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Electronic monitoring of the fetal heart rate during labor (EFM), originally designed to assess fetal stress and allow the early detection of the compromised fetus, has instead led to increasing maternal morbidity without decreasing fetal morbidity. The unintended consequences of this technologic advance have led to the creation of a pseudodisease and unwarranted intervention in response to its detection. Is it ethical to introduce a new technology without adequate assessment of its possible consequences? Are we about to repeat this (error resulting from the introduction of EFM?) There is increasing interest in monitoring the function of the newborn brain, to enable the early detection of subclinical seizures. The monitor may also be used for assessing brain function in older children and adults who are comatose or paralyzed and cannot appropriately respond to stimuli. Use of this amplitude-integrated electroencephalography (aEEG) in the newborn for detection of seizures and other brain abnormalities is not dissimilar to the use of electronic fetal heart rate monitoring. Whether seizures or subclinical seizures themselves cause harm to the developing nervous system is unclear. The effectiveness of medications for treatment of seizures in the newborn has not been established. Therefore, the consequences of introducing automated EEG for the detection of subclinical neonatal seizures are likely to be similar to the results of the introduction of EFM: creation of another pseudodisease, followed by unwarranted intervention, and increased legal liability. What are the ethics of continued approval and introduction of unevaluated technology? What is the wisdom of its use? Beware of the unintended consequences.

The authors debate whether routine EEG is an essential clinical tool for evaluation of a first seizure. One author suggests that because of the positive predictive value of interictal spikes for seizure recurrence, the EEG is a useful tool. The other author argues that since many clinicians would not treat after a single seizure, even if the EEG were abnormal, the EEG is not essential. Both authors agree that the EEG should only be ordered with forethought to answer a specific question.

The "periodic complex" associated with subacute sclerosing leucoencephalitis is highly responsive to alterations in body temperature. At an elevation in body temperature, the complexes progressively decrease in frequency and amplitude and are eventually abolished. A lowering of the body temperature has the opposite effect. Studies of the VER and H reflex at varying temperatures suggest that the changes in the periodic complexes are mediated by alterations in synaptic activity. © 1971.

Despite over 80 years of use, the ketogenic diet (KD) has never been tested in a blinded manner. Twenty children with intractable Lennox-Gastaut syndrome (LGS) were fasted 36  h and then randomized to receive the classic KD in conjunction with a solution containing either 60 g/day of glucose or saccharin. Parents and physicians were blinded to both the solution composition and level of ketosis. A crossover to the KD with the alternate solution occurred following the sixth day and a repeat fast. A 24-h electroencephalography (EEG) was obtained at baseline and after each arm. After administration of the solution, there was moderate evidence of a reduction in parent-reported seizures between the glucose and saccharin arms, with a median difference of 1.5 seizures per day (p = 0.07). There was no reduction in the number of EEG-identified events, with a median reduction of 7 events per day (p = 0.33). Ketosis was not completely eliminated in the glucose-added arm. [ABSTRACT FROM AUTHOR]

The EEG has proven to be a useful tool for investigating specific problems of the CNS of children. It is, however, used too frequently in a search for information that it cannot provide. The profitability of the test has led to a proliferation of machines in neurologists' offices and a consequent increase in the number of unnecessary tests run by uncertified electroencephalographers. Understanding of both the usefulness and the limitations of the EEG and proper interpretation of the results can assist pediatricians in curtailing abuse and in providing care for their patients. INSET: HOW MANY CHILDREN CAN A WOMAN BEAR?. [ABSTRACT FROM AUTHOR]

Comments on a study on the use of sedation for the preparation of children for an electroencephalogram. Behavioral techniques used to decrease the fear of a child; Way to avoid any possible complication; Dosage of chloral hydrate.