PEDIATRICS Vol. 121 No. 6 June 2008, pp. 1146-1154 (doi:10.1542/peds.2007-1839)
ARTICLE |
Accuracy of Bedside Electroencephalographic Monitoring in Comparison With Simultaneous Continuous Conventional Electroencephalography for Seizure Detection in Term Infants
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
 |
ABSTRACT |
|---|
 TOP ABSTRACT METHODSRESULTSDISCUSSIONREFERENCES |
|---|
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
The incidence of seizures in the term newborn population is estimated at 2 to 5 cases per 1000 infants.1,2 The management of seizures in newborns remains controversial, but experimental evidence in animal models suggests that seizures may exacerbate ischemic cerebral injury.2,3 In addition, there is preliminary evidence that seizures may be associated with a detrimental neurologic impact in human newborn infants.4,5
Bedside electroencephalography (EEG) using amplitude-integrated EEG (aEEG) for newborns has been used to assist in prognostication,6,7 to recruit infants for neuroprotection intervention studies,8,9 and to monitor for electrical seizures and responses to treatment.10,11 However, there are few data on the accuracy of limited-channel bedside monitoring with aEEG for seizure detection in newborns.12
Modern, digital, bedside EEG monitors incorporate aEEG results with unprocessed EEG signals from 1 or 2 channels. To date, there are no studies making a direct comparison of the utility of digital monitors and concurrent continuous conventional EEG (ccEEG) for seizure detection. Hellström-Westas12 showed previously that, with the use of aEEG alone, short seizures (<30 seconds) were more likely to be missed and some seizures were difficult to detect because of external artifacts. The aim of the present study was to compare the accuracy of digital, bedside, 2-channel aEEG and simultaneous ccEEG for off-line seizure detection in term newborns.
|
METHODS |
|---|
|
TOPABSTRACTMETHODSRESULTSDISCUSSIONREFERENCES |
|---|
Study Group
Infants with clinical seizures who were referred to a tertiary center (Royal Children's Hospital, Melbourne, Australia) were recruited prospectively between April 2004 and October 2005. Infant recruitment and the duration of recording depended on the availability of ccEEG. The study had received approval from the institutional research and ethics committee, and informed consent was obtained from the parents of each patient.
Bedside EEG and ccEEG
Infants underwent ccEEG concurrently with bedside aEEG by using a BRM2 brain monitor (BrainZ Instruments, Auckland, New Zealand). EEG-video monitoring was not available for this study. The BRM2 monitor provided an aEEG trace as well as a raw EEG trace from 1 channel from each hemisphere (C3-P3 and C4-P4, ie, central and parietal electrode positions).13 The aEEG trace resulted from smoothing, rectifying, and filtering the raw EEG signal and attenuating frequencies of <2 and >15 Hz. The 1-channel aEEG trace was obtained as the voltage potential difference between the P3 and P4 electrodes, and the 2-channel traces were obtained as the voltage potential differences between the C3-P3 and C4-P4 electrodes.
Infants underwent ccEEG with 11 standard, gold disk electrodes applied by using the 10–20 international system, at the following locations: Fp2, Fp1, T4, T3, C4, Cz, C3, P4, P3, O2, and O1, with 1 ground electrode, 1 reference electrode, and 1 electrocardiographic electrode. The C3, P3, C4, and P4 electrodes were used for both conventional EEG (Siesta; Compumedics, Melbourne, Australia) and digital BRM2 monitoring, with split leads. BRM2 and ccEEG traces were recorded simultaneously. The input signal gain was not altered when electrodes were shared between the 2 systems.
