Accuracy of the rapid‐response electroencephalography's Automated Seizure Burden Estimator: A follow‐up validation study of version 8 ( AccuRASE II )
Year: 2026
Type: article
Abstract: OBJECTIVE: Ceribell Inc.'s point-of-care electroencephalographic (EEG) system and artificial intelligence-based Automated Seizure Burden Estimator (ASBE; ClarityPro) have US Food and Drug Administration clearance for diagnosing electrographic status epilepticus (ESE). The AccuRASE study using ASBE version 6 (V6) showed high negative predictive value (NPV) but limited sensitivity and positive predictive value (PPV) at certain thresholds. Version 8 (V8) is the updated algorithm trained with additional EEG samples. METHODS: We tested V8 on the previously used rapid-response EEG test dataset (not used to train V8). Sensitivity, specificity, PPV, and NPV were compared against blinded expert annotations. ESE, ESE and possible ESE (ESE/pESE), electrographic seizures (ESz), and Esz with highly epileptiform patterns (Esz/HEPs) at burden thresholds of >1%, >10%, >20%, >50%, and >90% were analyzed. Additionally, we evaluated the built-in ESE and ESE/pESE alerts (≥90% over 5 min, ≥20% over 1 h, or ≥10 continuous minutes of seizure). RESULTS: V8 showed 100% sensitivity at lower thresholds (>10%-20%) for ESE (V6 .86), without a specificity loss (V8 .9 vs. V6 .85), and retained NPV (V8 1.0 vs. V6 .99). Sensitivity at 50% threshold was .86 for ESE (V6 .71), and specificity was .94 (V6 .91); PPV for ESE was 30% for ESE and 80% for ESE/pESE. The specificity for ESE remained high for 90% burden (V8 .96, V6 .97) but the sensitivity dropped (.29 vs. V6 .43). Sensitivity was lower for ESz/HEPs (.54 → .44 at >10% threshold), although the algorithm is not designed to detect HEPs. Built-in alert analysis showed significantly improved sensitivity for ESE (.57 → .86); specificity and NPV remained high (>.94). SIGNIFICANCE: ASBE V8 showed meaningful improvements in sensitivity, continued excellent NPV, and improved built-in alert accuracy for ESE and ESE/pESE. The best seizure burden threshold for ruling out ESE now is 20% (vs. 10% with V6) and that for ruling in ESE/pESE with reasonable certainty is 50% (vs. 90% with V6).
Source: Epilepsia
DOI: 10.1002/epi.70352
Institutions: Virginia Commonwealth University, Yale University, Virginia Commonwealth University Medical Center, The University of Sydney, Brown University, University of New Mexico, University of New Mexico Health Sciences Center, Rhode Island Hospital, University of Chicago Medical Center, University of Cincinnati Medical Center, SUNY Downstate Health Sciences University, University of Crete, Emory University, Medical University of South Carolina, Mayo Clinic, Icahn School of Medicine at Mount Sinai
Language: English
Subfield: Cognitive Neuroscience
Field: Neuroscience
Domain: Life Sciences
Open Access status: hybrid
Estimated APC paid: $4,360
OpenAlex ID: W7165869598