A decreased seizure burden was seen in neonates with moderate HIE who received cooling. This finding may explain some of the therapeutic benefits of cooling seen in term neonates with moderate HIE.

The study of genome size evolution in a phylogenetic context in related polyploid and diploid lineages can help us to understand the advantages and disadvantages of genome size changes and their effect on diversification. Here, we contribute 199 new DNA sequences and a nearly threefold increase in genome size estimates in polyploid and diploid Veronica (Plantaginaceae) (to 128 species, c. 30% of the genus) to provide a comprehensive baseline to explore the effect of genome size changes. We reconstructed internal transcribed spacer (ITS) and trnL‐trnL‐trnF phylogenetic trees and performed phylogenetic generalized least squares (PGLS), ancestral character state reconstruction, molecular dating and diversification analyses. Veronica 1C‐values range from 0.26 to 3.19 pg. Life history is significantly correlated with 1C‐value, whereas ploidy and chromosome number are strongly correlated with both 1C‐ and 1Cx‐values. The estimated ancestral Veronica 1Cx‐value is 0.65 pg, with significant genome downsizing in the polyploid Southern Hemisphere subgenus Pseudoveronica and two Northern Hemisphere subgenera, and significant genome upsizing in two diploid subgenera. These genomic downsizing events are accompanied by increased diversification rates, but a ‘core shift’ was only detected in the rate of subgenus Pseudoveronica. Polyploidy is important in the evolution of the genus, and a link between genome downsizing and polyploid diversification and species radiations is hypothesized. © 2015 The Linnean Society of London, Botanical Journal of the Linnean Society, 2015, 178, 243–266.

HighlightsSeizure detection algorithm (SDA) validated on unseen, unedited EEG of 70 neonates.Results at SDA sensitivity settings of 0.5–0.3 acceptable for clinical use.Seizure detection rate of 52.6–75.0%, false detection rate 0.04–0.36 FD/h.

BackgroundStroke is the second most common cause of seizures in term neonates and is associated with abnormal long-term neurodevelopmental outcome in some cases.ObjectiveTo aid diagnosis earlier in the postnatal period, our aim was to describe the characteristic EEG patterns in term neonates with perinatal arterial ischaemic stroke (PAIS) seizures.DesignRetrospective observational study.PatientsNeonates >37 weeks born between 2003 and 2011 in two hospitals.MethodContinuous multichannel video-EEG was used to analyze the background patterns and characteristics of seizures. Each EEG was assessed for continuity, symmetry, characteristic features and sleep cycling; morphology of electrographic seizures was also examined. Each seizure was categorized as electrographic-only or electroclinical; the percentage of seizure events for each seizure type was also summarized.ResultsNine neonates with PAIS seizures and EEG monitoring were identified. While EEG continuity was present in all cases, the background pattern showed suppression over the infarcted side; this was quite marked (>50% amplitude reduction) when the lesion was large. Characteristic unilateral bursts of theta activity with sharp or spike waves intermixed were seen in all cases. Sleep cycling was generally present but was more disturbed over the infarcted side. Seizures demonstrated a characteristic pattern; focal sharp waves/spike-polyspikes were seen at frequency of 1–2 Hz and phase reversal over the central region was common. Electrographic-only seizure events were more frequent compared to electroclinical seizure events (78 vs 22%).ConclusionsFocal electrographic and electroclinical seizures with ipsilateral suppression of the background activity and focal sharp waves are strong indicators of PAIS. Approximately 80% of seizure events were the result of clinically unsuspected seizures in neonates with PAIS. Prolonged and continuous multichannel video-EEG monitoring is advocated for adequate seizure surveillance.

More than half of the children surveyed had used some form of CAM, usually without their Paediatrician's knowledge.

HighlightsA novel method for in-depth analysis of neonatal seizure detection algorithms is proposed.The analysis estimated how seizure features are exploited by automated detectors.This method led to significant improvement of the ANSeR algorithm.