Off-line Analyses
Criteria for Seizures
The diagnostic criteria for electrical seizure activity in ccEEG were rhythmic, repetitive, stereotypic waveforms with an evolution of morphologic features, amplitude, or electric field,14,15 lasting 
10 seconds. Status epilepticus was defined as recurrent seizure activity lasting 50% of the time for a minimal duration of 1 hour.14
ccEEG
The ccEEG recordings were reviewed independently off-line by 2 neurologists with expertise in EEG (Drs Mackay and Harvey).
aEEG Plus 2-Channel EEG
Two neonatal raters (Dr Shah and Ms Lavery), who had 3 years of experience each but no specific training, independently reviewed the 2-channel aEEG recordings in combination with the raw traces (aEEG plus 2-channel EEG) off-line for electrical seizures, in a blinded fashion. When there was disagreement between the 2 raters, a consensus was reached, so that a meaningful comparison could be made between the 2-channel bedside EEG tool and multichannel conventional EEG.
aEEG
Two aEEG users (Drs Mathur and Zempel), who also had 3 years of experience each but no specific training, independently reviewed the cross-cerebral (P3-P4) aEEG traces and the 2-channel (C3-P3 and C4-P4) aEEG traces, with a 3-month interval between reviews. The users were blinded to patient information and the raw EEG traces. They were asked to point out areas of "definite" electrical seizure activity on each aEEG trace, as would be constituted by a distinct rise in the lower and upper margins of the aEEG trace above baseline.
Data Analyses
To allow reporting of specificity and negative predictive values, a model was used with the assumption that the number of ictal periods was equal to the number of interictal periods (ie, the period immediately adjacent to an electrical seizure). The ictal periods consist of true-positive episodes plus false-negative episodes. The interictal periods consist of false-positive episodes plus true-negative episodes. Therefore, with known values for true-positive, false-positive, and false-negative episodes, it was possible to calculate values for true-negative episodes for each patient. Seizure-free epochs were not used to model true-negative episodes because the prolonged periods of recording provided very high 
scores for all modalities of monitoring, limiting the discrimination between tests.
The statistic was obtained for each pair of independent reviewers for each modality of bedside monitoring assessed. Sensitivity, specificity, positive predictive value, and negative predictive values were calculated for all modalities with respect to ccEEG. Analyses were conducted by using SPSS 15 (SPSS, Chicago, IL).
|
RESULTS |
|---|
|
TOPABSTRACTMETHODSRESULTSDISCUSSIONREFERENCES |
|---|
Study Group
Between April 2004 and October 2005, 21 term infants referred with clinical seizures were enrolled. During this time period, a total of 53 infants were admitted to the NICU with a diagnosis of seizures. Three families refused consent, and the remaining infants could not be enrolled in the study because of restricted availability of ccEEG. Preterm infants were included in the study if they were of term-corrected postconceptional age. Table 1 shows the characteristics of the infants entered into the study.
|
The most common diagnosis was hypoxic-ischemic encephalopathy. The majority of the infants (19 of 21 infants) had been treated with anticonvulsants before study entry, with up to 5 different anticonvulsants being used. Phenobarbitone and phenytoin were the most commonly used. Nineteen infants (90%) required mechanical endotracheal ventilation, in relation to the severity of seizures with a need for airway protection.
ccEEG Seizures
Infants were monitored for a median period of 18.6 hours, with 351 hours of data obtained. From the group, 7 infants had electrical seizures captured with ccEEG (Table 2). One infant (patient E) had status epilepticus. A total of 41 non–status epilepticus seizures were detected. The interobserver agreement for the ccEEG review was 0.84 (P < .001), consistent with a high level of agreement.
|
aEEG Plus 2-Channel EEG
Seizures were correctly identified for 6 of 7 patients with ccEEG electrical seizures by using aEEG in combination with the raw trace on 2 channels of the bedside monitor (Table 2). Status epilepticus in patient E was also correctly identified. The duration of seizures identified ranged from 12 to 300 seconds (median: 89 seconds). A short single seizure (11-second duration) in patient G was not detected by using aEEG plus 2-channel EEG. The seizures were recorded within 5 to 24 hours after commencement of monitoring. Using aEEG plus 2-channel EEG, 31 (76%) of 41 non–status epilepticus seizures were identified (sensitivity, 76%; specificity, 78%; positive predictive value, 78%; negative predictive value, 78%) (Table 3). The interobserver agreement (Cohen's
) was 0.67 (P < .001), consistent with a substantial level of agreement.
