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Arch Dis Child Fetal Neonatal Ed 2004;89:F37-F40 doi:10.1136/fn.89.1.F37
  • Original article

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

  1. J M Rennie1,
  2. G Chorley1,
  3. G B Boylan1,
  4. R Pressler2,
  5. Y Nguyen2,
  6. R Hooper3
  1. 1Department of Child Health, King’s College Hospital, London, UK
  2. 2Department of Neurophysiology, King’s College Hospital
  3. 3Department of Public Health Sciences, King’s College Hospital
  1. Correspondence to:
    Dr Rennie
    Neonatal Unit, King’s College Hospital, Denmark Hill, London SE5 9RS, UK; janet.renniekcl.ac.uk
  • Accepted 2 December 2002

Abstract

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 κ.

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 (κ 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.

Footnotes

    Responses to this article

    • The role of the cerebral function monitor in neontal intensive care
      • Denis Azzopardi,
      • Marianne Thoresen, St Michael's Hospital Bristol, and Andrew Whitelaw, Southmead Hospital Bristol
      Arch Dis Child - Fetal Neonatal Ed published online March 2, 2004
    • Non-expert use of the cerebral function monitor for neonatal seizure detection
      • Linda S. de Vries,
      • Mona C. Toet, Kees van Huffelen
      Arch Dis Child - Fetal Neonatal Ed published online March 2, 2004

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