Listening to sonified electroencephalograms (EEGs) for rhythmic fluctuations is a potentially effective strategy for identifying seizures among at-risk patients presenting with no clinical signs of seizure, according to study findings published in Epilepsia.

Investigators obtained 15-second-long EEG samples (n=84) from patients presenting with altered mental status but no signs of seizure (“silent” seizure) at time of evaluation. A total of 3 EEG experts reviewed the visually presented samples and defined sample patterns as those that were seizures (n=7), those that had seizure-like abnormalities (n=25), or those that featured slowing or normal patterns (n=52).

Medical students (n=34) and nurses (n=30) without EEG interpretation experience received a 4-minute training video and were subsequently asked to determine which sonified EEG audio sample was representative of a seizure or nonseizure. Findings from this survey were compared with reports from neurologists experienced with EEG (n=12) as well as nonexpert medical students (n=29) who reviewed and differentiated the visual EEG samples.

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Medical students and nurses who reviewed the sonified EEGs were able to identify seizures with greater sensitivity than EEG experts or nonexperts who visually reviewed the same EEG data (98%±5% and 95%±14% vs 88%±11% and 76%±19%, respectively). Despite these findings, the specificity for detecting seizures (65% and 66%, respectively) was lower than the sensitivity (95% and 98%, respectively) among nonexperienced nurses and students.

In the event where EEGs featured either seizures or seizure-like patterns, nonexpert medical students who auditorily reviewed the EEGs rated samples as seizures with a higher degree of specificity vs experts or nonexpert medical students who reviewed them visually (85%±9% [students] and 82%±12% [nurses] vs 90%±7% [neurologists] and 65%±20% [students]). When visually reviewing the EEG samples, nonexpert medical students demonstrated less sensitivity (76%; P <.001) and specificity (65%; P =.92) for detecting seizures and less sensitivity (62%; P <.001) and specificity (65%; P <.001) for detecting seizures and seizure-like activity.

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Considering the investigators selected only single-channel EEGs (eg, T3-T5 or T4-T6) for assessment, it is possible that focal seizures on other channels may have been missed. In addition, findings from this study were obtained in a retrospective fashion and may not be fully representative of findings obtained at the bedside.

The investigators suggest that the use of sonified EEGs “should be used as a triage diagnostic tool to help nonexpert users discern normal or slow activity from seizures and grossly abnormal seizure-like rhythmic or periodic discharges.”


Parvizi J, Gururangan K, Razavi B, Chafe C. Detecting silent seizures by their sound. Epilepsia. 2018;59(4):877-884.