The probability of seizures during continuous EEG monitoring in high‐risk neonates

Worden, Lila; Chinappen, Dhinakaran M.; Stoyell, Sally M.; Gold, Jacquelyn; Paixao, Luis; Krishnamoorthy, Kalpathy S.; Kramer, Mark A.; Westover, M. Brandon; Chu, Catherine J.

doi:10.1111/epi.16387

Cited by 17 publications

(16 citation statements)

References 51 publications

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“…However, this notion is not, at present, provable or disprovable. Studies have shown that the most of clinical‐only events are not of epileptic origin 9,15 and that in epileptic seizures an electrographic ictal pattern will become apparent during more prolonged EEG monitoring 16,47 . Polygraphic video‐EEG can help to evaluate any manifestations in question such as autonomic features or automatisms and decrease the risk of over‐diagnosing of common nonseizure events as epileptic 9,15,48,49 …”

Section: Classificationmentioning

confidence: 99%

The ILAE classification of seizures and the epilepsies: Modification for seizures in the neonate. Position paper by the ILAE Task Force on Neonatal Seizures

et al. 2021

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Seizures are the most common neurological emergency in the neonatal period and in contrast to those in infancy and childhood, are often provoked seizures with an acute cause and may be electrographic‐only. Hence, neonatal seizures may not fit easily into classification schemes for seizures and epilepsies primarily developed for older children and adults. A Neonatal Seizures Task Force was established by the International League Against Epilepsy (ILAE) to develop a modification of the 2017 ILAE Classification of Seizures and Epilepsies, relevant to neonates. The neonatal classification framework emphasizes the role of electroencephalography (EEG) in the diagnosis of seizures in the neonate and includes a classification of seizure types relevant to this age group. The seizure type is determined by the predominant clinical feature. Many neonatal seizures are electrographic‐only with no evident clinical features; therefore, these are included in the proposed classification. Clinical events without an EEG correlate are not included. Because seizures in the neonatal period have been shown to have a focal onset, a division into focal and generalized is unnecessary. Seizures can have a motor (automatisms, clonic, epileptic spasms, myoclonic, tonic), non‐motor (autonomic, behavior arrest), or sequential presentation. The classification allows the user to choose the level of detail when classifying seizures in this age group.

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Section: Classificationmentioning

confidence: 99%

The ILAE classification of seizures and the epilepsies: Modification for seizures in the neonate. Position paper by the ILAE Task Force on Neonatal Seizures

et al. 2021

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“…As most neonatal seizures are subclinical and many abnormal movements are not seizures, 8 research using EEG diagnosis of neonatal seizures is necessary. Recent studies of epilepsy after neonatal seizures included EEG diagnosis of neonatal seizures; however, these often relied upon single center cohorts, or focused solely on neonates with hypoxic‐ischemic encephalopathy 9–12 . Some forms of post‐neonatal epilepsy, e.g.…”

Section: Introductionmentioning

confidence: 99%

Early‐life epilepsy after acute symptomatic neonatal seizures: A prospective multicenter study

