HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS REGISTER		Author Keyword(s) Vol Page [Advanced]

This Article Full Text Full Text (PDF) Submit a response Read responses to this article Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this link to a friend Similar articles in ADC Online Similar articles in PubMed Add article to my folders Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Rennie, J M Articles by Hooper, R Search for Related Content PubMed PubMed Citation Articles by Rennie, J M Articles by Hooper, R

Non-expert use of the cerebral function monitor for neonatal seizure detection

¹ Department of Child Health, King’s College Hospital, London, UK
² Department of Neurophysiology, King’s College Hospital
³ Department of Public Health Sciences, King’s College Hospital

Correspondence to:
Correspondence to:
Dr Rennie
Neonatal Unit, King’s College Hospital, Denmark Hill, London SE5 9RS, UK; janet.rennie{at}kcl.ac.uk

Background: The cerebral function monitor (CFM) is widely used to detect neonatal seizures, but there are very few studies comparing it with simultaneous electroencephalography (EEG).

Objective: To determine the accuracy of non-expert use of the CFM and to assess interobserver agreement of CFM seizure detection.

Patients: Babies admitted to the neonatal intensive care unit at King’s College Hospital who were at high risk of seizure and had video-EEG monitoring.

Methods: Video-EEG was used to detect seizures. Each baby had CFM recordings at speeds of 6, 15, and 30 cm/h during the EEG. Four neonatologists, trained in CFM seizure recognition, independently rated one hour CFM samples at three speeds from each baby. Interobserver agreement was quantified using Cohen’s .

Results: CFM traces from 19 babies with EEG seizures and 21 babies without EEG seizures were analysed. Overall non-expert interpretation of the CFM performed poorly as a seizure detector compared with simultaneous EEG (sensitivities 38% at 6 cm/h; 54% at 15 cm/h; 55% at 30 cm/h). Although babies with seizures were more likely to be correctly classified at higher speeds (p = 0.02), babies without seizures were also more likely to be misclassified (p < 0.001). Agreement between observers was not good at any speed ( values from 0.01 to 0.39). The observers usually detected generalised seizures but often missed seizures that were focal, low amplitude, or lasted less than one minute.

Conclusion: Approximately half of all neonatal seizures may be missed using CFM alone. Neonatal seizures need to be diagnosed, characterised, and quantified first using EEG. The CFM may then be useful for long term monitoring.

Keywords: cerebral function monitor; electroencephalography; seizures; brain; epilepsy

Abbreviations: EEG, electroencephalography; CFM, cerebral function monitor

This article has been cited by other articles:

				D. K. Shah, M. T. Mackay, S. Lavery, S. Watson, A. S. Harvey, J. Zempel, A. Mathur, and T. E. Inder Accuracy of Bedside Electroencephalographic Monitoring in Comparison With Simultaneous Continuous Conventional Electroencephalography for Seizure Detection in Term Infants Pediatrics, June 1, 2008; 121(6): 1146 - 1154. [Abstract] [Full Text] [PDF]

				R. A. Shellhaas, A. I. Soaita, and R. R. Clancy Sensitivity of Amplitude-Integrated Electroencephalography for Neonatal Seizure Detection Pediatrics, October 1, 2007; 120(4): 770 - 777. [Abstract] [Full Text] [PDF]

				R. E. Spitzmiller, T. Phillips, J. Meinzen-Derr, and S. B. Hoath Amplitude-Integrated EEG Is Useful in Predicting Neurodevelopmental Outcome in Full-Term Infants With Hypoxic-Ischemic Encephalopathy: A Meta-Analysis J Child Neurol, September 1, 2007; 22(9): 1069 - 1078. [Abstract] [PDF]

				L. G.M. van Rooij, L. S. de Vries, S. Handryastuti, D. Hawani, F. Groenendaal, A. C. van Huffelen, and M. C. Toet Neurodevelopmental Outcome in Term Infants With Status Epilepticus Detected With Amplitude-Integrated Electroencephalography Pediatrics, August 1, 2007; 120(2): e354 - e363. [Abstract] [Full Text] [PDF]

				E. Shany, O. Benzaqen, and N. Watemberg Comparison of Continuous Drip of Midazolam or Lidocaine in the Treatment of Intractable Neonatal Seizures J Child Neurol, March 1, 2007; 22(3): 255 - 259. [Abstract] [PDF]

				D. M. Murray, C. A. Ryan, G. B. Boylan, A. P. Fitzgerald, and S. Connolly Prediction of Seizures in Asphyxiated Neonates: Correlation With Continuous Video-Electroencephalographic Monitoring Pediatrics, July 1, 2006; 118(1): 41 - 46. [Abstract] [Full Text] [PDF]

				L. Hellstrom-Westas, I. Rosen, L.S. de Vries, and G. Greisen Amplitude-integrated EEG Classification and Interpretation in Preterm and Term Infants NeoReviews, February 1, 2006; 7(2): e76 - e87. [Full Text] [PDF]

				L S de Vries and L Hellstrom-Westas Role of cerebral function monitoring in the newborn Arch. Dis. Child. Fetal Neonatal Ed., May 1, 2005; 90(3): F201 - f207. [Abstract] [Full Text] [PDF]

				D. M. Ferriero Neonatal Brain Injury N. Engl. J. Med., November 4, 2004; 351(19): 1985 - 1995. [Full Text] [PDF]

eLetters: