Sándor Beniczky

• M.D., Ph.D.
• Professor Head of Department at Aarhus University

The International League Against Epilepsy (ILAE) has updated the operational classification of epileptic seizures, building upon the framework established in 2017. This revision, informed by the implementation experience, involved a working group appointed by the ILAE Executive Committee. Comprising 37 members from all ILAE regions, the group utili...

Objective To develop and validate a wrist‐worn accelerometer‐based, deep‐learning tunable algorithm for the automated detection of generalized or bilateral convulsive seizures (CSs) to be integrated with off‐the‐shelf smartwatches. Methods We conducted a prospective multi‐center study across eight European epilepsy monitoring units, collecting dat...

Ideally, pediatric electroencephalograms (EEGs) should be performed by accredited neurophysiology technologists and interpreted by specialists trained in epileptology However, low‐ and middle‐income countries (LMICs) lack such specialists. Aim To collate expert consensus on essential curriculum content for non‐epilepsy specialists in EEG interpret...

Purpose To understand the current state of epilepsy surgery education delivered to epilepsy fellows in the United States. Methods An online survey focused on characteristics of epilepsy surgery education was distributed to all 93 epilepsy fellowship program directors listed on the ACGME website (accessed in May 2022). Programs were stratified per...

Seizure detection devices (SDDs) offer promising technological advancements in epilepsy management, providing real‐time seizure monitoring and alerts for patients and caregivers. This critical review explores user perspectives and experiences with SDDs to better understand factors influencing their adoption and sustained use. An electronic literatu...

Purpose Delivering optimal care to patients with seizures and epilepsy requires all EEGs to be interpreted accurately and reliably. This study investigated neurology professionals' opinions on the ideal standards for EEG in clinical care. Methods We developed an anonymous e-survey targeting practicing and trainee neurologists focused on participan...

Abstract The International League Against Epilepsy (ILAE) has updated the operational classification of epileptic seizures, building upon the framework established in 2017. This revision, informed by the implementation experience, involved a working group appointed by the ILAE Executive Committee. Comprising 37 members from all ILAE regions, the gr...

Objective EEG patterns and quantitative EEG (qEEG) features have been poorly explored in monogenic epilepsies. Herein, we investigate regional differences in EEG frequency composition in patients with STXBP1 developmental and epileptic encephalopathy (STXBP1‐DEE). Methods We conducted a retrospective study collecting electroclinical data of patien...

Epilepsy care generates multiple sources of high‐dimensional data, including clinical, imaging, electroencephalographic, genomic, and neuropsychological information, that are collected routinely to establish the diagnosis and guide management. Thanks to high‐performance computing, sophisticated graphics processing units, and advanced analytics, we...

Objective This study was undertaken to assess the clinical utility, safety, and tolerability in epilepsy patients of ultra long‐term monitoring with a novel subcutaneous electroencephalographic (EEG) device (sqEEG). Methods Five patients with drug‐resistant focal epilepsy were implanted (one patient bilaterally) with sqEEG. In phase 1, we assessed...

Objective Reproducibility is key for diagnostic tests involving subjective evaluation by experts. Our aim was to systematically review the reproducibility of visual analysis in clinical electroencephalogram (EEG). In this paper, we give data on the scope of EEG features found, and detailed reproducibility data for the most studied feature. Methods...

Objective This systematic review aims to describe the involvement of persons with epilepsy (PWE), healthcare professionals (HP) and caregivers (CG) in the design and development of medical devices is epilepsy. Methods A systematic review was conducted, adhering to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guid...

The need for high‐quality automated seizure detection algorithms based on electroencephalography (EEG) becomes ever more pressing with the increasing use of ambulatory and long‐term EEG monitoring. Heterogeneity in validation methods of these algorithms influences the reported results and makes comprehensive evaluation and comparison challenging. T...

Introduction Epilepsy surgery is the only curative treatment for patients with drug-resistant focal epilepsy. Stereoelectroencephalography (SEEG) is the gold standard to delineate the seizure-onset zone (SOZ). However, up to 40% of patients are subsequently not operated as no focal non-eloquent SOZ can be identified. The 5-SENSE Score is a 5-point...

