Accuracy of amplitude integrated EEG in a neonatal cohort
Accuracy of amplitude integrated EEG in a neonatal cohort
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DOI：
10.1136/adc.2009.165969
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发表时间：
2010-05-01
影响因子：
4.4
通讯作者：
Garg, M.
中科院分区：
文献类型：
--
作者：
Evans, E.;Koh, S.;Garg, M.
目的比较振幅积分脑电(AEEG)和同步标准脑电(SEEG)检测癫痫发作和背景中断的敏感性和特异性。设计前瞻性配对队列。设立三级新生儿重症监护病房。需要sEEG的新生儿被招募进行同步aEG。在sEEG和AEEG之后，癫痫发作被记录为存在或不存在，背景以每种形式被记录为正常或不连续。主要结果衡量记录过程中至少存在一次癫痫发作。背景活动被报告为正常或不连续。结果共完成51例sEEG和AEEG研究。44项研究分析了癫痫发作的存在，46项研究分析了背景不连续性。AEEG对癫痫发作的敏感性为80%，特异性为50%。AEEG对婴儿癫痫的误诊率为63.6%，而sEEG为45.5%，P=0.045。背景活动中断的敏感性(88.6%)和特异性(54.5%)高于癫痫检出。当按脑电、缺氧性发作(n=14)或可疑癫痫(n=33)的指征分层时，aEEG和sEEG对癫痫的敏感性相似(80%)。但AEEG对可疑癫痫的新生儿的特异度较高(66.7%vs22.2%)。结论AEEG能较准确地发现背景异常，但单一的AEEG标准会导致对新生儿癫痫的过度诊断。因此，在对新生儿癫痫实施抗惊厥治疗之前，AEEG上记录的癫痫发作需要sEEG确认。
Objective To determine the sensitivity and specificity of amplitude integrated electroencephalogram (aEEG) compared to simultaneous standard electroencephalogram (sEEG) for seizure detection and background discontinuity.Design Prospective paired cohort.Setting Tertiary academic neonatal intensive care unit.Patients Infants were recruited from 2005 to 2008. Neonates requiring sEEG were recruited for simultaneous aEEG.Interventions Following sEEG and aEEG, seizures were recorded as present or absent, and background was recorded as normal or discontinuous in each format.Main outcome measures Presence of at least one seizure during recording. The background activity was reported as normal or discontinuous. Discontinuity of brain activity was further ranked as mild, moderate or severe.Results 51 sEEG and aEEG studies were completed. 44 studies were analysed for presence of seizures and 46 were analysed for background discontinuity. Sensitivity for presence of seizures by aEEG was 80% and specificity was 50%. The proportion of infants with seizures were overdiagnosed by aEEG (63.6% vs 45.5% for sEEG p=0.045). Discontinuity of background activity had higher sensitivity (88.6%) and specificity (54.5%) when compared with seizure detection.When stratified by indication for EEG, hypoxic episode (n=14) or suspected seizures (n=33), similar sensitivity for presence of seizure (80%) was noted by aEEG and sEEG. However the specificity of aEEG for seizure detection was higher in neonates undergoing EEG for suspected seizures (66.7% vs 22.2%).Conclusions Background abnormalities were detected with fair accuracy by aEEG but aEEG criteria alone would result in the overdiagnosis of neonatal seizures. Therefore seizures noted on aEEG require sEEG confirmation prior to implementing anticonvulsant therapy for neonatal seizures.