Consensus protocol for EEG and amplitude-integrated EEG assessment and monitoring in neonates

Dilena, Robertino; Raviglione, Federico; Cantalupo, Gaetano; Cordelli, Duccio Maria; Liso, Paola De; Capua, M. Di; Falsaperla, Raffaele; Ferrari, Fabrizio; Fumagalli, Monica; Lori, S.; Suppiej, Agnese; Tadini, L.; Bernardina, Bernardo Dalla; Mastrangelo, Massimo; Pisani, Francesco

doi:10.1016/j.clinph.2021.01.012

Cited by 28 publications

(17 citation statements)

References 95 publications

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“…Recorded seizures were mainly electrographic-only type, which is known to be very common in critically ill neonates with many kinds of acute encephalopathy. This finding makes amplitude EEG or continuous video-EEG monitoring essential to ensure good diagnostic accuracy ( 8 ). Furthermore, there is increasing evidence suggesting that monitoring and early seizure treatment for neonates with intracranial AVSs could lead to improved neurodevelopmental outcomes ( 13 ).…”

Section: Discussionmentioning

confidence: 99%

“…In our NICU, all infants with intracranial AVs are monitored with amplitude-integrated electroencephalogram (aEEG) in the first 48–72 h. Video-electroencephalogram (EEG) recordings were performed using the 10–20 international system for scalp electrode placement. Electrocardiogram (EKG), pneumogram, and electromyogram (usually two deltoids) were also recorded ( 8 ). Furthermore, standard non-invasive neurophysiological tests were performed, assessing the functional integrity of deep brain structures and cortical areas which can be selectively vulnerable in these patients.…”

Section: Methodsmentioning

confidence: 99%

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Neurodevelopmental and genetic findings in neonates with intracranial arteriovenous shunts: A case series

et al. 2023

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BackgroundDespite the latest advances in prenatal diagnosis and postnatal embolization procedures, intracranial arteriovenous shunts (AVSs) are still associated with high mortality and morbidity rates. Our aim was to evaluate the presentation and clinical course, the neurodevelopmental outcome, and the genetic findings of neonates with AVSs.MethodsIn this retrospective observational study, medical records of neonates with cerebral AVSs admitted to our hospital from January 2020 to July 2022 were revised. In particular, we evaluated neuroimaging characteristics, endovascular treatment, neurophysiological features, neurodevelopmental outcomes, and genetic findings.ResultsWe described the characteristics of 11 patients with AVSs. Ten infants (90.9%) required embolization during the first three months of life. In 5/9 infants, pathological electroencephalography findings were observed; of them, two patients presented seizures. Eight patients performed Median Nerve Somatosensory Evoked Potentials (MN-SEPs): of them, six had an impaired response. We found normal responses at Visual Evoked Potentials and Brainstem Auditory Evoked Potentials. Eight patients survived (72.7%) and were enrolled in our multidisciplinary follow-up program. Of them, 7/8 completed the Bayley-III Scales at 6 months of corrected age: none of them had cognitive and language delays; conversely, a patient had a moderate delay on the Motor scale. The remaining survivor patient developed cerebral palsy and could not undergo Bayley-III evaluation because of the severe psychomotor delay. From the genetic point of view, we found a novel pathogenic variant in the NOTCH3 gene and three additional genomic defects of uncertain pathogenicity.ConclusionWe propose SEPs as an ancillary test to discern the most vulnerable infants at the bedside, particularly to identify possible future motor impairment in follow-up. The early identification of a cognitive or motor delay is critical to intervene with personalized rehabilitation treatment and minimize future impairment promptly. Furthermore, the correct interpretation of identified genetic variants could provide useful information, but further studies are needed to investigate the role of these variants in the pathogenesis of AVSs.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Neurodevelopmental and genetic findings in neonates with intracranial arteriovenous shunts: A case series

et al. 2023

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“…Nowadays, the distinction between genetic neonatal-onset epilepsy and provoked seizures could be performed very early (8). The role of neurophysiological evaluation and monitoring by conventional EEG and aEEG has become crucial in clinical practice (17). The recognition of a typical sequential seizure pattern with a prominent tonic onset on video-EEG in a neonate without structural brain damage or acute etiology is an accessible and reliable marker of genetic epilepsy due to KCNQ2/KCNQ3/SCN2A channelopathies, allowing for a tailored diagnostic workup and early targeted effective treatment (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14).…”