|
Seizures Not Detected With aEEG Plus 2-Channel EEG
The duration of seizures missed by using aEEG plus 2-channel EEG ranged from 11 to 753 seconds (median: 170 seconds). The majority of the undetected seizures (7 of 10 seizures) were from patient D. Six of those seizures consisted of unilateral, occipital, slow, sharp wave activity (Fig 1).
|
False-Positive Results
There were 9 false-positive results in 351 hours of recording (1 false-positive result per 39 hours). These were obtained from 4 patients. Seven episodes were obtained from 2 patients who had had no electrical seizures on ccEEG. These were thought to be related to electrode, patting, and muscle artifact (Fig 2).
|
Clinical Course of Infants in Relation to Monitoring and Anticonvulsant Administration
Table 4 shows the clinical course of the infants who had ccEEG seizures (patients A to G) and the "error" patients. Six of the 7 patients who had seizures on ccEEG (patients A to F) had clinical correlates with the electrical seizure activity, although those occurred in only 20% to 50% of ccEEG-confirmed seizures. All infants with clinical seizures had true-positive findings noted with aEEG plus 2-channel EEG. In addition, 23 of 38 non–status epilepticus seizures on ccEEG and 16 of 31 non–status epilepticus seizures on aEEG plus 2-channel EEG did not have a clinical correlate noted.
|
The most common clinical correlate was apnea and desaturation, which was noted for all 6 infants. Other signs included clonic jerking, posturing, increase in heart rate, and abnormal respiratory pattern. The seventh patient (patient G), who had had a single short seizure, did not have a clinical correlate and was also missed with all modes of bedside monitoring.
Of the 9 infants in Table 4, 8 had received anticonvulsants before commencement of monitoring. For 7 infants, ccEEG seizures occurred within 1 to 12 hours after a dose of anticonvulsant. For 2 infants, seizures were noted within 1 hour after anticonvulsant administration. For 1 infant (patient E), who was thought to have an undiagnosed inborn error of metabolism, an increase in electrical seizures frequency (with clinical correlates) was noted to coincide with the administration of phenytoin.
"Error" Patients
Seven of 21 infants had either false-positive episodes or seizures not detected with aEEG plus 2-channel EEG. Three of the 4 infants with missed seizures had some true-positive electrical seizures detected by using aEEG plus 2-channel EEG (7 of 8, 11 of 12, and 3 of 10 seizures) (Table 2). The fourth infant (patient G) had an isolated short (12-second) seizure that was not detected with aEEG plus 2-channel EEG. For all 4 patients, clinical management was not changed as a result of conventional EEG findings.
Four of these 7 error patients had false-positive seizure episodes on aEEG plus 2-channel EEG. Two infants (patients D and F) had single false-positive episodes but also had true-positive episodes (5 and 10 electrical seizures on ccEEG). Patients H and I had 5 and 2 false-positive episodes, respectively, and neither had had any true-positive episodes. One such episode in patient H coincided with an episode of apnea for which the patient received bag-and-mask ventilation. In the absence of EEG-video monitoring, it could not ascertained whether the electrode artifact was related to the apnea or to the resuscitation process.
Patients With No ccEEG Seizure Activity
Of the 14 patients who did not have seizures on ccEEG, 2 infants were noted to have apnea, desaturation, and abnormal limb movements. Both infants had already received loading doses of anticonvulsant treatment. Another 2 infants were noted to have apnea and desaturation only.
