Limitations of single-channel EEG on the forehead for neonatal seizure detection

Abstract

Objectives: In amplitude-integrated EEG, lead placement across the forehead is convenient, but this location has unknown effects on neonatal seizure (NS) detection sensitivity. This study describes the limits of NS detection by a single forehead EEG channel.Study Design: Records were taken from a digital library of conventional EEGs (CEEGs) with NS, previously characterized at a bicentral channel, C 3 -C 4 . We analyzed electrographic characteristics in a single forehead channel, Fp 3 -Fp 4 .Result: A total of 330 seizures from 125 CEEGs were included. 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). Of 330 seizures, 46% appeared in Fp 3 -Fp 4 vs 73% in C 3 -C 4 (P<0.0001). Seizures appeared briefer in Fp 3 -Fp 4 than C 3 -C 4 (P<0.006) and CEEG (P<0.0001). Conclusion:NSs are significantly more difficult to detect with a single forehead channel than bicentrally or on CEEG. In Fp 3 -Fp 4 , a third of records with seizures were missed and over half of seizures were undetected.

Online EEG channel weighting for detection of seizures in the neonate

“…In [15], it has been reported that the theoretical visibility of a seizure in the central zone is as high as 94%. In another study [16], it has been shown that 46% of seizures are visible in the Fp1, Fp2 zone, which is close to F3, F4 in our montage. No data were found regarding the visibility of seizures in the temporal or occipital zones, and there are no premises to believe that a seizure is more visible in the occipital and temporal zones than in the frontal zone.…”

The prognostic value of continuous amplitude-integrated electroencephalogram applied immediately after return of spontaneous circulation in therapeutic hypothermia-treated cardiac arrest patients

“…Our study was not primarily focused on postanoxic seizures. Although seizure detection is different depending on the number of electrodes used and their locations, [29][30][31] aEEG, which has the ability to review the raw EEG tracing, has the highest sensitivity for detecting seizures. 32 Mild hypothermia does not influence aEEG, and EEG is not significantly affected at a body temperature of 33 • C. [33][34][35] Benzodiazepines have been described to increase frequency but do not decrease EEG amplitude in frontal brain areas.…”

EEG background features that predict outcome in term neonates with hypoxic ischaemic encephalopathy: A structured review

“…For longer term monitoring including for the detection of seizures, we suggest aEEG ideally with intermittent full array EEG as described in (Shellhaas et al, 2011) to confirm features and seek evidence of seizures not seen in two channel EEG. aEEG electrode position should be at P 3 and P 4 location because it is over the cerebrovascular watershed region at high risk for acquired injury (Hellström-Westas et al, 2008) and more prone to seizure (Wusthoff et al, 2008).…”