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      Characterisation of neonatal seizures and their treatment using continuous EEG monitoring: a multicentre experience

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          Abstract

          Objective

          The aim of this multicentre study was to describe detailed characteristics of electrographic seizures in a cohort of neonates monitored with multichannel continuous electroencephalography (cEEG) in 6 European centres.

          Methods

          Neonates of at least 36 weeks of gestation who required cEEG monitoring for clinical concerns were eligible, and were enrolled prospectively over 2 years from June 2013. Additional retrospective data were available from two centres for January 2011 to February 2014. Clinical data and EEGs were reviewed by expert neurophysiologists through a central server.

          Results

          Of 214 neonates who had recordings suitable for analysis, EEG seizures were confirmed in 75 (35%). The most common cause was hypoxic-ischaemic encephalopathy (44/75, 59%), followed by metabolic/genetic disorders (16/75, 21%) and stroke (10/75, 13%). The median number of seizures was 24 (IQR 9–51), and the median maximum hourly seizure burden in minutes per hour (MSB) was 21 min (IQR 11–32), with 21 (28%) having status epilepticus defined as MSB>30 min/hour. MSB developed later in neonates with a metabolic/genetic disorder. Over half (112/214, 52%) of the neonates were given at least one antiepileptic drug (AED) and both overtreatment and undertreatment was evident. When EEG monitoring was ongoing, 27 neonates (19%) with no electrographic seizures received AEDs. Fourteen neonates (19%) who did have electrographic seizures during cEEG monitoring did not receive an AED.

          Conclusions

          Our results show that even with access to cEEG monitoring, neonatal seizures are frequent, difficult to recognise and difficult to treat.

          Oberservation study number

          NCT02160171

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          Most cited references20

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          The American Clinical Neurophysiology Society's Guideline on Continuous Electroencephalography Monitoring in Neonates.

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            Contemporary Profile of Seizures in Neonates: A Prospective Cohort Study

            To determine the contemporary etiology, burden, and short-term outcomes of seizures in neonates monitored with continuous video-electroencephalogram (cEEG).
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              Effect of treatment of subclinical neonatal seizures detected with aEEG: randomized, controlled trial.

              The goals were to investigate how many subclinical seizures in full-term neonates with hypoxic-ischemic encephalopathy (HIE) would be missed without continuous amplitude-integrated electroencephalography (aEEG) and whether immediate treatment of both clinical and subclinical seizures would result in a reduction in the total duration of seizures and a decrease in brain injury, as seen on MRI scans. In this multicenter, randomized, controlled trial, term infants with moderate to severe HIE and subclinical seizures were assigned randomly to either treatment of both clinical seizures and subclinical seizure patterns (group A) or blinding of the aEEG registration and treatment of clinical seizures only (group B). All recordings were reviewed with respect to the duration of seizure patterns and the use of antiepileptic drugs (AEDs). MRI scans were scored for the severity of brain injury. Nineteen infants in group A and 14 infants in group B were available for comparison. The median duration of seizure patterns in group A was 196 minutes, compared with 503 minutes in group B (not statistically significant). No significant differences in the number of AEDs were seen. Five infants in group B received AEDs when no seizure discharges were seen on aEEG traces. Six of 19 infants in group A and 7 of 14 infants in group B died during the neonatal period. A significant correlation between the duration of seizure patterns and the severity of brain injury in the blinded group, as well as in the whole group, was found. In this small group of infants with neonatal HIE and seizures, there was a trend for a reduction in seizure duration when clinical and subclinical seizures were treated. The severity of brain injury seen on MRI scans was associated with a longer duration of seizure patterns.
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                Author and article information

                Journal
                Arch Dis Child Fetal Neonatal Ed
                Arch. Dis. Child. Fetal Neonatal Ed
                fetalneonatal
                fnn
                Archives of Disease in Childhood. Fetal and Neonatal Edition
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                1359-2998
                1468-2052
                September 2019
                24 November 2018
                : 104
                : 5
                : F493-F501
                Affiliations
                [1 ] Institute of Women’s Health University College London , London, UK
                [2 ] University Medical Center Utrecht , Utrecht, The Netherlands
                [3 ] departmentDepartment of Neonatology , Karolinska University Hospital , Stockholm, Sweden
                [4 ] CLINTEC, Karolinska Institute , Solna, Sweden
                [5 ] Rotunda Hospital , Dublin, Ireland
                [6 ] Royal London Hospital , London, UK
                [7 ] Queen Mary University of London , London, UK
                [8 ] Irish Centre for Fetal and Neonatal Translational Research (INFANT) , Cork, Ireland
                [9 ] departmentDepartment of Paediatrics and Child Health , University College Cork , Cork, Ireland
                [10 ] departmentClinical Neurophysiology , University Medical Center Utrecht , Utrecht, The Netherlands
                Author notes
                [Correspondence to ] Professor Geraldine B Boylan, Department of Paediatrics and Child Health, Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland; g.boylan@ 123456ucc.ie
                Author information
                http://orcid.org/0000-0002-7282-8304
                http://orcid.org/0000-0002-2201-9912
                http://orcid.org/0000-0002-2509-4416
                Article
                fetalneonatal-2018-315624
                10.1136/archdischild-2018-315624
                6788873
                30472660
                cd345bf9-25b2-4204-9850-34d623bfd836
                © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

                History
                : 30 May 2018
                : 05 October 2018
                : 12 October 2018
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100004440, Wellcome Trust;
                Funded by: FundRef http://dx.doi.org/10.13039/501100001602, Science Foundation Ireland;
                Categories
                Original Article
                1506
                Custom metadata
                unlocked

                Neonatology
                clin neurophysiology,neonatology,seizures,antiepileptic drug,eeg
                Neonatology
                clin neurophysiology, neonatology, seizures, antiepileptic drug, eeg

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