Electroencephalogram and Flash Visual Evoked Potentials for Detecting Periventricular Leukomalacia

Abstract

Objective: The aim of this study was to evaluate the usefulness of a combination of electroencephalogram (EEG) and flash visual evoked potentials (FVEPs) for predicting periventricular leukomalacia (PVL) in the early days of life.

Study Design: Eighty-six of 108 infants admitted to Anjo Kosei Hospital during 1998 through 2000 were enrolled in this study. All subjects underwent EEG and FVEP during the early neonatal period and were followed-up until 18 months of corrected age. EEG was performed once within 72 h after birth, every 1–2 weeks during the first month and every 2–4 weeks during the second month. FVEPs were recorded at least twice, at the first and the second week of life.

Results: Of the 86 infants, 13 were diagnosed as having PVL. Among them, EEG abnormalities were observed in 11 infants and FVEP abnormalities in 10. The sensitivity and specificity of EEG were 0.85 and 0.95, respectively. The sensitivity and specificity of FVEPs were 0.77 and 0.96, respectively. All except one (92%) infant with PVL had EEG and/or FVEP abnormalities.

Conclusions: The combination of EEG and FVEPs can increase the sensitivity, but reduces the specificity to identify infants with PVL. The combination can makes up for the shortcomings of each method.

Key words

periventricular leukomalacia (PVL) - electroencephalogram (EEG) - flash visual evoked potentials (FVEPs)

