title: Validation of a smartphone-based EEG among people with epilepsy: A prospective study.
abstract: Our objective was to assess the ability of a smartphone-based electroencephalography (EEG) application, the Smartphone Brain Scanner-2 (SBS2), to detect epileptiform abnormalities compared to standard clinical EEG. The SBS2 system consists of an Android tablet wirelessly connected to a 14-electrode EasyCap headset (cost ~ 300 USD). SBS2 and standard EEG were performed in people with suspected epilepsy in Bhutan (2014-2015), and recordings were interpreted by neurologists. Among 205 participants (54% female, median age 24 years), epileptiform discharges were detected on 14% of SBS2 and 25% of standard EEGs. The SBS2 had 39.2% sensitivity (95% confidence interval (CI) 25.8%, 53.9%) and 94.8% specificity (95% CI 90.0%, 97.7%) for epileptiform discharges with positive and negative predictive values of 0.71 (95% CI 0.51, 0.87) and 0.82 (95% CI 0.76, 0.89) respectively. 31% of focal and 82% of generalized abnormalities were identified on SBS2 recordings. Cohen's kappa (κ) for the SBS2 EEG and standard EEG for the epileptiform versus non-epileptiform outcome was κ = 0.40 (95% CI 0.25, 0.55). No safety or tolerability concerns were reported. Despite limitations in sensitivity, the SBS2 may become a viable supportive test for the capture of epileptiform abnormalities, and extend EEG access to new, especially resource-limited, populations at a reduced cost.
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Erica D
authors.initials: ED
authors.lastname: McKenzie
authors.affiliation: Division of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
authors.forename: Andrew S P
authors.initials: AS
authors.lastname: Lim
authors.affiliation: Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada.
authors.forename: Edward C W
authors.initials: EC
authors.lastname: Leung
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Cole
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Alice D
authors.initials: AD
authors.lastname: Lam
authors.affiliation: Department of Biostatistics, School of Public Health, Brown University, Providence, RI, USA.
authors.forename: Ani
authors.initials: A
authors.lastname: Eloyan
authors.affiliation: Department of Psychiatry, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan.
authors.forename: Damber K
authors.initials: DK
authors.lastname: Nirola
authors.affiliation: Department of Psychiatry, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan.
authors.forename: Lhab
authors.initials: L
authors.lastname: Tshering
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Ronald
authors.initials: R
authors.lastname: Thibert
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Rodrigo Zepeda
authors.initials: RZ
authors.lastname: Garcia
authors.affiliation: Division of Neurology, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada.
authors.forename: Esther
authors.initials: E
authors.lastname: Bui
authors.affiliation: Department of Psychiatry, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan.
authors.forename: Sonam
authors.initials: S
authors.lastname: Deki
authors.affiliation: Division of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
authors.forename: Liesly
authors.initials: L
authors.lastname: Lee
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Clark
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Cohen
authors.affiliation: Division of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
authors.forename: Jo
authors.initials: J
authors.lastname: Mantia
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Kate T
authors.initials: KT
authors.lastname: Brizzi
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Tali R
authors.initials: TR
authors.lastname: Sorets
authors.affiliation: Department of Neurology, University of Washington, Seattle, WA, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Wahlster
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Mia
authors.initials: M
authors.lastname: Borzello
authors.affiliation: Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby, Denmark.
authors.forename: Arkadiusz
authors.initials: A
authors.lastname: Stopczynski
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Sydney S
authors.initials: SS
authors.lastname: Cash
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Farrah J
authors.initials: FJ
authors.lastname: Mateen
mesh_terms: D000293:Adolescent; D000328:Adult; D001631:Bhutan / Q000453:epidemiology; D004569:Electroencephalography; D004827:Epilepsy / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012640:Seizures / Q000175:diagnosis* / Q000503:physiopathology; D000068997:Smartphone / Q000706:statistics & numerical data*; D055815:Young Adult