Acute symptomatic seizures in neonates and use of amplitude-integrated EEG (aEEG)

Background Seizures in neonates are mainly acute symptomatic seizures and a sign of an underlying neurological disorder. The diagnosis of neonatal seizures carried out according to the International League Against Epilepsy (ILAE) classification is based only on electroencephalography (EEG) and then it is described if they are accompanied by motor symptoms or not. Therefore, the simplified method of amplitude-integrated EEG (aEEG), which can be easily used for long-term monitoring directly at the bedside, has proven helpful and is not just a compensatory measure until conventional video EEG becomes available. Objective This manuscript discusses the value of aEEG for diagnosis and surveillance of neonatal seizures. Results and discussion For exact assessment of the seizure burden (duration of seizure activity within a given time frame) and for guidance of a possible treatment, the aEEG has proven value, in addition to conventional video EEG. The duration and frequency of seizures, background activity and experience of the assessing caregiver have a significant influence on the seizure detection rate of aEEG. Only short, very focal seizures or seizures with amplitudes not significantly different from background activity cannot be easily detected by aEEG, whereby longer seizures that spread regionally can be identified by an experienced user in up to 85% using aEEG. As there are increasing data showing that the exact seizure burden correlates to neurodevelopmental outcome, a continuous neurophysiological surveillance of patients at risk is preferred. The aEEG can significantly contribute to this aim.