopathology; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011336:Probability; D012016:Reference Values; D012680:Sensitivity and Specificity; D012815:Signal Processing, Computer-Assisted; D012890:Sleep / Q000502:physiology; D014851:Wakefulness / Q000502:physiology