Objective The automated interpretation of clinical electroencephalograms (EEGs) using artificial intelligence (AI) holds the potential to bridge the treatment gap in resource‐limited settings and reduce the workload at specialized centers. However, to facilitate broad clinical implementation, it is essential to establish generalizability across div...

Objective Stereoelectroencephalography (SEEG) is increasingly utilized worldwide in epilepsy surgery planning. International guidelines for SEEG terminology and interpretation are yet to be proposed. There are worldwide differences in SEEG definitions, application of features in epilepsy surgery planning, and interpretation of surgical outcomes. Th...

This paper introduces BrainFuseNet , a novel lightweight seizure detection network based on the sensor fusion of electroencephalography (EEG) with photoplethysmography (PPG) and accelerometer (ACC) signals, tailored for low-channel count wearable systems. BrainFuseNet utilizes the Sensitivity-Specificity Weighted Cross-Entropy (SSWCE), an innov...

Although several validated wearable devices are available for detection of generalized tonic–clonic seizures, automated detection of tonic seizures is still a challenge. In this phase 1 study, we report development and validation of an artificial neural network (ANN) model for automated detection of tonic seizures with visible clinical manifestatio...

Objective To develop a low‐cost portable EEG system, with real‐time automated guidance, for application in resource‐limited areas, to bridge the diagnostic and treatment gap. Methods We designed, developed, and produced a low‐cost system, which records 27‐channel EEG plus ECG and streams the signals to an application on a smartphone, which assesse...

Pathogenic variants in CACNA1E are associated with early‐onset epileptic and developmental encephalopathy (DEE). Severe to profound global developmental delay, early‐onset refractory seizures, severe hypotonia, and macrocephaly are the main clinical features. Patients harboring the recurrent CACNA1E variant p.(Gly352Arg) typically present with the...

Objective We created a framework to assess the competency‐based EEG curriculum, outlined by the International League Against Epilepsy (ILAE) through a video‐based online educational resource (“Roadmap to EEGs”) and assessed its effectiveness and feasibility in improving trainees' knowledge. Methods Ten video‐based e‐learning modules addressed seve...

Objective Recording seizures on video‐EEG has a high diagnostic value. However, bilateral convulsive seizures constitute a risk for the patients. Our aim was to investigate the diagnostic yield and associated risks of provocation methods in short‐term video‐EEGs. Methods We extracted data on seizures and provocation methods from a large database o...

Introduction Automated seizure detection promises to aid in the prevention of SUDEP and improve the quality of care by assisting in epilepsy diagnosis and treatment adjustment. Methods In this phase 2 exploratory study, the performance of a contactless, marker-free, video-based motor seizure detection system is assessed, considering video recordin...

Background and Objectives In the United States, many child neurologists (CNs) and neurodevelopmental disability (NDD) specialists who read EEGs in clinical practice had no additional EEG training other than what was received during residency. This practice highlights the importance of ensuring that CN/NDD residents achieve EEG competence before gra...

Objective This study was undertaken to develop a standardized grading system based on expert consensus for evaluating the level of confidence in the localization of the epileptogenic zone (EZ) as reported in published studies, to harmonize and facilitate systematic reviews in the field of epilepsy surgery. Methods We conducted a Delphi study invol...

Objective Automated seizure detection of focal epileptic seizures is needed for objective seizure quantification to optimize the treatment of patients with epilepsy. Heart rate variability (HRV)‐based seizure detection using patient‐adaptive threshold with logistic regression machine learning (LRML) methods has presented promising performance in a...

Electroencephalography (EEG) is widely used to monitor epileptic seizures, and standard clinical practice consists of monitoring patients in dedicated epilepsy monitoring units via video surveillance and cumbersome EEG caps. Such a setting is not compatible with long-term tracking under typical living conditions, thereby motivating the development...

