Buttle Sarah Grace, Lemyre Brigitte, Sell Erick, Redpath Stephanie, Bulusu Srinivas, Webster Richard J, Pohl Daniela
1 Division of Neurology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada.
2 Division of Neonatology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
J Child Neurol. 2019 May;34(6):313-320. doi: 10.1177/0883073819829256. Epub 2019 Feb 14.
BACKGROUND/OBJECTIVE: Seizure monitoring via amplitude-integrated EEG is standard of care in many neonatal intensive care units; however, conventional EEG is the gold standard for seizure detection. We compared the diagnostic yield of amplitude-integrated EEG interpreted at the bedside, amplitude-integrated EEG interpreted by an expert, and conventional EEG.
Neonates requiring seizure monitoring received amplitude-integrated EEG and conventional EEG in parallel. Clinical events and amplitude-integrated EEG were interpreted at bedside. Subsequently, amplitude-integrated EEG and conventional EEG were independently analyzed by experienced neonatology and neurology readers. Sensitivity and specificity of bedside amplitude-integrated EEG as compared to expert amplitude-integrated EEG interpretation and conventional EEG were evaluated.
Thirteen neonates were monitored for an average duration of 33 hours (range 15-94, SD 25). Fourteen seizure-like events were detected by clinical observation, and 12 others by bedside amplitude-integrated EEG analysis. One of the clinical, and none of the bedside amplitude-integrated EEG events were confirmed as seizures on conventional EEG. Post hoc expert amplitude-integrated EEG interpretation revealed eight suspected seizures, all different from the ones detected by the bedside amplitude-integrated EEG team, of which one was confirmed via conventional EEG. Eight seizures were recorded on conventional EEG. Expert amplitude-integrated EEG interpretation had a sensitivity of 13% with 46% specificity for individual seizure detection, and a sensitivity of 50% with 46% specificity for detecting patients with seizures.
Real-world bedside amplitude-integrated EEG monitoring failed to detect all seizures evidenced via conventional EEG, while misclassifying other events as seizures. Even post hoc expert amplitude-integrated EEG interpretation provided limited sensitivity and specificity. Considering the poor sensitivity and specificity of bedside amplitude-integrated EEG interpretation, combined monitoring may provide limited clinical benefit.
背景/目的：在许多新生儿重症监护病房，通过振幅整合脑电图进行癫痫监测是护理标准；然而，传统脑电图是癫痫检测的金标准。我们比较了床边解读的振幅整合脑电图、专家解读的振幅整合脑电图和传统脑电图的诊断率。
需要进行癫痫监测的新生儿同时接受振幅整合脑电图和传统脑电图检查。临床事件和振幅整合脑电图在床边进行解读。随后，经验丰富的新生儿科和神经科医生独立分析振幅整合脑电图和传统脑电图。评估床边振幅整合脑电图与专家解读的振幅整合脑电图及传统脑电图相比的敏感性和特异性。
对13名新生儿进行了平均33小时（范围15 - 94小时，标准差25）的监测。通过临床观察检测到14次癫痫样事件，通过床边振幅整合脑电图分析又检测到12次。临床检测到的1次事件以及床边振幅整合脑电图检测到的所有事件在传统脑电图上均未被确认为癫痫。事后专家对振幅整合脑电图的解读发现了8次疑似癫痫发作，均与床边振幅整合脑电图团队检测到的不同，其中1次通过传统脑电图得到确认。传统脑电图记录到8次癫痫发作。专家对振幅整合脑电图的解读在个体癫痫检测中的敏感性为13%，特异性为46%，在检测癫痫患者时的敏感性为50%，特异性为46%。
在实际临床中，床边振幅整合脑电图监测未能检测到传统脑电图证实的所有癫痫发作，同时将其他事件误分类为癫痫发作。即使是事后专家对振幅整合脑电图的解读，其敏感性和特异性也有限。考虑到床边振幅整合脑电图解读的敏感性和特异性较差，联合监测可能仅提供有限的临床益处。