Duration of Seizures on the Bedside Monitor, Compared With Duration on ccEEG
The duration of electrical seizure activity observed on the bedside monitor using aEEG with 2-channel EEG correlated strongly with the duration of the seizures observed with conventional EEG (Pearson's correlation coefficient: 0.95; P < .001) (Fig 3).
|
aEEG Tracing Alone
With single-channel aEEG, 23 (56%) of 41 seizures were identified in 4 of 7 infants with electrical seizures on ccEEG by 1 or both raters. Between the 2 raters, 14 false-positive seizures were identified. With 2-channel aEEG alone, 18 (44%) of 41 seizures were correctly identified in 5 of 7 infants by 1 or both raters. Between the 2 raters, 10 false-positive results were obtained. The interobserver agreement
for aEEG tracing alone was 0.29 to 0.31 (P < .05), consistent with a fair degree of agreement.
Seizures Not Detected With Single-Channel or 2-Channel aEEG
Thirteen seizures were missed by both raters by using both single-channel and 2-channel aEEG alone. These included the same 6 seizures from patient D that were missed by using aEEG plus 2-channel EEG (ie, unilateral, occipital, slow, sharp waves that were moderately long (range: 27–753 seconds; median: 184 seconds). All 5 seizures missed in another patient (patient F) (Table 2) were short (range: 10–18 seconds; median: 17 seconds). These were all diagnosed with aEEG in combination with the raw traces. On posthoc review, it was noted that there was no distinct rise in the lower and upper aEEG band margins for 8 of 13 of the missed seizures. It was also observed that 6 of those had a discontinuous background and 7 had a normal but "spiky" background.
Infant Outcomes
To date, 2-year outcome information is available for 12 of 21 infants (Table 1). Seven (33%) of the 21 infants have died and 3 infants have cerebral palsy. Of the 7 infants who died, 3 infants had hypoxic-ischemic encephalopathy, 2 had cardiorespiratory problems, 1 had intraventricular hemorrhage, and 1 had seizures of undetermined cause. Only 2 of those infants had electrical seizures detected with ccEEG.
|
DISCUSSION |
|---|
|
TOPABSTRACTMETHODSRESULTSDISCUSSIONREFERENCES |
|---|
Bedside EEG monitors are being used increasingly for seizure detection and treatment monitoring in sick newborns in the neonatal intensive care setting. However, there are few data on their accuracy. From this study, 2-channel bedside monitoring using aEEG and raw signals identified electrical seizures off-line in 6 of 7 infants with seizures on ccEEG. The same 6 patients had clinical seizures that correlated with electrical seizures, as observed at the bedside, although clinical correlates were noted for only 37% of all non–status epilepticus electrical seizures. The single infant who was missed had a short isolated seizure, the clinical significance of which might be questionable. Seventy-six percent of all non–status epilepticus seizures were identified. The duration of seizures detected with aEEG plus 2-channel EEG correlated strongly with the duration of electrical seizures on ccEEG.
Ten seizure episodes were not detected with aEEG plus 2-channel EEG. Seven were in 1 patient who had focal, occipital, slow, sharp wave seizure activity. The missed seizures were not brief, with a longer median duration than the detected electrical seizures. Electrical seizures in newborn infants tend to be predominantly focal or multifocal.2 Limited-channel bedside EEG monitoring may miss focal seizures remote from the centroparietal region, as demonstrated in our study with focal occipital seizures. Limited channels also limit observation of spatial evolution, compared with multiple channels. Our findings suggest that, in addition to the duration and focus of the seizures, other important factors that may contribute to seizure detection with limited-channel bedside EEG monitoring include the amplitude, frequency, and morphologic features of the seizure waves.
Over 351 hours, 9 false-positive results were obtained by using the combination of aEEG with 2-channel EEG. These false-positive results were thought to be related to cup electrode artifacts, but the exact nature could not be defined without direct observation or EEG-video monitoring. Of the 7 error patients, 4 patients had true seizures on ccEEG. Of the remaining 3, 1 had a short, isolated, electrical seizure that was not detected by using aEEG with 2-channel EEG and the other 2 infants had 7 false-positive seizure episodes between them. These 3 patients had been receiving anticonvulsant treatment before monitoring, and no changes were made in clinical decision-making on the basis of monitoring findings.
