Limitations of single-channel EEG on the forehead for neonatal seizure detection

Objectives: 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. Study Design: Records were taken from a digital library of conventional EEGs (CEEGs) with NS, previously characterized at a bicentral channel, C₃ → C₄. We analyzed electrographic characteristics in a single forehead channel, Fp₃ → Fp₄. Result: A total of 330 seizures from 125 CEEGs were included. With Fp₃ → Fp₄, at least one NS was detected in 66% of records vs 90% using C₃ → C₄ (P<0.0001). Of 330 seizures, 46% appeared in Fp₃ → Fp₄ vs 73% in C₃ → C₄ (P<0.0001). Seizures appeared briefer in Fp₃ → Fp₄ than C₃ → C₄ (P<0.006) and CEEG (P<0.0001). Conclusion: NSs are significantly more difficult to detect with a single forehead channel than bicentrally or on CEEG. In Fp₃ → Fp₄, a third of records with seizures were missed and over half of seizures were undetected.