title: Wavelet-denoising of electroencephalogram and the absolute slope method: a new tool to improve electroencephalographic localization and lateralization.
abstract: OBJECTIVE
  In ictal scalp electroencephalogram (EEG) the presence of artefacts and the wide ranging patterns of discharges are hurdles to good diagnostic accuracy. Quantitative EEG aids the lateralization and/or localization process of epileptiform activity.
  
  
  METHODS
  Twelve patients achieving Engel Class I/IIa outcome following temporal lobe surgery (1 year) were selected with approximately 1-3 ictal EEGs analyzed/patient. The EEG signals were denoised with discrete wavelet transform (DWT), followed by computing the normalized absolute slopes and spatial interpolation of scalp topography associated to detection of local maxima. For localization, the region with the highest normalized absolute slopes at the time when epileptiform activities were registered (>2.5 times standard deviation) was designated as the region of onset. For lateralization, the cerebral hemisphere registering the first appearance of normalized absolute slopes >2.5 times the standard deviation was designated as the side of onset. As comparison, all the EEG episodes were reviewed by two neurologists blinded to clinical information to determine the localization and lateralization of seizure onset by visual analysis.
  
  
  RESULTS
  16/25 seizures (64%) were correctly localized by the visual method and 21/25 seizures (84%) by the quantitative EEG method. 12/25 seizures (48%) were correctly lateralized by the visual method and 23/25 seizures (92%) by the quantitative EEG method. The McNemar test showed p=0.15 for localization and p=0.0026 for lateralization when comparing the two methods.
  
  
  CONCLUSIONS
  The quantitative EEG method yielded significantly more seizure episodes that were correctly lateralized and there was a trend towards more correctly localized seizures.
  
  
  CONCLUSIONS
  Coupling DWT with the absolute slope method helps clinicians achieve a better EEG diagnostic accuracy.
authors.affiliation: Division of Neurology, Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China. howanleung@hotmail.com
authors.forename: Howan
authors.initials: H
authors.lastname: Leung
authors.forename: Kaspar
authors.initials: K
authors.lastname: Schindler
authors.forename: Anne Y Y
authors.initials: AY
authors.lastname: Chan
authors.forename: Alexander Y L
authors.initials: AY
authors.lastname: Lau
authors.forename: Ka Lau
authors.initials: KL
authors.lastname: Leung
authors.forename: Eric Him Shing
authors.initials: EH
authors.lastname: Ng
authors.forename: Ka Sing
authors.initials: KS
authors.lastname: Wong
mesh_terms: D000293:Adolescent; D000328:Adult; D016477:Artifacts; D001921:Brain / Q000503:physiopathology*; D001931:Brain Mapping; D004569:Electroencephalography / Q000379:methods*; D004833:Epilepsy, Temporal Lobe / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D012189:Retrospective Studies; D055815:Young Adult