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Comparative Study
. 2022 Jan:126:96-103.
doi: 10.1016/j.pediatrneurol.2021.10.012. Epub 2021 Oct 19.

Using EEG in Resource-Limited Areas: Comparing Qualitative and Quantitative Interpretation Methods in Cerebral Malaria

Alexander Andrews  1 , Tesfaye Zelleke  2 , Rima Izem  3 , Jiaxiang Gai  4 , Dana Harrar  2 , Jessica Mvula  5 , Douglas G Postels  6
Affiliations
Comparative Study

Using EEG in Resource-Limited Areas: Comparing Qualitative and Quantitative Interpretation Methods in Cerebral Malaria

Alexander Andrews et al. Pediatr Neurol. 2022 Jan.

Abstract

Background: Our goal was to compare the strength of association and predictive ability of qualitative and quantitative electroencephalographic (EEG) factors with the outcomes of death and neurological disability in pediatric cerebral malaria (CM).

Methods: We enrolled children with a clinical diagnosis of CM admitted to Queen Elizabeth Central Hospital (Blantyre, Malawi) between 2012 and 2017. A routine-length EEG was performed within four hours of admission. EEG data were independently interpreted using qualitative and quantitative methods by trained pediatric neurophysiologists. EEG interpreters were unaware of patient discharge outcome.

Results: EEG tracings from 194 patients were reviewed. Multivariate modeling revealed several qualitative and quantitative EEG variables that were independently associated with outcomes. Quantitative methods modeled on mortality had better goodness of fit than qualitative ones. When modeled on neurological morbidity in survivors, goodness of fit was better for qualitative methods. When the probabilities of an adverse outcome were calculated using multivariate regression coefficients, only the model of quantitative EEG variables regressed on the neurological sequelae outcome showed clear separation between outcome groups.

Conclusions: Multiple qualitative and quantitative EEG factors are associated with outcomes in pediatric CM. It may be possible to use quantitative EEG factors to create automated methods of study interpretation that have similar predictive abilities for outcomes as human-based interpreters, a rare resource in many malaria-endemic areas. Our results provide a proof-of-concept starting point for the development of quantitative EEG interpretation and prediction methodologies useful in resource-limited settings.

Keywords: Africa; Coma; Electroencephalography; Malaria.

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Conflict of interest statement

Declarations of Interest:

Drs. Postels and Zelleke received salary support for this project via Interagency Personnel Agreements with the National Institute of Allergy and Infectious Diseases. No other authors had potential conflicts of interest.

Figures

Figure 1:
Figure 1:
Correlation between 2-second and 5-minute average sampling methods. Plots and numeric Pearson correlation coefficients for power of frequency bands (total, delta, theta, and alpha) comparing the two sampling methods
Figure 2:
Figure 2:
Probability density curves predicting death using qualitative (A) or quantitative (B) EEG interpretation methods; predicting neurologic sequelae in survivors using qualitative (C) or quantitative (D) methods. Separation of two defined peaks indicates superior predictive ability.
See this image and copyright information in PMC

References

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