With the use of aEEG alone, there was no substantial difference between 1 or 2 channels for seizure detection, although using aEEG alone was clearly less accurate than using the combination of aEEG plus 2-channel EEG. With the use of aEEG alone, all 5 seizures in 1 infant were missed. On posthoc review of the aEEG trace, there was no distinct discernible rise in the lower and upper aEEG margins and these seizures were all <20 seconds in duration and were predominantly from infants with normal or discontinuous aEEG backgrounds. The time compression in aEEG facilitates monitoring of the background and its evolution after the onset of encephalopathy.6,16 However, for seizure detection with aEEG alone, time compression necessitates a longer duration of seizure. Therefore, the ability to identify seizures by using aEEG alone not only relies on the experience of the users17 but also seems to be related to the duration of the seizures12 and the aEEG background.
The present study included critically ill infants with a heterogeneous group of diagnoses who had already been treated with substantial doses of multiple anticonvulsants. This may account for why only one third of this high-risk group had electrical seizures. Anticonvulsants may bring about a quantifiable reduction in EEG amplitude13 and thus suppress aEEG background.18 This may affect electrical seizure detection in this group, compared with infants with no previous anticonvulsant treatment.
Previous studies have made direct comparisons between analog, not digital, aEEG and conventional EEG for seizure detection in newborns12,17,19 (Table 5). Hellström-Westas12 showed that seizures of short duration may be missed by aEEG. Toet et al19 demonstrated high interobserver agreement, sensitivity, specificity, and predictive values for aEEG, compared with conventional EEG recordings of 30-minute duration. Rennie et al17 found poor interobserver agreement and sensitivity for seizure detection for selected aEEG traces, in comparison with EEG-video monitoring. However, Rennie et al17 used variable aEEG speeds and inexperienced aEEG raters who had received 3 to 5 hours of training.
|
Our findings confirm that the current practice of using aEEG in combination with the unprocessed EEG signal in modern bedside EEG monitors is clearly better for seizure detection, compared with aEEG alone, in newborn infants. The interobserver agreement for the use of the aEEG with 2-channel EEG was substantially better than that for either single-channel aEEG alone or 2-channel aEEG alone, when conducted by experienced reviewers. By using the former, a greater proportion of seizures were detected correctly and greater sensitivity and specificity were obtained.
The significance and management of electrical seizures in newborns remain controversial. However, repeated seizures may exacerbate ischemic injury or lead to direct injury from the seizures.2,3,5 Given that a substantial proportion of seizures in newborns are subclinical,20 accurate methods for detecting electrical seizures are required. Continuous, multiple-channel, EEG-video monitoring would be the ideal tool for monitoring seizure activity. It allows better distinction between seizure activity and artifact and detects focal seizures in cortical locations remote from bedside monitor electrode locations. However, it requires substantially more resources and trained personnel, particularly to give online, 24-hour feedback for seizure management.
Our study shows that bedside EEG monitoring by using aEEG in combination with the unprocessed EEG signal, reviewed off-line by skilled operators, provides acceptable sensitivity, specificity, and positive and negative predictive values, compared with simultaneous ccEEG. Our preliminary data confirm that the use of limited-channel, bedside EEG monitoring may be effective in screening at-risk term infants for electrical seizure activity. Electrical seizures detected on the bedside monitor should be confirmed with conventional EEG or EEG-video monitoring, where available.
