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Additional value of two-channel amplitude integrated EEG recording in full-term infants with unilateral brain injury
  1. Linda G M van Rooij1,
  2. Linda S de Vries1,
  3. Alexander C van Huffelen2,
  4. Mona C Toet1
  1. 1Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, The Netherlands
  2. 2Department of Clinical Neurophysiology, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, The Netherlands
  1. Correspondence to Dr Linda S de Vries, Department of Neonatology, Wilhelmina Children's Hospital, KE 04.123.1, PO Box 85090, 3508 AB Utrecht, The Netherlands; l.s.devries{at}


Background Amplitude integrated electroencephalography (aEEG) is a valuable tool for evaluating neonatal encephalopathy and identifying electrographic seizures.

Objective To compare seizure activity and background pattern (BGP) between one-channel and two-channel aEEG recordings in full-term neonates.

Methods The two-channel aEEG recordings (F3-P3; F4-P4) of 34 neonates with seizures were compared with single-channel recordings (P3-P4).

Results All 34 infants with unilateral (n=14), diffuse (n=18) or without (n=2) brain injury had seizure patterns on one-channel and two-channel recordings, with 18% more seizure patterns detected with two-channel recording. In 79% of infants with unilateral injury more seizures were noted on the ipsilateral side compared to the contralateral side. In 39% of the infants with diffuse brain damage more seizures were found with two-channel recordings. A sensitivity of 65% was found when using the automatic seizure detection algorithm. In 4/14 (29%) infants with unilateral injury a more severely affected BGP was seen on the ipsilateral side compared to the BGP on one-channel recording. In infants with diffuse injury differences in BGP pattern were seen in 6–17% of the infants depending on the system used for scoring.

Conclusion Although there were no major differences found between seizure detection with one-channel or two-channel aEEG, in a subgroup of infants with a predominantly unilateral brain lesion, two-channel recording did provide additional information with identification of more seizure patterns on the affected side, sometimes also associated with a difference in BGP. To improve early diagnosis of unilateral lesions and improve seizure detection in these infants, routine use of two-channel recordings is recommended.

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  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the medical ethics committee, UMC Utrecht, The Netherlands.

  • Funding LvR was supported by the Dutch Epilepsy Foundation (NEF 3-15).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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