Bedside amplitude-integrated electroencephalogram (EEG) possesses low sensitivity and specificity for detecting seizures compared with conventional EEG and may be prone to error in seizure classification in neonates, according to study results published in the Journal of Child Neurology.

Neonates from the Children’s Hospital of Eastern Ontario in Ottawa, Canada, who presented with possible seizure activity underwent parallel amplitude-integrated EEG and conventional EEG. Clinicians interpreted clinical events and amplitude-integrated EEG at bedside. Independent assessment of amplitude-integrated EEG and conventional EEG was performed by experienced neonatology and neurology readers. In addition, readers compared bedside amplitude-integrated EEG with amplitude-integrated EEG interpretation and conventional EEG in terms of sensitivity and specificity.

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A total of 13 neonates were evaluated for a mean of 33 hours (range, 15 to 94). Conventional EEG recorded 8 seizures. Clinical observation was capable of identifying 14 seizure-like events, whereas bedside amplitude-integrated EEG detected 12 similar events. Conventional EEG confirmed one of the clinical observation events as a seizure; however, none of the bedside amplitude-integrated EEG events were confirmed.

For individual seizure detection, expert amplitude-integrated EEG interpretation featured a sensitivity of 13% with specificity of 46%. For the detection of patients with seizures, the expert amplitude-integrated EEG interpretation had a sensitivity of 50% and a specificity of 64%.

Limitations of the analysis included the small number of neonates in the final cohort, the recruitment of patients from a single center, and the heterogeneity of the sample in terms of age and clinical diagnosis.

The researchers concluded that the combination of amplitude-integrated EEG and conventional EEG remains feasible, yet “in view of the limited sensitivity and specificity of amplitude-integrated EEG, combined monitoring provides limited clinical benefit with regard to seizure detection.”

Reference

Buttle SG, Lemyre B, Sell E, et al. Combined conventional and amplitude-integrated EEG monitoring in neonates: a prospective study [published online February 14, 2019]. J Child Neurol. doi:10.1177/0883073819829256