A larger study with around-the-clock bedside EEG monitoring used online by less-experienced neonatal clinicians is required to assess the feasibility and impact of monitoring for electrical seizures in the NICU. Real-time seizure detection with limited-channel bedside monitors may become a more practical alternative to EEG-video and multichannel EEG monitoring when reliable, computerized, seizure detection algorithms21 have been developed and validated for use in newborns.
|
ACKNOWLEDGMENTS |
|---|
We acknowledge BrainZ Instruments for research grant support for this study.
We are grateful to Prof Lex W. Doyle for expert advice and Dr Peter Anderson and Kelly Howard for neurodevelopmental assessments. We are indebted to the families involved in the study.
|
FOOTNOTES |
|---|
Accepted Sep 27, 2007.
Address correspondence to Divyen K. Shah, MB, ChB, Washington University, Department of Pediatrics, One Children's Place, St Louis, MO 63110. E-mail: shah_d{at}kids.wustl.edu
Financial Disclosure: Dr Shah was the recipient of a PhD scholarship from BrainZ Instruments, and Ms Lavery is a research nurse cocoordinator whose salary was partly funded by BrainZ Instruments; the other authors have indicated they have no financial relationships relevant to this article to disclose.
| What's Known on This Subject To date, there have been no studies on the accuracy of digital bedside EEG monitors for electrical seizure detection in at-risk term infants.
|
| What This Study Adds Compared with continuous conventional EEG, amplitude-integrated EEG plus 2-channel EEG has acceptable sensitivity and specificity for electrical seizure detection in critically ill term newborns, when used off-line by experienced users.
|
|
REFERENCES |
|---|
|
TOPABSTRACTMETHODSRESULTSDISCUSSIONREFERENCES |
|---|
1. Lanska MJ, Lanska DJ. Neonatal seizures in the United States: results of the National Hospital Discharge Survey, 1980–1991. Neuroepidemiology. 1996;15 (3):117 –125[Web of Science][Medline]
2. Volpe JJ. Neurology of the Newborn. 4th ed. Philadelphia, PA: Saunders; 2001
3. Wirrell EC, Armstrong EA, Osman LD, Yager JY. Prolonged seizures exacerbate perinatal hypoxic-ischemic brain damage. Pediatr Res. 2001;50 (4):445 –454[Web of Science][Medline]
4. McBride MC, Laroia N, Guillet R. Electrographic seizures in neonates correlate with poor neurodevelopmental outcome.
Neurology. 2000;55
(4):506
–513
5. Miller SP, Weiss J, Barnwell A, et al. Seizure-associated brain injury in term newborns with perinatal asphyxia.
Neurology. 2002;58
(4):542
–548
6. Toet MC, Hellström-Westas L, Groenendaal F, Eken P, de Vries LS. Amplitude integrated EEG 3 and 6 hours after birth in full term neonates with hypoxic-ischaemic encephalopathy.
Arch Dis Child Fetal Neonatal Ed. 1999;81
(1):F19
–F23
7. al Naqeeb N, Edwards AD, Cowan FM, Azzopardi D. Assessment of neonatal encephalopathy by amplitude-integrated electroencephalography.
Pediatrics. 1999;103
(6):1263
–1271
8. Gluckman PD, Wyatt JS, Azzopardi D, et al. Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial. Lancet. 2005;365 (9460):663 –670[Web of Science][Medline]
9. Azzopardi D, Robertson NJ, Cowan FM, Rutherford MA, Rampling M, Edwards AD. Pilot study of treatment with whole body hypothermia for neonatal encephalopathy.
Pediatrics. 2000;106
(4):684
–694
10. Hellström-Westas L, Rosen I, Swenningsen NW. Silent seizures in sick infants in early life: diagnosis by continuous cerebral function monitoring. Acta Paediatr Scand. 1985;74 (5):741 –748[Web of Science][Medline]
11. Shany E, Khvatskin S, Golan A, Karplus M. Amplitude-integrated electroencephalography: a tool for monitoring silent seizures in neonates. Pediatr Neurol. 2006;34 (3):194 –199[CrossRef][Web of Science][Medline]
12. Hellström-Westas L. Comparison between tape-recorded and amplitude-integrated EEG monitoring in sick newborn infants. Acta Paediatr. 1992;81 (10):812 –819[Web of Science][Medline]
13. Shah DK, Lavery S, Doyle LW, Wong C, McDougall P, Inder TE. Use of 2-channel bedside electroencephalogram monitoring in term-born encephalopathic infants related to cerebral injury defined by magnetic resonance imaging.
