Monitoring of seizures in the newborn

Shah, Divyen K.; Boylan, Geraldine B.; Rennie, Janet M.

doi:10.1136/adc.2009.169508

Cited by 42 publications

(32 citation statements)

References 32 publications

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“…Excluding patients with status epilepticus, EEG-confirmed seizures conferred a much higher risk of subsequent epilepsy (26%) than clinical seizures (11%). This is congruent with the low correlation between clinical and electrographic signs of neonatal seizures (4). This finding supports the use of electrographic data as the gold standard for diagnosis of neonatal seizures.…”

supporting

confidence: 84%

Neonatal Encephalopathy, MRI Lesions, and Later Epilepsy: No Harm, No Foul?

Staley¹

2012

Epilepsy Curr

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In Clinical Science Commentary Neonatal encephalopathy refers to the clinical manifestations of acute perinatal brain injury, most commonly as a result of a hypoxic-ischemic insult. Neonatal seizures are a potentially treatable manifestation of moderate to severe neonatal encephalopathy and have long been recognized as a risk factor for later developmental deficits (1). The million-dollar question is: are seizures merely a marker for injury severity (2) or do neonatal seizures contribute to the injury (3)? If the latter is true, then seizures should be treated aggressively. However, neonatal seizures can only reliably be identified by electrographic monitoring (4) and are frequently refractory to anticonvulsant treatment (5). Further, there are theoretical reasons to be concerned that some treatment strategies for neonatal seizures could be toxic (6). Experimental anticonvulsant neurotoxicity has only been demonstrated with high dosages, has only been demonstrated acutely, and has only been demonstrated in normal animals rather than injured animals, let alone in animals with repetitive seizures. Nevertheless, the possibility of toxicity makes it all the more important to know whether successful treatment of neonatal seizures actually benefits the patient.

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supporting

confidence: 84%

Neonatal Encephalopathy, MRI Lesions, and Later Epilepsy: No Harm, No Foul?

Staley¹

2012

Epilepsy Curr

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“…The current gold standard for seizure detection is the visual interpretation of conventional multichannel EEG by the human expert 4, 5. EEG seizures are traditionally characterized by the appearance of sudden, repetitive, evolving, and stereotyped waveforms that have a definite beginning, middle, and end and last for at least 10 sec 6.…”

Section: Introductionmentioning

confidence: 99%

Interobserver agreement for neonatal seizure detection using multichannel EEG

Stevenson

Clancy

Vanhatalo

et al. 2015

Ann Clin Transl Neurol

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ObjectiveTo determine the interobserver agreement (IOA) of neonatal seizure detection using the gold standard of conventional, multichannel EEG.MethodsA cohort of full‐term neonates at risk of acute encephalopathy was included in this prospective study. The EEG recordings of these neonates were independently reviewed for seizures by three international experts. The IOA was estimated using statistical measures including Fleiss' kappa and percentage agreement assessed over seizure events (event basis) and seizure duration (temporal basis).ResultsA total of 4066 h of EEG recordings from 70 neonates were reviewed with an average of 2555 seizures detected. The IOA was high with temporal assessment resulting in a kappa of 0.827 (95% CI: 0.769–0.865; n = 70). The median agreement was 83.0% (interquartile range [IQR]: 76.6–89.5%; n = 33) for seizure and 99.7% (IQR: 98.9–99.8%; n = 70) for nonseizure EEG. Analysis of events showed a median agreement of 83.0% (IQR: 72.9–86.6%; n = 33) for seizures with 0.018 disagreements per hour (IQR: 0.000–0.090 per hour; n = 70). Observers were more likely to disagree when a seizure was less than 30 sec. Overall, 33 neonates were diagnosed with seizures and 28 neonates were not, by all three observers. Of the remaining nine neonates with contradictory EEG detections, seven presented with low total seizure burden.InterpretationThe IOA is high among experts for the detection of neonatal seizures using conventional, multichannel EEG. Agreement is reduced when seizures are rare or have short duration. These findings support EEG‐based decision making in the neonatal intensive care unit, inform EEG interpretation guidelines, and provide benchmarks for seizure detection algorithms.

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“…Seizures are defined in both term and preterm infants as clear ictal events consisting of a sudden, repetitive, stereotyped waveform, which has a clear onset and end, a typical evolution in frequency, morphology, and topography, lasting more than 10 s [86,87] . Some differences in the electrographic features have been described between term and preterm infants; seizures are shorter in duration in preterm infants [22,26] , and the interictal period might be longer in duration [22] .…”

Section: Seizuresmentioning

confidence: 99%

EEG - A Valuable Biomarker of Brain Injury in Preterm Infants

Pavlidis¹,

Lloyd²,

Boylan³

2017

Dev Neurosci

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This review focuses on the role of electroencephalography (EEG) in monitoring abnormalities of preterm brain function. EEG features of the most common developmental brain injuries in preterm infants, including intraventricular haemorrhage, periventricular leukomalacia, and perinatal asphyxia, are described. We outline the most common EEG biomarkers associated with these injuries, namely seizures, positive rolandic sharp waves, EEG suppression/increased interburst intervals, mechanical delta brush activity, and other deformed EEG waveforms, asymmetries, and asynchronies. The increasing survival rate of preterm infants, in particular those that are very and extremely preterm, has led to a growing demand for a specific and shared characterization of the patterns related to adverse outcome in this unique population. This review includes abundant high-quality images of the EEG patterns seen in premature infants and will provide a valuable resource for everyone working in developmental neuroscience.

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Monitoring of seizures in the newborn

Cited by 42 publications

References 32 publications

Neonatal Encephalopathy, MRI Lesions, and Later Epilepsy: No Harm, No Foul?

Neonatal Encephalopathy, MRI Lesions, and Later Epilepsy: No Harm, No Foul?

Interobserver agreement for neonatal seizure detection using multichannel EEG

EEG - A Valuable Biomarker of Brain Injury in Preterm Infants

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