Objective Bilateral tonic–clonic seizures with focal semiology or focal interictal electroencephalography (EEG) can occur in both focal and generalized epilepsy types, leading to diagnostic errors and inappropriate therapy. We investigated the prevalence and prognostic values of focal features in patients with idiopathic generalized epilepsy (IGE),...

Objective To develop and validate a method for long‐term (24‐h) objective quantification of absence seizures in the EEG of patients with childhood absence epilepsy (CAE) in their real home environment using a wearable device (waEEG), comparing automatic detection methods with auditory recognition after seizure sonification. Methods The waEEG recor...

Purpose of review Clinical electroencephalography (EEG) is a conservative medical field. This explains likely the significant gap between clinical practice and new research developments. This narrative review discusses possible causes of this discrepancy and how to circumvent them. More specifically, we summarize recent advances in three applicatio...

Objective This study was undertaken to conduct external validation of previously published epilepsy surgery prediction tools using a large independent multicenter dataset and to assess whether these tools can stratify patients for being operated on and for becoming free of disabling seizures (International League Against Epilepsy stage 1 and 2). M...

Objective We published a list of “must‐know” routine EEG (rEEG) findings for trainees based on expert opinion. Here, we studied the accuracy and inter‐rater agreement (IRA) of these “must‐know” rEEG findings among international experts. Methods A previously validated online rEEG examination was disseminated to EEG experts. It consisted of a survey...

Artificial intelligence (AI) allows data analysis and integration at an unprecedented granularity and scale. Here we review the technological advances, challenges and future perspectives of using AI for electro‐clinical phenotyping of animal models and patients with epilepsy. In translational research AI models accurately identify behavioral states...

Background and Objectives We recently published expert consensus-based curricular objectives for routine EEG (rEEG) interpretation for adult and child neurology residents. In this study, we used this curriculum framework to develop and validate an online, competency-based, formative and summative rEEG examination for neurology residents. Methods W...

Objective This study was undertaken to establish whether advanced workup including long‐term electroencephalography (LT‐EEG) and brain magnetic resonance imaging (MRI) provides an additional yield for the diagnosis of new onset epilepsy (NOE) in patients presenting with a first seizure event (FSE). Methods In this population‐based study, all adult...

Wearable seizure detection devices have the potential to address unmet needs of people with epilepsy. A recently published evidence‐based international guideline recommends using such devices for safety indications in patients with tonic‐clonic seizures (TCS). Our objective was to map existing guidelines and clinical practices at national level. We...

Objective The Salzburg criteria for nonconvulsive status epilepticus (NCSE) and the American Clinical Neurophysiology Society (ACNS) Standardized Critical Care EEG Terminology 2021 include a diagnostic trial with intravenous (IV) antiseizure medications (ASMs) to assess electroencephalographic (EEG) and clinical response as a diagnostic criterion f...

Importance: Electroencephalograms (EEGs) are a fundamental evaluation in neurology but require special expertise unavailable in many regions of the world. Artificial intelligence (AI) has a potential for addressing these unmet needs. Previous AI models address only limited aspects of EEG interpretation such as distinguishing abnormal from normal o...

Purpose The purpose of this study is to investigate the impact of Bergen Epileptiform Morphology Score (BEMS) and interictal epileptiform discharge (IED) candidate count in EEG classification. Methods We included 400 consecutive patients from a clinical SCORE EEG database during 2013–2017 who had focal sharp discharges in their EEG, but no previou...

Phase 2 studies showed that focal seizures could be detected by algorithms using heart rate variability (HRV) in patients with marked autonomic ictal changes. However, wearable surface electrocardiographic (ECG) devices use electrode patches that need to be changed often and may cause skin irritation. We report the first study of automated seizure...

Correctly diagnosing and classifying seizures and epilepsies is paramount to ensure the delivery of optimal care to patients with epilepsy. Focal seizures, defined as those that originate within networks limited to one hemisphere, are primarily subdivided into focal aware, focal impaired awareness, and focal to bilateral tonic–clonic seizures. Foca...

Automated seizure detection promises to aid in the prevention of SUDEP and improve the quality of care by assisting in epilepsy diagnosis and treatment adjustment. In this phase 2 validation, the algorithmic model performance of a contactless, marker-free video-based motor seizure detection system is evaluated against video-electroencephalographic...

