Clinical Significance of Focal Periodic Discharges in Neonates

Scher, Mark S.; Beggarly, Marquita E.

doi:10.1177/088307388900400303

Cited by 53 publications

(13 citation statements)

References 40 publications

(19 reference statements)

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“…2, 1993 Although the EEG has been emphasized as the means by which seizures are diagnosed (Mizrahi and Kellaway, 1987;, Shewmon, 1990) emphasizes the problems in defining an electrographic seizure by surface-EEG recordings. Shewmon (1990) suggested that the arbitrary duration of 10 s does not allow consideration of brief intermittent rhythmic discharges (BIRDS) or prolonged periodic discharges as ictal phenomena (Scher and Beggarly, 1989).…”

Section: Discussionmentioning

confidence: 99%

“…Average seizure duration was calculated based on averages for each of the three age groups of neonates. Brief, intermittent, rhythmic discharges (i.e., BIRDS) (Shewmon, 1990) or prolonged periodic discharges (Scher and Beggarly, 1989) were not included in this classification. Each EEG recording was visually analyzed by two of the authors (M.S.S.…”

Section: Eeg Seizure Definitionmentioning

confidence: 99%

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Ictal and Interictal Electrographic Seizure Durations in Preterm and Term Neonates

Scher¹,

Hamid²,

Steppe³

et al. 1993

Epilepsia

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170

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The effect of gestational age on neonatal ictal and interictal durations has not been investigated. Sixty-eight neonates with 644 electrographic seizures were identified retrospectively. Thirty-five full-term (FT) neonates were compared with 33 preterm (PT) neonates. Eighteen older preterm infants (OPT) [> 31 weeks estimated gestational age (EGA)] were also compared with 15 young preterm infants (YPT) of < or = 31 weeks EGA. Ictal/interictal durations were calculated for the total cohort with and without status epilepticus (SE). Statistical analyses were two-tailed t tests, chi-square calculations, and one-way analysis of variance (ANOVA) with Duncan's multiple-range test. Eleven of 35 (33%) FT had SE as compared with 3 of 33 (9%) PT (chi-square = 7.8, p < 0.05). The mean ictal duration was 14.2 min for FT infants as compared with 3.1 min for PT infants (p < 0.01); only borderline differences were noted after those with SE were excluded. Interictal durations were longer for OPT than YPT (p < 0.05). By ANOVA and Duncan's multiple-range tests, group differences included longer mean ictal durations for FT infants as compared with OPT infants (p = 0.06, ANOVA; p < 0.05, Duncan's), and longer mean interictal durations for FT infants versus OPT and OPT versus YPT (p = 0.02, ANOVA; p < 0.05, Duncan's). More developed neuronal networks result in longer ictal durations in FT than in PT neonates, including FT infants with SE.(ABSTRACT TRUNCATED AT 250 WORDS)

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Section: Discussionmentioning

confidence: 99%

Section: Eeg Seizure Definitionmentioning

confidence: 99%

Ictal and Interictal Electrographic Seizure Durations in Preterm and Term Neonates

Scher¹,

Hamid²,

Steppe³

et al. 1993

Epilepsia

Self Cite

170

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“…The presence of asymmetrical EEG abnormalities has been associated with focal structural brain lesions such as stroke in children. 5,6,23,24,[43][44][45] However, asymmetrical EEG abnormalities with HIE 23,44 and transient asymmetries of the background in healthy term neonates 45,46 have also been reported.…”

Section: Discussionmentioning

confidence: 99%

Predictive Value of Clinical and EEG Features in the Diagnosis of Stroke and Hypoxic Ischemic Encephalopathy in Neonates With Seizures

Rafay

Cortez

Veber

et al. 2009

Stroke

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Background and Purpose-In neonates, the differentiation of stroke and hypoxic ischemic encephalopathy (HIE) is important. Neuroimaging presents technical challenges in unstable neonates, resulting in frequently delayed or missed diagnosis of stroke. Differentiating clinical and electroencephalographic (EEG) features would assist physicians in the timely diagnosis. We sought to determine, in neonates with seizures, clinical and EEG features that differentiate stroke and HIE. Methods-Retrospective cohort study comparing clinical, seizure, and EEG features in term neonates with ischemic stroke or HIE and seizures within 7 days after birth, admitted at The Hospital for Sick Children. Putative clinical and EEG predictors of stroke were analyzed with univariate and multivariate methods. Results-Sixty-two newborns with stroke (nϭ27) or HIE (nϭ35) were studied. With univariate analysis, predictors of stroke included delayed seizure onset (Ն12-hours after birth) (PϽ0. Key Words: acute care Ⅲ EEG Ⅲ hypoxix ischemic encephelopathy Ⅲ predictors of diagnosis Ⅲ cereberal infarction Ⅲ neonates S eizures occurring in the neonatal period may be the manifestation of a serious underlying brain insult. The etiologic diagnosis of neonatal seizures is necessary to permit accurate decisions regarding management and prognosis. The incidence of seizures in neonates ranges from 0.15% to 3.5%, with most occurring within the first week of life. 1-3 Although neonatal seizures can result from transient metabolic derangements such as hypoglycemia or hypocalcaemia, hypoxic ischemic encephalopathy (HIE) accounts for as many as 60% to 65% 4 and ischemic stroke for 12% to 20%. 5,11,12 Stroke is frequently misdiagnosed as HIE because of overlapping clinical features. 9,10 In neonates with stroke, seizures are the only manifestation in 70% to 91% 1-5 and hemiparesis is uncommon (20%). 13 Generalized neurological abnormalities including encephalopathy can be present in both HIE and stroke. The prognosis and clinical management of neonatal stroke and HIE are very different. 6 -12 Early identification of these conditions maximizes opportunities for disease specific management strategies. The current approach for differentiating neonatal stroke and HIE relies on neuroimaging. Neuroimaging, however, is not straightforward in neonates who, when unstable, can be difficult to safely transport and image with CT (computed tomogram) and preferably MRI. 13,19 In neonates, cranial ultrasound is a useful noninvasive easily accessible intervention for the evaluation of both HIE and focal brain lesions such as stroke. However, it may not accurately diagnose stroke. 15,16 In addition, an early CT and MRI without diffusion may be normal in neonates with ischemic injury. 20 Electroencephalograph (EEG) is often the first diagnostic tool used to evaluate seizures, howeve, the utility of clinical seizure and EEG features in ascertaining the cause for neonatal seizures is not well established. Study Design and MethodsTerm neonates with clinical seizures and a diagnosi...

