Shah Divyen K, Mackay Mark T, Lavery Shelly, Watson Susan, Harvey A Simon, Zempel John, Mathur Amit, Inder Terrie E
Washington University, Department of Pediatrics, One Children's Place, St Louis, MO 63110, USA.
Pediatrics. 2008 Jun;121(6):1146-54. doi: 10.1542/peds.2007-1839.
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.
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.
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.
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.
我们的目标是比较（1）单独的单通道振幅整合脑电图，（2）单独的双通道振幅整合脑电图，以及（3）振幅整合脑电图加双通道脑电图与同步连续常规脑电图用于足月儿癫痫检测，以检验有限通道的准确性并比较床边脑电图监测的不同模式。
转诊至三级中心且有临床癫痫发作的婴儿接受同步连续常规脑电图和双通道（C3 - P3和C4 - P4）床边监测。2名神经科医生独立对连续常规脑电图结果进行离线分析。2名经验丰富的新生儿阅片者审查振幅整合脑电图和双通道脑电图联合以及单通道和双通道振幅整合脑电图获得的结果。所有阅片均独立进行然后比较。
对21名足月儿进行了监测。7名患者检测到癫痫发作，最多有12次电发作，其中1名婴儿为癫痫持续状态。7名癫痫发作患者中，6名通过振幅整合脑电图加双通道脑电图被正确识别。漏诊的婴儿有一次孤立的12秒癫痫发作。采用振幅整合脑电图加双通道脑电图时，41次非癫痫持续状态发作中有31次被正确识别（敏感性76%；特异性78%；阳性预测值78%；阴性预测值78%），阅片者间一致性较高。漏诊的发作主要是来自1例患者的枕部起源的慢尖波（10次发作中的7次）。在351小时的记录中获得了9例假阳性结果（每39小时1例假阳性结果）。这些被认为与肌肉、电极和拍击伪迹有关。单独使用振幅整合脑电图（单通道或双通道）敏感性较低（27% - 56%）且观察者间一致性较低。
由经验丰富的新生儿阅片者解读的，将振幅整合脑电图与双通道脑电图相结合的有限通道床边脑电图，可检测出大多数高危新生儿的电发作。