Purpose: Wearable automated detection devices of focal epileptic seizures are needed to alert patients and caregivers and to optimize the medical treatment. Heart rate variability (HRV)-based seizure detection devices have presented good detection sensitivity. However, false alarm rates (FAR) are too high. Methods: In this phase-2 study we pursu...

This article provides recommendations on the minimum standards for recording routine (“standard”) and sleep electroencephalography (EEG). The joint working group of the International Federation of Clinical Neurophysiology (IFCN) and the International League Against Epilepsy (ILAE) developed the standards according to the methodology suggested for e...

This article provides recommendations on the minimum standards for recording routine ("standard") and sleep electroencephalography (EEG). The joint working group of the International Federation of Clinical Neurophysiology (IFCN) and the International League Against Epilepsy (ILAE) developed the standards according to the methodology suggested for e...

Objective To determine the duration of epileptic seizure types in patients who did not undergo withdrawal of antiseizure medication. Methods From a large, structured database of 11 919 consecutive, routine video‐electroencephalograpy (EEG) recordings, labeled using the SCORE (Standardized Computer‐Based Organized Reporting of EEG) system, we extra...

The ILAE Academy is the online learning platform of the International League Against Epilepsy (ILAE) and offers a structured educational program addressing the competency‐based ILAE curriculum in epileptology. The platform was launched in July 2020 with a self‐paced course portfolio of interactive e‐learning modules addressing ILAE Level 1 learning...

Background A third of people with juvenile myoclonic epilepsy (JME) are drug-resistant. Three-quarters have a seizure relapse when attempting to withdraw anti-seizure medication (ASM) after achieving seizure-freedom. It is currently impossible to predict who is likely to become drug-resistant and safely withdraw treatment. We aimed to identify pred...

Objective Postictal generalized electroencephalography (EEG) suppression (PGES) is a surrogate marker of sudden unexpected death in epilepsy (SUDEP). It is still unclear which ictal phenomena lead to prolonged PGES and increased risk of SUDEP. Semiology features of generalized convulsive seizure (GCS type 1) have been reported as a predictor of pro...

Electric source imaging (ESI) estimates the cortical generator of the electroencephalography (EEG) signals recorded with scalp electrodes. ESI has gained increasing interest for the presurgical evaluation of patients with drug-resistant focal epilepsy. In spite of a standardised analysis pipeline, several aspects tailored to the individual patient...

Behavior during 3–4 Hz spike‐wave discharges (SWDs) in absence epilepsy can vary from obvious behavioral arrest to no detectible deficits. Knowing if behavior is impaired is crucial for clinical care but may be difficult to determine without specialized behavioral testing, often inaccessible in practice. We aimed to develop a pure electroencephalog...

Objective To assess whether implementing the freeware version of the SCORE EEG system (Standardized Computer-based Organized Reporting of EEG) leads to improvement in the quality of clinical EEG reading, and whether EEG reports in SCORE EEG are understood and accepted by the referring physicians. Methods We generated EEG reports in the conventiona...

We sought to investigate electroencephalographers’ real-world behaviors and opinions concerning reading routine EEG (rEEG) with or without clinical information. An eight-question, anonymous, online survey targeted at electroencephalographers was disseminated on social media from the authors’ personal accounts and emailed to authors’ select colleagu...

Background Unsupervised nocturnal tonic‐clonic seizures (TCSs) may lead to sudden unexpected death in epilepsy (SUDEP). Major motor seizures (TCSs and hypermotor seizures) may lead to injuries. Our goal was to develop and validate an automated audio‐video system for the real‐time detection of major nocturnal motor seizures. Methods In this Phase‐3...

Objective Ultra long-term monitoring with subcutaneous EEG (sqEEG) offers objective outpatient recording of electrographic seizures as an alternative to self-reported epileptic seizure diaries. This methodology requires an algorithm-based automatic seizure detection to indicate periods of potential seizure activity to reduce the time spent on visua...