Neonatal Seizures—Are We there Yet?

Abstract

Neonatal seizures are the most prevalent and distinctive sign of neurologic dysfunction in early life and pose an immense challenge for clinicians. Improvements in neonatal care have increased the survival rate of extremely premature infants, considerably changing the spectrum of underlying etiologies, and instigating a gradual shift from mortality to morbidity. Recognizing neonatal seizures can be challenging due to variability in presentation but clinical features can often provide valuable clues about etiology. Yet, the majority of neonatal seizures are subclinical. Even though conventional electroencephalography (EEG) with simultaneous video detection of seizures still represents the diagnostic gold standard, continuous monitoring using a one- to two-channel amplitude-integrated EEG with concurrent unprocessed EEG can be crucial for early recognition and intervention. Furthermore, tremendous progress has been made in neuroimaging, and all infants with seizures should have a magnetic resonance imaging (MRI) to help identify the underlying etiology. While the majority of neonatal seizures are caused by hypoxic-ischemic events, stroke, hemorrhage, or infection, approximately 15% of patients will require more sophisticated algorithms for diagnostic workup, including metabolic and genetic screening. These recent developments have led to renew interest in the classification of neonatal seizures, which aim to help identify etiology and guide appropriate therapeutic and prognostic decisions. In this review, we outline recent progress made in the etiology, diagnosis, and treatment of neonatal seizures and highlight areas that deserve further research.

Precision Medicine in Neonates: A Tailored Approach to Neonatal Brain Injury

“…However, the majority of neonatal seizures are subclinical. Conventional video EEG and aEEG represents the gold standard for diagnosis, but ~15% of patients will require more sophisticated algorithms for diagnosis, including metabolic and genetic screening ( 110 , 122 , 123 ) ( Figure 2 ). Currently, the standard recommendation is to monitor all neonates at high risk for seizures with long-term video-EEG ( 124 ) and to develop brain-oriented NICUs where neonatologists and pediatric neurologists would collaborate for early diagnosis and ad hoc treatments based on electroclinical phenotypes and etiology ( 125 ).…”

Neonatal Seizures and Purinergic Signalling

“…Furthermore, there is limited evidence of therapies to protect against long-term consequences of neonatal seizures, and as such, current clinical focus is targeting initial neonatal seizure [4,70]. In recent years, with better standard of care and earlier diagnosis for neonates, mortality rates have decreased, yet the levels of later life neurological sequelae remain unchanged [71,72], suggesting that current medications are not tackling this aspect effectively.…”

Advanced Deep Learning Spectroscopy of Scalogram Infused CNN Classifiers for Robust Identification of Post‐Hypoxic Epileptiform EEG Spikes

“…Electroencephalogram (EEG) recordings can provide useful diagnostic and prognostic biomarkers of evolving HI injury. [ 7,8 ] We have previously shown, in preterm fetal sheep EEG recordings, that epileptiform transients such as sharp waves and high‐frequency microscale spike transients in the gamma frequency band (80–120 Hz), superimposed on a suppressed EEG background, are key EEG waveforms and are predictive of neural outcome during the first 6 h of recovery from an HI insult (see Figure ). [ 6,8–11 ] Similar EEG transients are also seen clinically and are associated with adverse neurological outcomes.…”