Subscribe to RSS
How Helpful Is aEEG? Context and User Experience Matter
Objective The aim of the study is to model amplitude-integrated electroencephalography (aEEG) utility to diagnose seizures in common clinical scenarios.
Study Design Using reported neonatal seizure prevalence and aEEG sensitivities and specificities, likelihood ratios (LRs) and post-test probabilities were calculated to quantify aEEG utility to diagnose seizures in three typical clinical scenarios.
Results Prevalence data supported pretest probabilities for neonatal seizures of 0.4 in neonatal hypoxic ischemic encephalopathy (HIE), 0.27 in bacterial meningitis, and 0.05 in extreme prematurity. Reported sensitivity of 85% and specificity of 90% for seizures with expert aEEG interpretation yielded a positive likelihood ratio (LR+) of 8.7 and a negative likelihood ratio (LR−) of 0.17. Reported sensitivity of 65% and specificity of 70% with intermediate interpretation yielded LR+ 2.17 and LR− 0.5. Reported sensitivity of 40% and sensitivity of 50% with inexperienced interpretation gave LR+ 0.8 and LR− 1.2. These translate the ability to move pretest to post-test probability highly dependent on user expertise. For HIE, a pretest probability of seizure of 0.4 moves to a post-test probability of 0.85 when aEEG is positive for seizures by expert interpretation, and down to 0.1 when aEEG is negative. In contrast, no useful information was gained between pretest and post-test probability by aEEG interpreted as negative or positive for seizure at the inexperienced user level. Similarly, in the models of meningitis or extreme prematurity, incremental information gained from aEEG ranged widely based on interpreter experience.
Conclusion aEEG is most useful to screen for neonatal seizures when used in conditions with high seizure prevalence, and when interpretation has a sensitivity and specificity as reported for expert users. In contrast, aEEG can become negligible in providing meaningful clinical information when applied in conditions having lower seizure prevalence or when interpretation has low accuracy. Appropriate patient selection and high quality interpretation are essential for aEEG utility in neonatal seizure detection.
aEEG utility for neonatal seizure screening relies on patient selection and quality interpretation.
Utility of aEEG is highest with high seizure prevalence and expert interpretation.
Utility of aEEG can be negligible with lower seizure prevalence or low accuracy interpretation.
Received: 04 June 2020
Accepted: 02 November 2020
15 December 2020 (online)
© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
- 1 Glass HC, Wusthoff CJ, Shellhaas RA. Amplitude-integrated electro-encephalography: the child neurologist's perspective. J Child Neurol 2013; 28 (10) 1342-1350
- 2 Hellström-Westas L. Amplitude-integrated electroencephalography for seizure detection in newborn infants. Semin Fetal Neonatal Med 2018; 23 (03) 175-182
- 3 Wusthoff CJ, Shellhaas RA, Clancy RR. Limitations of single-channel EEG on the forehead for neonatal seizure detection. J Perinatol 2009; 29 (03) 237-242
- 4 Glass HC, Shellhaas RA, Wusthoff CJ. et al; Neonatal Seizure Registry Study Group. Contemporary profile of seizures in neonates: a prospective cohort study. J Pediatr 2016; 174: 98-103.e1
- 5 Gaschignard J, Levy C, Romain O. et al. Neonatal bacterial meningitis: 444 cases in 7 years. Pediatr Infect Dis J 2011; 30 (03) 212-217
- 6 Baud O, Aujard Y. Neonatal bacterial meningitis. Handb Clin Neurol 2013; 112: 1109-1113
- 7 Lloyd RO, O'Toole JM, Pavlidis E, Filan PM, Boylan GB. Electrographic seizures during the early postnatal period in preterm infants. J Pediatr 2017; 187: 18-25.e2
- 8 Scher MS, Aso K, Beggarly ME, Hamid MY, Steppe DA, Painter MJ. Electrographic seizures in preterm and full-term neonates: clinical correlates, associated brain lesions, and risk for neurologic sequelae. Pediatrics 1993; 91 (01) 128-134
- 9 Le Bihannic A, Beauvais K, Busnel A, de Barace C, Furby A. Prognostic value of EEG in very premature newborns. Arch Dis Child Fetal Neonatal Ed 2012; 97 (02) F106-F109
- 10 Frenkel N, Friger M, Meledin I. et al. Neonatal seizure recognition—comparative study of continuous-amplitude integrated EEG versus short conventional EEG recordings. Clin Neurophysiol 2011; 122 (06) 1091-1097
- 11 Lawrence R, Mathur A, Nguyen The Tich S, Zempel J, Inder T. A pilot study of continuous limited-channel aEEG in term infants with encephalopathy. J Pediatr 2009; 154 (06) 835-41.e1
- 12 Shah DK, Mackay MT, Lavery S. et al. Accuracy of bedside electroencephalographic monitoring in comparison with simultaneous continuous conventional electroencephalography for seizure detection in term infants. Pediatrics 2008; 121 (06) 1146-1154
- 13 Zhang L, Zhou Y-X, Chang L-W, Luo X-P. Diagnostic value of amplitude-integrated electroencephalogram in neonatal seizures. Neurosci Bull 2011; 27 (04) 251-257
- 14 Rennie JM, Chorley G, Boylan GB, Pressler R, Nguyen Y, Hooper R. Non-expert use of the cerebral function monitor for neonatal seizure detection. Arch Dis Child Fetal Neonatal Ed 2004; 89 (01) F37-F40
- 15 Shellhaas RA, Soaita AI, Clancy RR. Sensitivity of amplitude-integrated electroencephalography for neonatal seizure detection. Pediatrics 2007; 120 (04) 770-777