Published online June 2, 2008
PEDIATRICS Vol. 121 No. 6 June 2008, pp. 1146-1154 (doi:10.1542/10.1542/peds.2007-1839)
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ARTICLE

Accuracy of Bedside Electroencephalographic Monitoring in Comparison With Simultaneous Continuous Conventional Electroencephalography for Seizure Detection in Term Infants

Divyen K. Shah, MB, ChBa,b, Mark T. Mackay, MB, BSb,c, Shelly Lavery, RNb, Susan Watson, Dipc, A. Simon Harvey, MDb,c, John Zempel, MD, PhDa,d, Amit Mathur, MDa and Terrie E. Inder, MDa,b,d

Departments of a Pediatrics
d Neurology, Washington University, St Louis, Missouri
b Murdoch Children's Research Institute, Melbourne, Australia
c Department of Neurology, Children's Neuroscience Centre, Royal Children's Hospital, Melbourne, Australia

OBJECTIVE. Our goals were to compare (1) single-channel amplitude-integrated electroencephalography alone, (2) 2-channel amplitude-integrated electroencephalography alone, and (3) amplitude-integrated electroencephalography plus 2-channel electroencephalography with simultaneous continuous conventional electroencephalography for seizure detection in term infants to check the accuracy of limited channels and compare the different modalities of bedside electroencephalography monitoring.

METHODS. Infants referred to a tertiary center with clinical seizures underwent simultaneous continuous conventional electroencephalography and 2-channel (C3-P3 and C4-P4) bedside monitoring. Off-line analysis of the continuous conventional electroencephalographic results was performed independently by 2 neurologists. Two experienced neonatal readers reviewed results obtained with amplitude-integrated electroencephalography and 2-channel electroencephalography combined and single-channel and 2-channel amplitude-integrated electroencephalography. All readings were performed independently and then compared.

RESULTS. Twenty-one term newborns were monitored. Seizures were detected in 7 patients who had up to 12 electrical seizures, with 1 infant in status epilepticus. Seizures were identified correctly in 6 of 7 patients with amplitude-integrated electroencephalography plus 2-channel electroencephalography. The missed infant had an isolated 12-second seizure. With amplitude-integrated electroencephalography plus 2-channel electroencephalography, 31 of 41 non–status epilepticus seizures were correctly identified (sensitivity, 76%; specificity, 78%; positive predictive value, 78%; negative predictive value, 78%), with a substantial level of interrater agreement. The seizures missed were predominantly slow sharp waves of occipital origin from a single patient (7 of 10 seizures). Nine false-positive results were obtained in 351 hours of recording (1 false-positive result per 39 hours). These were thought to be related to muscle, electrode, and patting artifacts. Use of amplitude-integrated electroencephalography alone (1 or 2 channel) provided low sensitivity (27%–56%) and low interobserver agreement.

CONCLUSIONS. Limited-channel bedside electroencephalography combining amplitude-integrated electroencephalography with 2-channel electroencephalography, interpreted by experienced neonatal readers, detected the majority of electrical seizures in at-risk newborn infants.

Key Words: neonate • seizure • amplitude-integrated electroencephalography

Abbreviations: EEG—electroencephalography • ccEEG—continuous conventional electroencephalography • aEEG—amplitude-integrated electroencephalography

Accepted Sep 27, 2007.


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