References

• 1 Aso K, Scher MS, Barmada MA. Neonatal electroencephalography and neuropathology.  J Clin Neurophysiol. 1989;  6 103-123
• 2 Baud O, Allest AM, Masmonteil TL. et al . The early diagnosis of periventricular leukomalacia in premature infants with positive rolandic sharp waves on serial electroencephalography.  J Pediatr. 1998;  132 813-817
• 3 Biagioni E, Bartalena L, Boldrini A. et al . Electroencephalography in infants with periventricular leukomalacia: prognostic features at preterm ant term age.  J Child Neurol. 2000;  15 1-6
• 4 Bozzao A, Paolo A, Mazzoleni C. et al . Diffusion-weighted MR imaging in the early diagnosis of periventricular leukomalacia.  Eur Radio. 2003;  13 1571-1576
• 5 Ekert PG, Keenan NK, Whyte HE. et al . Visual evoked potentials for prediction of neurodevelopmental outcome in preterm infants.  Biol Neonate. 1997;  71 148-155
• 6 Hayakawa F, Okumura A, Kato T. et al . Determination of timing of brain injury in preterm infants with periventricular leukomalacia with serial neonatal electroencephalography.  Pediatrics. 1999;  104 1077-1081
• 7 Hayakawa F, Okumura A, Kato T. et al . Disorganized pattern: chronic-stage EEG abnormalities of the late neonatal period following severely depressed EEG activities in early preterm infants.  Neuropediatrics. 1997;  28 272-275
• 8 Inder TE, Anderson NJ, Spencer C. et al . White matter injury in the premature infant: a comparison between serial cranial sonographic and MR findings at term.  Am J Neuroradiol. 2003;  24 805-809
• 9 Inder TE, Huppi PS, Zientara GP. et al . Early detection of periventricular leukomalacia by diffusion-weighted magnetic resonance imaging techniques.  J Pediatr. 1999;  134 631-634
• 10 Inder TE, Buckland L, Williams CE. et al . Lowered Electroencephalographic spectral edge frequency predicts the presence of cerebral white matter injury in premature infants.  Pediatrics. 2003;  111 27-33
• 11 Kato T, Hayakawa F, Okumura A. et al . Flash visual evoked potentials in preterm infants: correlation with neurodevelopmental outcome.  J Jpn Soc Perinat Neonat Med. 2000;  36 248 , (in Japanese)
• 12 Kato T, Okumura A, Hayakawa F. et al . The evolutionary change of flash visual evoked potentials in preterm infants with periventricular leukomalacia.  Clin Neurophysiol. 2005;  116 690-695
• 13 Kidokoro H, Okumura A, Watanabe K. Abnormal brushes in preterm infants with periventricular leukomalacia.  Neuropediatrics. 2006;  37 1-4
• 14 Kubota T, Okumura A, Hayakawa F. et al . combination of neonatal electroencephalography and ultrasonography: sensitive means of early diagnosis of periventricular leukomalacia.  Brain Dev. 2002;  24 698-702
• 15 Kubota T, Okumura A, Hayakawa F. et al . Relation between the date of cyst formation observable on ultrasonography and the timing of injury determined by serial encephalography in preterm infants with periventricular leukomalacia.  Brain Dev. 2001;  23 390-394
• 16 Maalouf EF, Duggan PJ, Counsell SJ. et al . Comparison of findings on cranial ultrasound and magnetic resonance imaging in preterm infants.  Pediatrics. 2001;  107 719-727
• 17 Marret S, Parain D, Jeannot E. et al . Positive rolandic sharp waves in the EEG of the premature newborn: a five year prospective study.  Arch Dis Child. 1992;  67 948-951
• 18 Maruyama K, Okumura A, Hayakawa F. et al . Prognostic value of EEG depression in preterm infants for late development of cerebral palsy.  Neuropediatrics. 2002;  33 133-137
• 19 Miller SP, Cozzio CC, Goldstein RB. et al . Comparing the diagnosis of white matter injury in premature newborns with serial MR imaging and transfontanel ultrasonography findings.  Am J Neuroradiol. 2003;  24 1661-1669
• 20 Mushin J. Visual evoked potentials. In: Fetal and Neonatal neurology and neurosurgery. Churchill Livingstone, London 1988: 206-211
• 21 Novotny FJ, Tharp BR, Coen RW. et al . Positive rolandic sharp waves in the EEG of the premature infant.  Neurology. 1987;  37 1481-1486
• 22 Okumura A, Hayakawa F, Kato T. et al . MRI findings in patients with spastic cerebral palsy. Correlation with gestational age at birth.  Dev Med Child Neurol. 1997;  39 363-368
• 23 Okumura A, Hayakawa F, Kato T. et al . Abnormal sharp transients on electroencephalograms in preterm infants with periventricular leukomalacia.  J Pediatr. 2003;  143 26-30
• 24 Okumura A, Hayakawa F, Kato T. et al . Positive rolandic sharp waves in preterm infants with periventricular leukomalacia: their relation to background electroencephalographic abnormalities.  Neuropediatrics. 1999;  30 278-282
• 25 Palisano R, Rosenbaum P, Walter S. et al . Development and reliability of a system to classify gross motor function in children with cerebral palsy.  Dev Med Child Neurol. 1997;  39 214-223
• 26 Pike MG, Holmstrom G, Vries LS de. et al . Patterns of visual impairment associated with lesions of the preterm infant brain.  Dev Med Child Neurol. 1994;  36 849-862
• 27 Shepherd AJ, Saunders KJ, MacCulloch DL. et al . Prognostic value of flash visual evoked potentials in preterm infants.  Dev Med Child Neurol. 1999;  41 9-15
• 28 Sofue A, Okumura A, Hayakawa F. et al . Sharp waves in preterm infants with periventricular leukomalacia.  Pediatr Neurol. 2003;  29 214-217
• 29 Vermeulen RJ, Sie LTL, Jonkman EJ. et al . Predictive value of EEG in the neonates with periventricular leukomalacia.  Dev Med Child Neurol. 2003;  45 586-590
• 30 Volpe JJ. Hypoxic-ischemic encephalopathy: neuropathology and pathogenesis. In: Volpe JJ, editor. Neurology of the Newborn. Philadelphia: W.B. Saunders 2001: 296-330
• 31 Watanabe K, Hayakawa F, Okumura A. Neonatal EEG: a powerful tool in the assessment of brain damage in preterm infants.  Brain Dev. 1999;  21 361-372
• 32 Watanabe K. the neonatal electroencephalogram and sleep-cycle pattern. In: Eyre JA, ed. The Neurophysiological Examination of the Newborn Infant. London: Mac Keith Press 1992: 11-47
• 33 Woodward LJ, Anderson PJ, Austin NC. et al . Neonatal MRI to predict neurodevelopmental outcomes in preterm infants.  N Eng J Med. 2006;  355 685-694

Correspondence