Perinatal stroke is the second most common cause of neonatal seizures, and can result in long-term neurological impairment. Diagnosis is often delayed until after seizure onset, owing to the subtle nature of associated signs. We report the early electroencephalographic (EEG) findings in a female infant with a perinatal infarction, born at 41 weeks 2 days and weighing 3.42kg. Before the onset of seizures, the EEG from 3 hours after delivery demonstrated occasional focal sharp waves over the affected region. After electroclinical seizures, focal sharp waves became more frequent, complex, and of higher amplitude, particularly in 'quiet sleep'. In 'active sleep', sharp waves often disappeared. Diffusion-weighted imaging confirmed the infarct, demonstrating left frontal and parietal diffusion restriction. At 9 months, the infant has had no further seizures, and neurological examination is normal. To our knowledge, this report is the first to describe the EEG findings in perinatal stroke before seizures, and highlights the evolution of characteristic background EEG features.Perinatal stroke is an important cause of long-term neurological morbidity, 1 and the second most common cause of seizures in the newborn period, accounting for 12 to 18% of all neonatal seizures.2,3 Most infants who suffer a stroke are well after delivery, and come to attention when they develop clinical seizure activity.2 Therefore, electroencephalography (EEG) is generally performed only after presentation with seizures. EEG can monitor ongoing seizure activity, aid diagnosis, and predict outcome. 4 The EEG features associated with neonatal stroke have been described only peri-or postictally. The early EEG changes that occur before the onset of clinical seizures in neonatal stroke are unknown. We present the early clinical and EEG findings from 3 hours after delivery in a term infant with a middle cerebral artery infarct who progressed to seizures at 33 hours post delivery. Parental informed consent was obtained for publication of this case report. CASE REPORTA female infant was born at 41 weeks 2 days to a 34-year-old mother whose pregnancy had been uneventful. The antenatal fetal heart rate and variability were normal. The infant was delivered by ventouse owing to failure to progress. Meconium was present at delivery, and the airway was intubated and aspirated. Positive-pressure ventilation was required for 2 minutes. The heart rate remained over 100 beats per minute throughout. The Apgar scores were 3 at 1 minute and 6 at 5 minutes. The arterial cord pH was 7.27, with a base excess of )7.6mEq ⁄ L and bicarbonate of 19.3mmol ⁄ L.The infant was admitted to the neonatal unit with mild tachypnoea requiring 30% fractional inspired oxygen (F i O 2 ) for 6 hours. A chest radiograph was consistent with mild meconium aspiration, and neurological examination at this time was normal. As part of an ongoing research study, continuous digital video EEG began at 3 hours post delivery.The infant stabilized quickly, and at 18 hours post-delivery EEG was disco...

Background: Phenobarbitone is the most common first-line anti-seizure drug and is effective in approximately 50% of all neonatal seizures. Objective: To describe the response of electrographic seizures to the administration of intravenous phenobarbitone in neonates using seizure burden analysis techniques. Methods: Multi-channel conventional EEG, reviewed by experts, was used to determine the electrographic seizure burden in hourly epochs. The maximum seizure burden evaluated 1 h before each phenobarbitone dose (T_-1) was compared to seizure burden in periods of increasing duration after each phenobarbitone dose had been administered (T₊₁, T₊₂ to seizure offset). Differences were analysed using linear mixed models and summarized as means and 95% CI. Results: Nineteen neonates had electrographic seizures and met the inclusion criteria for the study. Thirty-one doses were studied. The maximum seizure burden was significantly reduced 1 h after the administration of phenobarbitone (T₊₁) [-14.0 min/h (95% CI: -19.6, -8.5); p < 0.001]. The percentage reduction was 74% (IQR: 36-100). This reduction was temporary and not significant within 4 h of administrating phenobarbitone. Subgroup analysis showed that only phenobarbitone doses at 20 mg/kg resulted in a significant reduction in the maximum seizure burden from T_-1 to T₊₁ (p = 0.002). Conclusions: Phenobarbitone significantly reduced seizures within 1 h of administration as assessed with continuous multi-channel EEG monitoring in neonates. The reduction was not permanent and seizures were likely to return within 4 h of treatment.