Current and Future Uses of Continuous EEG in the NICU

Abstract

Continuous EEG (cEEG) is a fundamental neurodiagnostic tool in the care of critically ill neonates and is increasingly recommended. cEEG enhances prognostication via assessment of the background brain activity, plays a role in predicting which neonates are at risk for seizures when combined with clinical factors, and allows for accurate diagnosis and management of neonatal seizures. Continuous EEG is the gold standard method for diagnosis of neonatal seizures and should be used for detection of seizures in high-risk clinical conditions, differential diagnosis of paroxysmal events, and assessment of response to treatment. High costs associated with cEEG are a limiting factor in its widespread implementation. Centralized remote cEEG interpretation, automated seizure detection, and pre-natal EEG are potential future applications of this neurodiagnostic tool.

Acute seizure activity in neonatal inflammation-sensitized hypoxia-ischemia in mice

“…A recent study utilized amplitude-integrated EEG (aEEG) to detect electrographic seizures in a piglet model of neonatal IS-HI brain injury in the setting of TH and found aEEG tracing suppression following HI [ 21 , 26 ]. While an excellent screening tool for seizure activity, aEEG is less sensitive and specific in detecting seizures compared to continuous electroencephalography (cEEG) monitoring [ 27 ]. No studies have examined acute seizure activity, semiology, and neurohistologic brain injury in an animal model of neonatal IS-HI brain injury utilizing cEEG monitoring.…”

“…In terms of neonatal seizures in the setting in inflammation-sensitization, a neonatal rat study described greater histologic brain injury with lipopolysaccharide (LPS)-induced inflammation in combination with induced status epilepticus [25]. Electroencephalography (EEG) can be utilized with animal models of neonatal HIE, such as the Rice-Vannucci model, to replicate several key findings seen in humans with HIE including clinical and electrographic seizures, abnormal background activity, burst suppression, and status epilepticus [26][27][28]. A recent study utilized amplitudeintegrated EEG (aEEG) to detect electrographic seizures in a piglet model of neonatal IS-HI brain injury in the setting of TH and found aEEG tracing suppression following HI [21,26].…”

Sequential levetiracetam and phenytoin in electroencephalographic neonatal seizures unresponsive to phenobarbital: a multicenter prospective observational study in India

“…Conversely, many electrographic seizures may not have clinical manifestations. 5 , 6 , 7 Hence, medical regulatory bodies recommend that in clinical trials evaluating antiseizure medication (ASM), seizure freedom should be examined using EEG. 8 , 9 , 10 …”

Heart rate variability analysis for the prediction of EEG grade in infants with hypoxic ischaemic encephalopathy within the first 12 h of birth

“…Sometimes, the early clinical picture alone is insufficient to decide if a newborn will benefit from therapeutic hypothermia and many neonatal centres use electroencephalography (EEG) to help assess the severity of encephalopathy. The use of EEG monitoring in neonatal units for diagnosis, treatment monitoring and prognosis is increasing worldwide ( 8 , 9 ). International guidelines recognise the benefit of EEG for improved neonatal outcomes and recommend EEG for accurate diagnosis and monitoring of high risk infants ( 10 , 11 ).…”