Section: Discussionmentioning

confidence: 99%

Case Report: Effect of Targeted Therapy With Carbamazepine in KCNQ2 Neonatal Epilepsy

et al. 2022

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We present a family case of neonatal-onset KCNQ2-related epilepsy due to a novel intronic mutation. Three members of an Italian family (father and offspring) presented with neonatal-onset asymmetric tonic and clonic seizures with peculiar video-electroencephalography and aEEG features referring to sequential seizures. The father and the first son underwent standard of care treatments in line with current neonatal intensive care unit protocols, with a prolonged hospitalization before reaching full seizure control with carbamazepine. After the experience acquired with her family and the latest advances in the literature, the younger daughter was directly treated with carbamazepine, obtaining rapid seizure control and short hospitalization. They all had normal development. Carbamazepine is rarely administered as a first-line option in neonatal seizures. Recent evidence suggests that neonatal intensive care unit protocols should implement a trial with sodium channel blockers such as carbamazepine as first-option anti-seizure medication and a fast access to genetic testing in neonates with sequential seizures without structural brain injury or acute causes. Moreover, we report and discuss the laboratory studies performed on a novel causative intronic mutation in KCNQ2 (c.1525+5 G>A in IVS13), since pathogenicity may be difficult to prove for intronic variants.

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“…Standardization of amplitude‐integrated and conventional EEG acquisition is required to increase comparability across future studies and establish and implement normative neonatal quantitative EEG ranges where gestational age, PCA, age, drug exposure, sex, and vigilance states are taken into account. Bearing in mind current clinical practice guidelines that recommend the use of 8 to 12 electrodes 66 and limitations regarding EEG set‐ups within neonatal care units, we believe that, if possible, at least 21 electrodes should be used for a conventional EEG set‐up for research purposes because high‐density EEGs are needed for sufficient spatial resolution due to the high conductivity of the neonatal skull 67 . Registration length should cover a total sleep cycle with active and quiet sleep periods.…”

Section: Discussionmentioning

confidence: 99%

Neonatal quantitative electroencephalography and long‐term outcomes: a systematic review

Westende

Geraedts

Ramesdonk

et al. 2021

Develop Med Child Neuro

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To evaluate quantitative electroencephalogram (EEG) measures as predictors of longterm neurodevelopmental outcome in infants with a postconceptional age below 46 weeks, including typically developing infants born at term, infants with heterogeneous underlying pathologies, and infants born preterm.METHOD A comprehensive search was performed using PubMed, Embase, and Web of Science from study inception up to 8th January 2021. Studies that examined associations between neonatal quantitative EEG measures, based on conventional and amplitudeintegrated EEG, and standardized neurodevelopmental outcomes at 2 years of age or older were reviewed. Significant associations between neonatal quantitative EEG and long-term outcome measures were grouped into one or more of the following categories: cognitive outcome; motor outcome; composite scores; and other standardized outcome assessments. RESULTSTwenty-four out of 1740 studies were included. Multiple studies showed that conventional EEG-based absolute power in the delta, theta, alpha, and beta frequency bands and conventional and amplitude-integrated EEG-related amplitudes were positively associated with favourable long-term outcome across several domains, including cognition and motor performance. Furthermore, a lower presence of discontinuous background pattern was also associated with favourable outcomes. However, interpretation of the results is limited by heterogeneity in study design and populations.

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Consensus protocol for EEG and amplitude-integrated EEG assessment and monitoring in neonates

Cited by 28 publications

References 95 publications

Neurodevelopmental and genetic findings in neonates with intracranial arteriovenous shunts: A case series

Neurodevelopmental and genetic findings in neonates with intracranial arteriovenous shunts: A case series

Case Report: Effect of Targeted Therapy With Carbamazepine in KCNQ2 Neonatal Epilepsy

Neonatal quantitative electroencephalography and long‐term outcomes: a systematic review

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