What You're Looking At

What the Screen Shows

Top Panel - Raw EEG

• Continuous brainwave (EEG) waveforms from electrodes placed on the scalp at positions C3 and C4 (central left and right - standard neonatal montage)
• This is the raw electrical activity of the brain

Bottom Panel - aEEG / CFM (Amplitude-Integrated EEG)

• The large blue area is the Cerebral Function Monitor (CFM) or aEEG trend
• It compresses hours of brain activity into a trend line so clinicians can quickly assess background brain patterns, sleep-wake cycling, or detect subclinical seizures over time
• Current amplitude shown: 4 µV (microvolts)

Bottom Bar - Event Annotations

• Buttons for clinicians to mark events: Convulsions, Medicine Administration, Crying, Feeding, Nursing, Suction, etc. - these get logged directly onto the EEG recording.

Clinical Purpose

• Monitor brain health in sick newborns (e.g., after birth asphyxia, hypoxic-ischemic encephalopathy)
• Detect seizures that may not be visually obvious
• Guide treatment decisions (e.g., cooling therapy, anti-epileptic drugs)

High-Yield MCQs: Neonatal EEG & aEEG Monitoring

BLOCK 1 - aEEG (DigiTrack / CFM)

• A) More channels, higher sensitivity
• B) Fewer channels, time-compressed, semi-logarithmic display
• C) Requires specialist neurophysiologist for real-time interpretation
• D) Cannot detect subclinical seizures

✅ Answer: B aEEG displays 1-2 channels of time-compressed, processed EEG signal on a semi-logarithmic scale. It is less sensitive than full EEG but can be interpreted by trained bedside clinicians (nurses, neonatologists). It CAN detect subclinical seizures. (Bradley & Daroff's Neurology in Clinical Practice)

• A) Fp1 and Fp2
• B) O1 and O2
• C) C3 and C4
• D) T3 and T4

✅ Answer: C C3 and C4 (central electrode positions) are standard for neonatal aEEG monitoring, representing the central regions of both hemispheres.

• A) Discontinuous pattern in first 6-12 hours
• B) Burst suppression pattern that normalizes within 24 hours
• C) Flat/isoelectric trace
• D) Low-voltage continuous pattern

✅ Answer: C A flat (isoelectric) trace is severely abnormal and associated with death or major handicap after perinatal asphyxia. Burst suppression that normalizes within 12-24 hours carries a better prognosis.

• A) Electroclinical dissociation
• B) Uncoupling
• C) Burst suppression
• D) Status epilepticus

✅ Answer: B Uncoupling = clinical manifestations terminate while electrographic seizures persist. It commonly occurs after anticonvulsant administration in neonates. Electroclinical dissociation is the reverse: clinical seizure expression without electrical correlate. (Bradley & Daroff's Neurology in Clinical Practice)

BLOCK 2 - Neonatal Seizures: Diagnosis

• A) Clinical observation
• B) MRI brain
• C) Continuous conventional EEG
• D) aEEG (amplitude-integrated EEG)

✅ Answer: C Continuous conventional EEG is the gold standard (ACNS recommendation). aEEG is a useful bedside screening tool but is less sensitive. (Bradley & Daroff's Neurology in Clinical Practice)

• A) Sudden electrographic change
• B) Repetitive waveforms evolving in morphology/frequency/location
• C) Amplitude of at least 2 µV
• D) Duration of at least 10 seconds

✅ Answer: All of the above (A, B, C, D) All four criteria must be met for an EEG seizure in neonates (Tsuchida et al., 2013).

• A) Hypoxic-ischemic encephalopathy
• B) Hypoglycemia
• C) Focal cerebral infarction (stroke)
• D) Hypocalcemia

✅ Answer: C Focal clonic seizures in a term newborn are most commonly associated with focal cerebral infarction. HIE more typically causes subtle, tonic, or multifocal seizures. (Bradley & Daroff's Neurology in Clinical Practice)

• A) EEG electrode misplacement
• B) Anticonvulsant suppression
• C) Brainstem release phenomena or seizures in deep structures not reaching the surface
• D) Artefact from movement

✅ Answer: C Subtle and generalized tonic seizures do not consistently show electrographic discharges. They may represent nonepileptic brainstem release phenomena or seizures in deep cerebral structures not transmitted to the surface EEG.

BLOCK 3 - Neonatal Seizures: Management

• A) Levetiracetam
• B) Midazolam
• C) Lorazepam
• D) Phenobarbital

✅ Answer: D Phenobarbital 20 mg/kg IV is first-line. Note: there is increasing evidence of phenobarbital-induced neuronal apoptosis. Second line = phenytoin/fosphenytoin. Refractory = benzodiazepine infusion. (Rosen's Emergency Medicine; Bradley & Daroff's)

• A) Levetiracetam was superior
• B) Both were equally effective
• C) Levetiracetam was less effective than phenobarbital
• D) Phenobarbital caused more side effects

✅ Answer: C The Sharpe et al. (2020) RCT showed levetiracetam was less effective than phenobarbital for neonatal seizures, despite its increasing use.

• A) Biotin deficiency
• B) Folate deficiency
• C) Pyridoxine (Vitamin B6) deficiency
• D) Thiamine deficiency

✅ Answer: C Empirical pyridoxine 15-30 mg/kg/day (max 500 mg/day) should be tried for refractory neonatal seizures, under EEG monitoring, if no other cause is found.

• A) Neonates cannot express pain
• B) Most neonatal seizures are generalized tonic-clonic
• C) Many neonatal seizures are subclinical (no clinical manifestation)
• D) Neonatal EEG is always normal

✅ Answer: C A significant proportion of neonatal seizures are electrographic only (subclinical), making EEG/aEEG monitoring essential. This is why the DigiTrack system you saw is used in NICUs.

BLOCK 4 - Bonus High-Yield Associations

Exam tip: NEET PG and AMC love asking about (1) gold standard vs bedside tool, (2) uncoupling vs electroclinical dissociation, (3) first-line drug, and (4) aEEG pattern prognosis. All high-yield from what you saw on that monitor!