title: Limitations of single-channel EEG on the forehead for neonatal seizure detection.
abstract: OBJECTIVE
  In amplitude-integrated EEG, lead placement across the forehead is convenient, but this location has unknown effects on neonatal seizure (NS) detection sensitivity. This study describes the limits of NS detection by a single forehead EEG channel.
  
  
  METHODS
  Records were taken from a digital library of conventional EEGs (CEEGs) with NS, previously characterized at a bicentral channel, C(3) --> C(4). We analyzed electrographic characteristics in a single forehead channel, Fp(3) --> Fp(4).
  
  
  RESULTS
  A total of 330 seizures from 125 CEEGs were included. With Fp(3) --> Fp(4), at least one NS was detected in 66% of records vs 90% using C(3) --> C(4) (P<0.0001). Of 330 seizures, 46% appeared in Fp(3) --> Fp(4) vs 73% in C(3) --> C(4) (P<0.0001). Seizures appeared briefer in Fp(3) --> Fp(4) than C(3) --> C(4) (P<0.006) and CEEG (P<0.0001).
  
  
  CONCLUSIONS
  NSs are significantly more difficult to detect with a single forehead channel than bicentrally or on CEEG. In Fp(3) --> Fp(4), a third of records with seizures were missed and over half of seizures were undetected.
authors.affiliation: Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA. wusthoff@email.chop.edu
authors.forename: C J
authors.initials: CJ
authors.lastname: Wusthoff
authors.forename: R A
authors.initials: RA
authors.lastname: Shellhaas
authors.forename: R R
authors.initials: RR
authors.lastname: Clancy
mesh_terms: D004569:Electroencephalography / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods*; D012640:Seizures / Q000175:diagnosis*; D012680:Sensitivity and Specificity