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Arch Dis Child Fetal Neonatal Ed. 2018 Nov 24. pii: fetalneonatal-2018-315624. doi: 10.1136/archdischild-2018-315624. [Epub ahead of print]

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

Author information

1
Institute of Women's Health University College London, London, UK.
2
University Medical Center Utrecht, Utrecht, The Netherlands.
3
Department 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
Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.
10
Clinical Neurophysiology, University Medical Center Utrecht, Utrecht, The Netherlands.

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.

KEYWORDS:

EEG; antiepileptic drug; clin neurophysiology; neonatology; seizures

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