The purpose of this study was to determine the validity of abbreviated EEG montages for seizure detection during polysomnography. Three electroencephalographers reviewed files containing seizures or nonepileptic events using 8- and 18-channel montages. Files were rated as to whether they contained seizures and assigned a "probability of seizure" score from 0% to 100% reflecting the confidence that it was a seizure. Readers then localized seizures as temporal, frontal, parieto-occipital, or nonlocalized and provided a probability of correct localization with 0% to 100% confidence. Data were analyzed using the Adjusted McNemar Test method of Obochuwski. The probability of seizure score was measured using the receiver operating characteristic curve. Observed agreement was 78% and 84% for 8- and 18-channel montages, respectively. Readers were better able to distinguish seizures from nonepileptic events using the 18-channel montage (P = 0.004). Seizures localized to the temporal and parieto-occipital regions were more likely to be correctly identified and localized. Readers were able to correctly localize 27% and 49% of seizures using the 8- and 18-channel montages, respectively (P < 0.001). Abbreviated EEG montages are inadequate in the differentiation of seizures and nonepileptic events arising from sleep during polysomnography. This seems to be particularly true in frontal lobe epilepsy.
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