A Multicenter Training and Interrater Reliability Study of the BASED Score for Infantile Epileptic Spasms Syndrome
Journal of Clinical Neurophysiology
AUTHORS
John R Mytinger 1 , Dara V F Albert 1 , Shawn C Aylward 1 , Christopher W Beatty 1 , Sonam Bhalla 2 3 , Sonal Bhatia 4 , Guy N Brock 5 6 , Micheal A Ciliberto 7 , Purva R Choudhari 8 , Daniel J Clark 1 , Jennifer Madan Cohen 9 , Theresa M Czech 7 , Megan M Fredwall 10 , Ernesto Gonzalez-Giraldo 11 , Chellamani Harini 12 , Senyene E Hunter 13 , Amanda G Sandoval Karamian 14 , Akshat Katyayan 15 , Isaac Kistler 16 17 , Neil Kulkarni 1 , Virginia B Liu 18 , Corinne McCabe 10 , Thomas Murray 1 , Kerri Neville 19 , Shital H Patel 20 , Spriha Pavuluri 21 , Donald J Phillips 18 , Debopam Samanta 22 , Deepa Sirsi 23 , Emily M Spelbrink 24 , Carl E Stafstrom 25 , Maija Steenari 18 , Danielle S Takacs 15 , Tyler Terrill 23 , Linh Tran 26 , Jorge Vidaurre 1 , Daniel W Shrey 18
ABSTRACT
Purpose: The best possible outcomes in infantile epileptic spasms syndrome require electroclinical remission; however, determining electrographic remission is not straightforward. Although the determination of hypsarrhythmia has inadequate interrater reliability (IRR), the Burden of AmplitudeS and Epileptiform Discharges (BASED) score has shown promise for the reliable interictal assessment of infantile epileptic spasms syndrome. Our aim was to develop a BASED training program and assess the IRR among learners. We hypothesized moderate or better IRR for the final BASED score and the presence or absence of epileptic encephalopathy (+/-EE).
Methods: Using a web-based application, 31 learners assessed 12 unmarked EEGs (length 1-6 hours) from children with infantile epileptic spasms syndrome.
Results: For all readers, the IRR was good for the final BASED score (intraclass correlation coefficient 0.86) and +/-EE (Marginal Multirater Kappa 0.63). For all readers, the IRR was fair to good for all individual BASED score elements.
Conclusions: These findings support the use of our training program to quickly learn the BASED scoring method. The BASED score may be a valuable clinical and research tool. Given that the IRR for the determination of epileptic encephalopathy is not perfect, clinical acumen remains paramount. Additional experience with the BASED scoring technique among learners and advances in collaborative EEG evaluation platforms may improve IRR.