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“…A definitive causal link between the characteristics of the neonatal EEG and the subsequent neurological outcome is difficult to establish in humans. Thus it is unclear whether acute neonatal seizures are causes of, or merely symptoms of, other processes that lead to a negative outcome, making it difficult to gauge the necessity and efficacy of early clinical interventions to suppress seizures during the critical "subacute" period after neonatal insults (Monod et al 1972;Tharp et al 1981;Scher and Beggarly 1989;Williams et al 1992;Holmes and Lombroso 1993;Murray et al 2009;Korotchikova et al 2011;Walsh et al 2011). Furthermore, other events besides seizures, such as background abnormalities in the EEG, have been proposed to be better predictors of outcome (Monod et al 1972;Tharp et al 1981;Watanabe et al 1980Watanabe et al , 1982bHolmes and Lombroso 1993), but well-designed prospective studies on the neonatal EEG are limited.…”

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confidence: 99%

Ischemic injury suppresses hypoxia-induced electrographic seizures and the background EEG in a rat model of perinatal hypoxic-ischemic encephalopathy

Zayachkivsky

Lehmkuhle

Ekstrand

et al. 2015

Journal of Neurophysiology

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Zayachkivsky A, Lehmkuhle MJ, Ekstrand JJ, Dudek FE. Ischemic injury suppresses hypoxia-induced electrographic seizures and the background EEG in a rat model of perinatal hypoxic-ischemic encephalopathy. J Neurophysiol 114: 2753-2763, 2015. First published September 9, 2015 doi:10.1152/jn.00796.2014.-The relationship among neonatal seizures, abnormalities of the electroencephalogram (EEG), brain injury, and long-term neurological outcome (e.g., epilepsy) remains controversial. The effects of hypoxia alone (Ha) and hypoxia-ischemia (HI) were studied in neonatal rats at postnatal day 7; both models generate EEG seizures during the 2-h hypoxia treatment, but only HI causes an infarct with severe neuronal degeneration. Single-channel, differential recordings of acute EEG seizures and background suppression were recorded with a novel miniature telemetry device during the hypoxia treatment and analyzed quantitatively. The waveforms of electrographic seizures (and their behavioral correlates) appeared virtually identical in both models and were identified as discrete events with high power in the traditional delta (0.1-4 Hz) and/or alpha (8 -12 Hz) bands. Although the EEG patterns during seizures were similar in Ha-and HI-treated animals at the beginning of the hypoxic insult, Ha caused a more severe electrographic seizure profile than HI near the end. Analyses of power spectral density and seizure frequency profiles indicated that the electrographic seizures progressively increased during the 2-h Ha treatment, while HI led to a progressive decrease in the seizures with significant suppression of the EEG background. These data show that 1) the hypoxia component of these two models drives the seizures; 2) the seizures during Ha are substantially more robust than those during HI, possibly because ongoing neuronal damage blunts the electrographic activity; and 3) a progressive decrease in background EEG, rather than the presence of electrographic seizures, indicates neuronal degeneration during perinatal HI.EEG; hypoxia-ischemia; neonatal; stroke; seizure SEIZURES ARE RELATIVELY COMMON in neonates and are a potential harbinger of intractable epilepsy, cerebral palsy, cognitive deficits, and other negative neurological outcomes. Prolonged periods of hypoxia alone (Ha; e.g., birth asphyxia or apnea) or hypoxia-ischemia (HI; e.g., perinatal stroke) are thought to be a major cause of neonatal seizures, but metabolic disturbances, encephalitis, and genetic abnormalities can also lead to seizures in neonates (Sarnat and Sarnat 1976;Finer et al. 1981; Watanabe et al. 1982a,b;Corey et al. 1988;Mercuri et al. 1999;Marin-Padilla 2000;Nelson and Lynch 2004;Malm 2009;Sorge and Sorge 2010). Although considerable EEG data are available on neonatal seizures, their predictive value is poor because outcomes range from benign to devastating. A definitive causal link between the characteristics of the neonatal EEG and the subsequent neurological outcome is difficult to establish in humans. Thus it is unclear whether acute neonatal seizures ...

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Clinical Significance of Focal Periodic Discharges in Neonates

Cited by 53 publications

References 40 publications

Ictal and Interictal Electrographic Seizure Durations in Preterm and Term Neonates

Ictal and Interictal Electrographic Seizure Durations in Preterm and Term Neonates

Predictive Value of Clinical and EEG Features in the Diagnosis of Stroke and Hypoxic Ischemic Encephalopathy in Neonates With Seizures

Ischemic injury suppresses hypoxia-induced electrographic seizures and the background EEG in a rat model of perinatal hypoxic-ischemic encephalopathy

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