A quick and reliable EEG montage for the detection of seizures in the critical care setting

Ioannis Karakis, Georgia D. Montouris, James A.D. Otis, Laurie M. Douglass, Rinat Jonas, Naymee Velez-Ruiz, Kesha Wilford, Patricio S. Espinosa

Research output: Contribution to journalArticlepeer-review

44 Scopus citations


Obtaining an emergent EEG for the diagnosis of nonconvulsive status epilepticus and conconvulsive seizures in the intensive care unit raises logistic problems in most hospitals. Previous studies have looked into the hairline EEG for a broader population than the critically ill, with controversial conclusions. The authors created a montage sufficiently simple to be performed and interpreted by residents and rapidly achievable to meet the time constraints of a busy on-call schedule. Seven electrodes (Fp1, Fp2, T3, T4, O1, O2, and Cz), easily applied without the need for tape measure by using only anatomic landmarks (pupils, ears, vertex, and inion), were used to configure three different montages: double diamond, circumferential, and Cz referential. EEG records obtained with the full 10-20 system in critically ill patients were reformatted into these montages and reviewed retrospectively independently by neurology attending physicians with expertise in EEG interpretation and senior neurology residents. A comparison was done with the previously studied hairline EEG. The average sensitivity of the study montage for seizure detection was 92.5%, whereas the average specificity was 93.5%. These results suggest that the seven-electrode montage could potentially be a quick and reliable EEG montage for the detection of seizures in the intensive care unit, when technical support is not available. Further prospective studies are required to validate these promising results in a larger population sample.

Original languageEnglish (US)
Pages (from-to)100-105
Number of pages6
JournalJournal of Clinical Neurophysiology
Issue number2
StatePublished - Apr 2010
Externally publishedYes


  • Critical care
  • EEG
  • Hairline montage
  • Neurologic intensive care unit
  • Seizures
  • Status epilepticus

ASJC Scopus subject areas

  • Physiology
  • Neurology
  • Clinical Neurology
  • Physiology (medical)


Dive into the research topics of 'A quick and reliable EEG montage for the detection of seizures in the critical care setting'. Together they form a unique fingerprint.

Cite this