Pediatrics. 2006;118
(1):47
–55
14. Scher MS, Hamid MY, Steppe DA, Beggarly ME, Painter MJ. Ictal and interictal electrographic seizure durations in preterm and term neonates. Epilepsia. 1993;34 (2):284 –288[CrossRef][Web of Science][Medline]
15. Clancy RR, Legido A. The exact ictal and interictal duration of electroencephalographic neonatal seizures. Epilepsia. 1987;28 (5):537 –541[Medline]
16. ter Horst HJ, Sommer C, Bergman KA, Fock JM, van Weerden TW, Bos AF. Prognostic significance of amplitude-integrated EEG during the first 72 hours after birth in severely asphyxiated neonates. Pediatr Res. 2004;55 (6):1026 –1033[CrossRef][Web of Science][Medline]
17. Rennie JM, Chorley G, Boylan GB, Pressler R, Nguyen Y, Hooper R. Non-expert use of the cerebral function monitor for neonatal seizure detection.
Arch Dis Child Fetal Neonatal Ed. 2004;89
(1):F37
–F40
18. Shany E. The influence of phenobarbital overdose on aEEG recording. Eur J Paediatr Neurol. 2004;8 (6):323 –325[CrossRef][Web of Science][Medline]
19. Toet MC, van der Meij W, de Vries LS, Uiterwaal CS, van Huffelen KC. Comparison between simultaneously recorded amplitude integrated electroencephalogram (cerebral function monitor) and standard electroencephalogram in neonates.
Pediatrics. 2002;109
(5):772
–779
20. Boylan GB, Rennie JM, Chorley G, et al. Second-line anticonvulsant treatment of neonatal seizures: a video-EEG monitoring study.
Neurology. 2004;62
(3):486
–488
21. Navakatikyan MA, Colditz PB, Burke CJ, Inder TE, Richmond J, Williams CE. Seizure detection algorithm for neonates based on wave-sequence analysis. Clin Neurophysiol. 2006;117 (6):1190 –1203[CrossRef][Web of Science][Medline]
PEDIATRICS (ISSN 1098-4275). ©2008 by the American Academy of Pediatrics
CiteULike 
Connotea 
Del.icio.us 
Digg 
Facebook 
Reddit 
Technorati 
Twitter What's this?
This article has been cited by other articles:
|
|
 |
|
  L. G. M. van Rooij, M. C. Toet, A. C. van Huffelen, F. Groenendaal, W. Laan, A. Zecic, T. de Haan, I. L. M. van Straaten, S. Vrancken, G. van Wezel, et al. Effect of Treatment of Subclinical Neonatal Seizures Detected With aEEG: Randomized, Controlled Trial Pediatrics, February 1, 2010; 125(2): e358 - e366. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. C. Glass and E. Wirrell Controversies in Neonatal Seizure Management J Child Neurol, May 1, 2009; 24(5): 591 - 599. [Abstract] [PDF]
|
|
|
|
 |
|
 V. Y. Chock and A. S. Davis Bedside Cerebral Monitoring to Predict Neurodevelopmental Outcomes NeoReviews, March 1, 2009; 10(3): e121 - e129. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. K. Shah, L. S. de Vries, L. Hellstrom-Westas, M. C. Toet, and T. E. Inder Amplitude-Integrated Electroencephalography in the Newborn: A Valuable Tool Pediatrics, October 1, 2008; 122(4): 863 - 865. [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
