Pediatrics

In clinical practice, predicting outcome in the acute period is most reliably based on assessment of the initial degree of brain injury and the persistence of brain dysfunction during the ensuing first few days. The EEG has an important role in the diagnosis and management of neurologic disorders in newborns. It has proven superior to clinical examination in newborns for the early detection and prognosis of brain dysfunction, and provides an important measure of quality of the brain function in critically ill infants. At present, continuous video-EEG monitoring of these children provides the best information about the presence of seizures, and is also very useful for monitoring the response to anticonvulsant treatment. Further, its unique place in clinical care setting is based on its providing of "real-time" and continuous information concerning brain function. This is in contrast to other techniques, such as head ultra-sonography and neuroimaging studies, which assess brain structure.

The clinical significance of the EEG, is that it may identify pathological changes in brain function and provide prognostic markers, which may have important roles in monitoring response to therapy and in pecifically aiding clinical management, such as determining duration of therapy. It is generally agreed on that more sensitive and specific quantitative EEG measures can provide relevant information about brain function prior to clinical manifestation, which may represent a window of opportunity for appropriate interventions. Monitoring can be used to determine whether the newborn is experiencing changes in EEG. Capturing a clinical seizure on video that is closely correlated with EEG seizure activity is the most definite criterion for the monitoring-based diagnosis of a seizure of epileptic origin. However, identifying EEG seizures can be a challenging experience, even for the more experienced clinical neurophysiologist. Also, video-EEGs are often reviewed post hoc, and in often after several hours from when the seizure actually occurred. In fact, in many neonatal intensive care units, “real-time” interpretation of the EEG is not possible or practical, and few neonatal health care professionals have received sufficient training in neonatal EEG interpretation as to assist with “real-time” EEG analysis at the bedside.

The ability to monitor brain function and dysfunction, and detect seizures in "real-time", would greatly empower the clinician's ability in making timely and accurate medical decisions about the newborns brain status. Being able to identify a newborn at risk for brain problems in the acute setting and in real time through quantitative means, would provide a greater degree of control over this disorder so that clinicians can make more efficient and effective treatment and management decisions. Furthermore, quantitative identification of brain vulnerable states also offers the scientist better tools in formulating an understanding of the disorder. Validated quantitative measures of EEG activity may help to determine the degree of brain dysfunction, which, in turn, may provide some early clinical insight into long-term outcome.

A Quantitative EEG Method for Real-Time Detection of Neonatal Seizures in the Neonatal Intensive Care Unit: Epilepsy Foundation of America Partnership for Pediatric Epilepsy Research Foundation
2003-2006

Real-Time Brain Monitoring System Inventors: Paul R. Carney, MD, J. Chris Sackellares, MD, Deng Shiau, Ph.D.