Amplitude-integrated electroencephalography for neonatal seizure detection. An electrophysiological point of view

Seizures in the newborn are associated with high morbidity and mortality, making their detection and treatment critical. Seizure activity in neonates is often clinically obscured, such that detection of seizures is particularly challenging. Amplitude-integrated EEG is a technique for simplified EEG monitoring that has found an increasing clinical application in neonatal intensive care. Its main value lies in the relative simplicity of interpretation, allowing nonspecialist members of the care team to engage in real-time detection of electrographic seizures. Nevertheless, to avoiding misdiagnosing rhythmic artifacts as seizures, it is necessary to recognize the electrophysiological ictal pattern in the conventional EEG trace available in current devices. The aim of this paper is to discuss the electrophysiological basis of the differentiation of epileptic seizures and extracranial artifacts to avoid misdiagnosis with amplitude-integrated EEG devices.

Keywords:
Electroencephalography; seizures; neonatal seizures

Authorship

Sebastián Gacio Correspondence: Sebastián Gacio; División de Neurología, Hospital de Niños R. Gutiérrez. Gallo 1330 (C1425EFD), Ciudad Autónoma de Buenos Aires, Argentina. E-mail: neurogacio@gmail.com

Hospital de Niños Ricardo Gutiérrez, División de Neurología, Ciudad Autónoma de Buenos Aires, ArgentinaHospital de Niños Ricardo GutiérrezArgentinaBuenos Aires, ArgentinaHospital de Niños Ricardo Gutiérrez, División de Neurología, Ciudad Autónoma de Buenos Aires, Argentina

Hospital Juan A. Fernández, División de Neonatología, Ciudad Autónoma de Buenos Aires, ArgentinaHospital Juan A. FernándezArgentinaBuenos Aires, ArgentinaHospital Juan A. Fernández, División de Neonatología, Ciudad Autónoma de Buenos Aires, Argentina

http://orcid.org/0000-0002-0017-0208

Correspondence: Sebastián Gacio; División de Neurología, Hospital de Niños R. Gutiérrez. Gallo 1330 (C1425EFD), Ciudad Autónoma de Buenos Aires, Argentina. E-mail: neurogacio@gmail.com

Conflict of interest: There is no conflict of interest to declare

SCIMAGO INSTITUTIONS RANKINGS

Figures

Figures (4)

Thumbnail

Figure 1
(A) Continuous background pattern, with prominent sleep-wake cycle: upper-margin voltage is > 10 mV and lower margin voltage is > 5 mV (arrow). The sleep-wake cycle is characterized by smooth cyclic variations, mainly of minimum amplitude, with periods of broader bandwidth that represent quiet sleep (circle) and periods of narrow bandwidth that correspond to wakefulness or active sleep (arrowhead). (B) Discontinuous background pattern: upper margin is > 10 mV and lower margin is < 5 mV. The sleep- wake cycle is not present. (C) Burst suppression pattern: upper and lower margin voltages are < 10 mV and <5 mV respectively reflecting voltage suppression, vertical lines (arrow) show periods of burst. Conventional EEG row shows a brief burst of cerebral activity (circle) between periods of voltage suppression. (D) Isoelectric or flat tracing: both margins are < 5 mV and prominent spikes are likely due to patient movement. (E) Ictal pattern: seizures are shown as a sudden rise in lower and upper margin (circle).

Thumbnail

Figure 2
Conventional EEG of a newborn with an electrographic seizure. The beginning of a rhythmic repetitive activity in left occipital area (01) is marked with the arrow in Figure 2A. The rhythmic discharge evolves in morphology, amplitude and frequency (A and B). Figure 2B shows diffusion to surrounding areas (circle) and the end of the seizure (arrow).

Thumbnail

Figure 3
A suspected seizure in the aEEG (circle in A) is reviewed. Each figure (A-E) shows three hours of aEEG trace in the upper row and the corresponding 15 seconds of conventional EEG in the lower row, both traces available simultaneously in current devices. The vertical line in the aEEG shows the part of the trace displayed in the conventional EEG. A repetitive high amplitude slow wave with a rhythmic pattern is noted in the beginning of the seizure (A). In B, C, D and E the ictal pattern evolves progressively in morphology, frequency and amplitude. F shows the end of the seizure (marked with the arrow in E). The spikes are of lower amplitude and lower frequency and at the end of the seizure, voltage flattening is observed (arrow). This figure shows the epileptic seizure typically evolving in frequency, amplitude and morphology.

