The initial step in the evaluation of a neonate with clinical paroxysmal events consists of determining whether the events are normal or abnormal. The distinction may be established by: (1) history; (2) direct observation of the events; (3) observation of conventional EEG, four-channel EEG, or amplitude integrated EEG recordings during the events; (4) interpretation of ictal and non-ictal cerebral single photon emission computed tomography images; (5) evaluation of near infrared spectroscopy studies; or (6) revision of the video-recorded clinical and electroencephalographic events captured by continuous video EEG telemetry.
Continuous video EEG telemetry is the gold standard for the evaluation of clinical paroxysmal. Near infrared spectroscopy is a very promising techniques. Ictal and non-ictal cerebral single photon emission computed tomography is seldom used to distinguish normal from abnormal clinical paroxysmal events.