The Frequency of Clinical Seizures in Paroxysmal Events in a Neonatal Intensive Care Unit

Chan, Oi-Wa; Chen, Wan-Hsuan; Lin, Jainn-Jim; Chiang, Ming-Chou; Hsia, Shao‐Hsuan; Wang, Huei-Shyong; Lee, En-Pei; Wang, Yishan; Kuo, Cheng-Yen; Lin, Kuang-Lin

doi:10.3390/children9020238

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“…Up to two-thirds of clinical paroxysmal events are either unrecognized or misinterpreted by experienced neonatal staff [ 12 ]. Chan et al reported that only 20% of paroxysmal events in 64 neonates in a neonatal intensive care unit were diagnosed as neonatal seizures on a simultaneous video-EEG recording [ 21 ]. Murray et al also reported that only 27% of the clinically paroxysmal events were confirmed to be neonatal seizures [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…Seizures may also be overdiagnosed by clinical observation, and clinical paroxysmal events may not show corresponding electrographic evidence of seizures [ 17 , 20 , 21 ]. In a study of critically ill neonates, 13% of the neonates who were monitored for paroxysmal events mimicking seizures showed no evidence of electrographic seizures [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

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Electrographic Seizures in Neonates with a High Risk of Encephalopathy

et al. 2022

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Background: Neonatal encephalopathy is caused by a wide variety of acute brain insults in newborns and presents with a spectrum of neurologic dysfunction, such as consciousness disturbance, seizures, and coma. The increased excitability in the neonatal brain appears to be highly susceptible to seizures after a variety of insults, and seizures may be the first clinical sign of a serious neurologic disorder. Subtle seizures are common in the neonatal period, and abnormal clinical paroxysmal events may raise the suspicion of neonatal seizures. Continuous video electroencephalographic (EEG) monitoring is the gold standard for the diagnosis of neonatal seizures. The aim of this study was to identify the prevalence of electrographic seizures and the impact of monitoring in neonates with a high risk of encephalopathy. Methods: We conducted this prospective cohort study in a tertiary neonatal intensive care unit over a 4-year period. Neonates with a high risk of encephalopathy who were receiving continuous video EEG monitoring were eligible. The patients were divided into 2 groups: (1) acute neonatal encephalopathy (ANE) and (2) other high-risk encephalopathy conditions (OHRs). The neonates’ demographic characteristics, etiologies, EEG background feature, presence of electrographic seizures and the impact of monitoring were analyzed. Results: A total of 71 neonates with a high risk of encephalopathy who received continuous video EEG monitoring were enrolled. In this consecutive cohort, 42 (59.2%) were monitored for ANE and 29 (40.8%) were monitored for OHRs. At the time of starting EEG monitoring, 54 (76.1%) of the neonates were term infants. The median gestational age at monitoring was 39 weeks (interquartile range, 37–41 weeks). The median total EEG monitoring duration was 64.7 h (interquartile range, 22.2–72.4 h). Electrographic seizures were captured in 25 of the 71 (35.2%) neonates, of whom 20 (80%) had electrographic-only seizures without clinical correlation. Furthermore, of these 20 neonates, 13 (65%) developed electrographic status epilepticus. Electrographic seizures were most commonly found in the ANE group (17, 40.5%) than in the OHRs group (8, 27.6%) (p = 0.013). Besides, normal/mild abnormality and inactive EEG background were less electrographic seizure than moderate and major abnormality EEG background (2 of 30, 6.7% vs. 23 of 41, 56.1%, p < 0.001). Finally, continuous video EEG monitoring excluded the diagnosis of electrographic seizures in two-thirds of the monitored neonates who had paroxysmal events mimicking seizures and led to a change in clinical management in 39.4% of the neonates. Conclusions: Our findings showed that monitoring could accurately detect seizures, and that it could be used to guide seizure medication management. Therefore, continuous video EEG monitoring has important clinical management implications in neonates with a high risk of encephalopathy.

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Section: Discussionmentioning

confidence: 99%