Comparison between simultaneously recorded amplitude integrated electroencephalogram (cerebral function monitor) and standard electroencephalogram in neonates
Comparison between simultaneously recorded amplitude integrated electroencephalogram (cerebral function monitor) and standard electroencephalogram in neonates
复制标题
DOI：
10.1542/peds.109.5.772
复制
发表时间：
2002-05-01
期刊：
影响因子：
8
通讯作者：
van Huffelen, KC
中科院分区：
文献类型：
--
作者：
Toet, MC;van der Meij, W;van Huffelen, KC
目的：评估脑功能监测仪（CFM）与标准脑电图相比，振幅积分脑电图（EEG）对缺氧缺血性脑病或疑似惊厥的新生儿的价值和局限性。方法。对 36 例胎龄大于或等于 36 周的新生儿进行 CFM 和同时记录的 EEG 迹线离线分析并独立分类。 CFM背景活动：连续正常电压；连续正常电压，轻微不连续（DNV）；突发抑制（BS）；持续极低电压；平面追踪。 CFM 癫痫样活动：疑似癫痫活动、单次癫痫发作 (SS)、反复癫痫发作 (RS)、癫痫持续状态 (SE)。 EEG背景活动：正常、抑郁、低电压未分化、过度不连续、BS、无活动。癫痫样活动：发作间期单灶性、发作间期多灶性、发作期单灶性、发作期多灶性、SE。结果。总共 33 条迹线适合分析。观察者间就 CFM 病例和 27 例 EEG 病例 (kappa=0.92) 和 27 例 (kappa=0.74) 背景活动达成一致。对于 CFM 发作活动（RS、SS 或 SE）和 EEG 发作活动完全一致。 90% 的情况下，正常的 CFM（连续正常电压）与正常或抑郁的 EEG 相对应。严重异常 CFM（BS、连续极低电压、平坦描迹）与严重异常 EEG（过度不连续、BS、低电压未分化、无活动）相对应的阳性预测值为 100%（阴性预测值，80%；敏感性，76%；特异性，100%）。 CFM 上的 DNV (10) 与 EEG 上的抑郁 (6) 或过度不连续 (4) 相对应。 8 例 EEG 上的发作活动与 CFM 上的 SS、RS 或 SE 相对应（敏感性，80%；特异性，100%；阳性预测值，100%；阴性预测值，92%）。结论。 CFM 是监测背景模式（尤其是正常和严重异常）和发作活动的可靠工具。某些局灶性、低幅度和非常短时间的癫痫放电可能会被遗漏。我们建议使用 CFM 作为监测设备，并在对 CFM 的分类（即 DNV 模式或可疑的癫痫样活动）有任何疑问时执行间歇性标准脑电图。
Objective: To assess the value and the limitations of amplitude integrated electroencephalogram (EEG) using the cerebral function monitor (CFM) in comparison with standard EEG in neonates who have hypoxic ischemic encephalopathy or were suspected of having convulsions.Methods. In 36 neonates with a gestational age greater than or equal to36 weeks, CFM and simultaneously recorded EEG traces were analyzed off-line and independently classified. CFM background activity: continuous normal voltage; continuous normal voltage, slightly discontinuous (DNV); burst-suppression (BS); continuous extremely low voltage; flat tracing. CFM epileptiform activity: suspected epileptic activity, single seizure (SS), repetitive seizures (RS), status epilepticus (SE). EEG background activity: normal, depressed, low voltage undifferentiated, excessive discontinuity, BS, no activity. Epileptiform activity: interictal unifocal, interictal multifocal, ictal unifocal, ictal multifocal, SE.Results. A total of 33 traces were suitable for analysis. Interobserver agreement on background activity was reached in 31 cases (kappa=0.92) for CFM and in 27 cases (kappa=0.74) for EEG. There was full agreement on CFM ictal activity (RS, SS, or SE) and EEG ictal activity. A normal CFM (continuous normal voltage) corresponded with a normal or a depressed EEG in 90% of the cases. The positive predictive value for a severely abnormal CFM (BS, continuous extremely low voltage, flat tracing) to correspond with a severely abnormal EEG (excessive discontinuity, BS, low voltage undifferentiated, no activity) was 100% (negative predictive value, 80%; sensitivity, 76%; specificity, 100%). DNV (10) on CFM corresponded either with depressed (6) or excessive discontinuity (4) on EEG. Ictal activity on EEG corresponded with SS, RS, or SE on CFM in 8 cases (sensitivity, 80%; specificity, 100%; positive predictive value, 100%; negative predictive value, 92%).Conclusion. CFM is a reliable tool for monitoring both background patterns (especially normal and severely abnormal) and ictal activity. Certain focal, low amplitude, and very short periods of seizure discharges can be missed. We recommend using CFM as a monitoring device and performing intermittent standard EEG whenever there is any doubt about the classification of the CFM (ie, DNV pattern or suspected epileptiform activity).