The logistic limitations of CEEG often include their brief duration (usually under 60 min) and limited access to appropriately trained electrophysiologists. These examinations are performed by trained technologists and interpreted by electrophysiologists expert in neonatal EEG.
EEG ELECTRODE PLACEMENT FULL
The gold standard for NS diagnosis and quantification is conventional electroencephalogram (CEEG), which uses a full array of electrodes placed according to the International 10–20 system modified for neonates ( Figure 1). 7, 8 Because of the concern for missing difficult to recognize or frankly subclinical electrographic NSs, diagnostic monitoring tools are increasingly used in intensive care units for high-risk neonates. 4, 5, 6, 7 Clinical NSs have been correlated with significant neurological morbidity and mortality. 1, 2, 3 Because most electrographic seizures in the neonate are subclinical, these figures may underestimate their true incidence. The incidence of clinically diagnosed NSs ranges from 1.5 to 3. In Fp 3 → Fp 4, a third of records with seizures were missed and over half of seizures were undetected.ĭespite advances in obstetrics and neonatology, neonatal seizures (NSs) remain a significant problem in the newborn period.
NSs are significantly more difficult to detect with a single forehead channel than bicentrally or on CEEG. Seizures appeared briefer in Fp 3 → Fp 4 than C 3 → C 4 ( P<0.006) and CEEG ( P<0.0001). With Fp 3 → Fp 4, at least one NS was detected in 66% of records vs 90% using C 3 → C 4 ( P<0.0001). Result:Ī total of 330 seizures from 125 CEEGs were included. We analyzed electrographic characteristics in a single forehead channel, Fp 3 → Fp 4. Records were taken from a digital library of conventional EEGs (CEEGs) with NS, previously characterized at a bicentral channel, C 3 → C 4. This study describes the limits of NS detection by a single forehead EEG channel. In amplitude-integrated EEG, lead placement across the forehead is convenient, but this location has unknown effects on neonatal seizure (NS) detection sensitivity.
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