The role of electroencephalogram in neonatal seizure detection

The role of EEG in neonatal seizure detection is well-established, being the multichannel video-EEG the gold standard. However, in the clinical practice often amplitude integrated EEG (aEEG) is used, in order to overcome the difficulties related to EEG use. Areas covered: An overview regarding neonatal seizures, current tools used to detect these (multichannel EEG versus aEEG) with respective strenghts and limitations, and some tools that can implement the use of multichannel EEG in the NICU. Expert commentary: Multichannel video-EEG is still a gold standard for seizure detection. Indeed, this tool allows to avoid both underestimation of neonatal seizure incidence and overtreatment with anticonvulsant drugs. Furthermore, it has to be acknowledged that multichannel video-EEG monitoring is not limited to the only seizure detection, providing also the information needed for a more accurate assessment of the background activity and some specific waves/pattern and features indicative of the brain development.