et al. 2021

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Objective We aimed to evaluate early‐life epilepsy incidence, seizure types, severity, risk factors, and treatments among survivors of acute neonatal seizures. Methods Neonates with acute symptomatic seizures born 7/2015‐3/2018 were prospectively enrolled at nine Neonatal Seizure Registry sites. One‐hour EEG was recorded at age three months. Post‐neonatal epilepsy and functional development (Warner Initial Developmental Evaluation of Adaptive and Functional Skills – WIDEA‐FS) were assessed. Cox regression was used to assess epilepsy‐free survival. Results Among 282 infants, 37 (13%) had post‐neonatal epilepsy by 24‐months [median age of onset 7‐months (IQR 3–14)]. Among those with post‐neonatal epilepsy, 13/37 (35%) had infantile spasms and 12/37 (32%) had drug‐resistant epilepsy. Most children with post‐neonatal epilepsy had abnormal neurodevelopment at 24‐months (WIDEA‐FS >2SD below normal population mean for 81% of children with epilepsy vs 27% without epilepsy, RR 7.9, 95% CI 3.6–17.3). Infants with severely abnormal neonatal EEG background patterns were more likely to develop epilepsy than those with mild/moderate abnormalities (HR 3.7, 95% CI 1.9–5.9). Neonatal EEG with ≥3 days of seizures also predicted hazard of epilepsy (HR 2.9, 95% CI 1.4–5.9). In an adjusted model, days of neonatal EEG‐confirmed seizures (HR 1.4 per day, 95% CI 1.2–1.6) and abnormal discharge examination (HR 3.9, 95% CI 1.9–7.8) were independently associated with time to epilepsy onset. Abnormal (vs. normal) three‐month EEG was not associated with epilepsy. Significance In this multicenter study, only 13% of infants with acute symptomatic neonatal seizures developed post‐neonatal epilepsy by age 24‐months. However, there was a high risk of severe neurodevelopmental impairment and drug‐resistant seizures among children with post‐neonatal epilepsy. Days of EEG‐confirmed neonatal seizures was a potentially modifiable epilepsy risk factor. An EEG at three months was not clinically useful for predicting epilepsy. These practice changing findings have implications for family counseling, clinical follow‐up planning, and future research to prevent post‐neonatal epilepsy.

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“…For this reason, some centers have developed pathways to employ cEEG for seizure detection among all neonates in high-risk groups, such as those with hypoxic-ischemic encephalopathy or other conditions. 12 Similarly, the American Clinical Neurophysiology Society has published guidelines for clinical conditions in which cEEG is indicated due to a high risk of seizures. 2 The American Academy of Pediatrics has suggested that centers providing therapeutic hypothermia to neonates with hypoxic-ischemic encephalopathy should also have the ability to provide cEEG or amplitude integrated EEG monitoring for seizure detection.…”

Section: Discussionmentioning

confidence: 99%

Seizure Control in Neonates Undergoing Screening vs Confirmatory EEG Monitoring

et al. 2021

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Objective:To determine whether screening continuous EEG monitoring (cEEG) is associated with greater odds of treatment success for neonatal seizures.Methods:We included term neonates with acute symptomatic seizures enrolled in the Neonatal Seizure Registry (NSR), a prospective, multicenter cohort of neonates with seizures. We compared two cEEG approaches: (1) Screening cEEG, initiated for indications of encephalopathy or paralysis without suspected clinical seizures, and (2) Confirmatory cEEG, initiated for the indication of clinical events suspicious for seizures, either alone or in addition to other indications. The primary outcome was successful response to initial seizure treatment, defined as seizures resolved without recurrence within 30 minutes after initial loading dose of anti-seizure medicine. Multivariable logistic regression analyses assessed the association between cEEG approach and successful seizure treatment.Results:Among 514 neonates included, 161 (31%) had screening cEEG and 353 (69%) had confirmatory cEEG. Neonates with screening cEEG had a higher proportion of successful initial seizure treatment than neonates with confirmatory cEEG (39% versus 18%; p<0.0001). After adjusting for covariates, there remained a greater odds ratio (OR) for successful initial seizure treatment in the screening vs. confirmatory cEEG groups (adjusted OR 2.44, 95% CI: 1.45-4.11, p=0.0008).Conclusions:These findings provide evidence from a large, contemporary cohort of neonates that a screening cEEG approach may improve odds of successful treatment of acute seizures.Classification of Evidence:This study provides Class III evidence that for neonates a screening CEEG approach, compared to a confirmatory EEG approach, increases the probability of successful treatment of acute seizures

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The probability of seizures during continuous EEG monitoring in high‐risk neonates

Cited by 17 publications

References 51 publications

The ILAE classification of seizures and the epilepsies: Modification for seizures in the neonate. Position paper by the ILAE Task Force on Neonatal Seizures

The ILAE classification of seizures and the epilepsies: Modification for seizures in the neonate. Position paper by the ILAE Task Force on Neonatal Seizures

Early‐life epilepsy after acute symptomatic neonatal seizures: A prospective multicenter study

Seizure Control in Neonates Undergoing Screening vs Confirmatory EEG Monitoring

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