American Clinical Neurophysiology Society Standardized EEG Terminology and Categorization for the Description of Continuous EEG Monitoring in Neonates:

Flashcards on continuous electroencephalography (cEEG) monitoring in neonates.

cEEG

Continuous EEG monitoring in neonates with seizures.

Neonatal Seizures

Acute neurologic injury often indicated by seizures in a neonate.

Seizure Diagnosis

Requires EEG confirmation for definitive diagnosis.

Uses of cEEG

Detecting seizures and facilitating diagnosis of underlying conditions.

ACNS

American Clinical Neurophysiology Society.

ACNS Guideline on Continuous EEG Monitoring in Neonates

Recommendations regarding indications and technical standards for cEEG use.

ACNS Methodology

Structured methodology requirements for clinical guideline development.

Neonatal cEEG

The focus is on cEEG of hospitalized neonates.

cEEG Guidelines

Do not constitute a universal standard of care.

ACNS

American Clinical Neurophysiology Society.

PICO Format

Patients, Intervention, Comparison group, and Outcome.

EEG Seizure

A paroxysmal, rhythmic, evolving event on EEG lasting 10 seconds or longer.

Electrographic-only Seizures

Seizures evident only on EEG without clear accompanying clinical signs.

Electroclinical Seizures

Seizures with both ictal evolution on EEG and simultaneous clinical signs.

Covidence

Software used for article screening, full text review, and data extraction.

QUADAS-2

Tool for studies of diagnostic tests.

QUIPS

Tool for studies of prognosis.

GRADE

Process used to evaluate the body of evidence for each priority question.

Recommendation Considerations

Considered for each recommendation: quality of evidence, benefits to harms, values, preferences, resource use.

Strong Recommendations

Most patients should receive the recommended course of action.

Conditional Recommendations

Some patients/families may not want the recommended course of action.

PRISMA

Extension for diagnostic test accuracy studies checklists.

Harms of cEEG

Direct harm from cEEG was not found for any priority question.

High-Resource Tool

Required equipment and skilled personnel.

Accuracy of Seizure Diagnosis

Clinically suspected seizures substantially improved by cEEG.

Clinical Observation

Clinical observation alone.

aEEG alone

There was a wide range of reported accuracy compared with cEEG.

Routine/spot EEG

Several studies indirectly examined the accuracy of cEEG.

Values and Preferences

The families typically value a definitive diagnosis of seizures.

Given that cEEG is resource intensive

The recommendation is conditional.

aEEG accuracy

aEEG evaluation.

False positive seizures

Movement artifacts.

Evidence

Moderate quality of evidence.

CHD

Congenital heart disease.

Balance

The balance of benefits versus harms is in favor of cEEG.

Clinical pathways for cEEG

Optimize resources for particular populations.

cEEG

Confirm the seizure control.

ASMs

antiepileptic medications.

Superior to

Clinical diagnosis alone.

Most accurate method

Objectively confirm resolution of seizures.

positional

mechanical interference with equipment.

Values

There may be situations in which families prefer not to have cEEG placed.

clinicians value

Information from cEEG.

cEEG results

Risk stratification.

evolving brain injury

Offer the possibility of acute preventative or supportive interventions.

Background asynchrony and asymmetry

Assessment of Interictal Background Patterns.

Real-time cEEG

Predict physiologic decompensation.

cEEG is known

Clinical decision making.

Evolving EEG

Risk stratification for evolving.

cEEG should be

Specialized care.

reactive confirmation

High risk.