Thumbnail

Figure 4
Each figure shows three hours of aEEG (upper row) with the corresponding 15 seconds of conventional EEG in the lower row (arrowhead A marks one hour of trace). The vertical line in the aEEG shows the portion of the trace displayed in the conventional EEG. A sudden rise in lower margin is noted and reviewed (circle in A). In the conventional EEG, the pattern is monorhythmic all along the suspected ictal trace with the same frequency, amplitude and morphology at the beginning (A); 60 minutes later (B); and 120 minutes later at the end of the event (C) refuting the ictal origin of the event.

Figure 1 (A) Continuous background pattern, with prominent sleep-wake cycle: upper-margin voltage is > 10 mV and lower margin voltage is > 5 mV (arrow). The sleep-wake cycle is characterized by smooth cyclic variations, mainly of minimum amplitude, with periods of broader bandwidth that represent quiet sleep (circle) and periods of narrow bandwidth that correspond to wakefulness or active sleep (arrowhead). (B) Discontinuous background pattern: upper margin is > 10 mV and lower margin is < 5 mV. The sleep- wake cycle is not present. (C) Burst suppression pattern: upper and lower margin voltages are < 10 mV and <5 mV respectively reflecting voltage suppression, vertical lines (arrow) show periods of burst. Conventional EEG row shows a brief burst of cerebral activity (circle) between periods of voltage suppression. (D) Isoelectric or flat tracing: both margins are < 5 mV and prominent spikes are likely due to patient movement. (E) Ictal pattern: seizures are shown as a sudden rise in lower and upper margin (circle).

Figure 2 Conventional EEG of a newborn with an electrographic seizure. The beginning of a rhythmic repetitive activity in left occipital area (01) is marked with the arrow in Figure 2A. The rhythmic discharge evolves in morphology, amplitude and frequency (A and B). Figure 2B shows diffusion to surrounding areas (circle) and the end of the seizure (arrow).

Figure 3 A suspected seizure in the aEEG (circle in A) is reviewed. Each figure (A-E) shows three hours of aEEG trace in the upper row and the corresponding 15 seconds of conventional EEG in the lower row, both traces available simultaneously in current devices. The vertical line in the aEEG shows the part of the trace displayed in the conventional EEG. A repetitive high amplitude slow wave with a rhythmic pattern is noted in the beginning of the seizure (A). In B, C, D and E the ictal pattern evolves progressively in morphology, frequency and amplitude. F shows the end of the seizure (marked with the arrow in E). The spikes are of lower amplitude and lower frequency and at the end of the seizure, voltage flattening is observed (arrow). This figure shows the epileptic seizure typically evolving in frequency, amplitude and morphology.

Figure 4 Each figure shows three hours of aEEG (upper row) with the corresponding 15 seconds of conventional EEG in the lower row (arrowhead A marks one hour of trace). The vertical line in the aEEG shows the portion of the trace displayed in the conventional EEG. A sudden rise in lower margin is noted and reviewed (circle in A). In the conventional EEG, the pattern is monorhythmic all along the suspected ictal trace with the same frequency, amplitude and morphology at the beginning (A); 60 minutes later (B); and 120 minutes later at the end of the event (C) refuting the ictal origin of the event.

How to cite

copy

Academia Brasileira de Neurologia - ABNEURO R. Vergueiro, 1353 sl.1404 - Ed. Top Towers Offices Torre Norte, 04101-000 São Paulo SP Brazil, Tel.: +55 11 5084-9463 | +55 11 5083-3876 - São Paulo - SP - Brazil
E-mail: revista.arquivos@abneuro.org

Acompanhe os números deste periódico no seu leitor de RSS

Versão para download de PDF

PDF

Inglês

Versões e tradução automática

Versão original do texto

English

Tradução automática

Google Translator
Microsoft Translator

Como citar

RIS

BIBTEX

Outros formatos de citação e exportação:

SciELO - Scientific Electronic Library Online
Rua Dr. Diogo de Faria, 1087 – 9º andar – Vila Clementino 04037-003 São Paulo/SP - Brasil
E-mail: scielo@scielo.org

Leia a Declaração de Acesso Aberto

Métricas

Amplitude-integrated electroencephalography for neonatal seizure detection. An electrophysiological point of view

PlumX

Mensagem

[1] Correspondence: Sebastián Gacio; División de Neurología, Hospital de Niños R. Gutiérrez. Gallo 1330 (C1425EFD), Ciudad Autónoma de Buenos Aires, Argentina. E-mail: neurogacio@gmail.com