Characterisation of Neonatal Seizures and Their Treatment Using Continuous EEG Monitoring: A Multicentre Experience

Arch Dis Child Fetal Neonatal Ed. 2019 Sep;104(5):F493-F501. doi: 10.1136/archdischild-2018-315624. Epub 2018 Nov 24.

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.

Publication types

  • Multicenter Study

MeSH terms

  • Anticonvulsants / therapeutic use
  • Cohort Studies
  • Electroencephalography / methods*
  • Europe / epidemiology
  • Female
  • Humans
  • Hypoxia-Ischemia, Brain* / complications
  • Hypoxia-Ischemia, Brain* / epidemiology
  • Infant, Newborn
  • Infant, Newborn, Diseases* / diagnosis
  • Infant, Newborn, Diseases* / epidemiology
  • Infant, Newborn, Diseases* / etiology
  • Infant, Newborn, Diseases* / therapy
  • Male
  • Metabolism, Inborn Errors* / complications
  • Metabolism, Inborn Errors* / epidemiology
  • Monitoring, Physiologic / methods
  • Neurologic Examination / statistics & numerical data
  • Retrospective Studies
  • Seizures* / diagnosis
  • Seizures* / epidemiology
  • Seizures* / etiology
  • Seizures* / therapy
  • Stroke* / complications
  • Stroke* / epidemiology

Substances

  • Anticonvulsants

Associated data

  • ClinicalTrials.gov/NCT02160171