Diagnosing seizures with amplitude integrated EEG

Introducing amplitude integrated electroencephalography in the neonatal intensive care unit has made us aware of the common occurrence of seizures in high risk newborn infants. Using this technique or conventional multi-channel electroencephalography we now know that clinical seizures are often not confirmed as seizure patterns on the amplitude integrated electroencephalography, that subclinical seizures are very common in newborn infants, especially after administration of a first antiepileptic drug, which is called electroclinical dissociation or decoupling. A status epilepticus is also not uncommon and is also usually entirely subclinical. We are well aware that focal, low amplitude and very brief seizures will not be detected using this technique. The amplitude integrated electroencephalography technology has greatly been improved over the last decade, changing from analogue to digital and from strictly one-channel to now mostly two channel recordings. The major improvement is the simultaneous display of the raw electroencephalography and in some machines even access to a seizure detection algorithm. These developments have made it possible to find the best electrode placements and to study the effects of antiepileptic drugs more effectively.