Electrographic Seizures in Neonates with a High Risk of Encephalopathy
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 seizu...
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MDPI AG
2022-05-01
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| Series: | Children |
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| Online Access: | https://www.mdpi.com/2227-9067/9/6/770 |
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| author | Wan-Hsuan Chen Oi-Wa Chan Jainn-Jim Lin Ming-Chou Chiang Shao-Hsuan Hsia Huei-Shyong Wang En-Pei Lee Yi-Shan Wang Cheng-Yen Kuo Kuang-Lin Lin on the behalf of the iCNS Group |
| author_facet | Wan-Hsuan Chen Oi-Wa Chan Jainn-Jim Lin Ming-Chou Chiang Shao-Hsuan Hsia Huei-Shyong Wang En-Pei Lee Yi-Shan Wang Cheng-Yen Kuo Kuang-Lin Lin on the behalf of the iCNS Group |
| author_sort | Wan-Hsuan Chen |
| collection | DOAJ |
| description | 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%) (<i>p</i> = 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%, <i>p</i> < 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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| spelling | doaj.art-5e6f48868c524a5cbb376fa463c1e5ab2023-11-23T16:04:29ZengMDPI AGChildren2227-90672022-05-019677010.3390/children9060770Electrographic Seizures in Neonates with a High Risk of EncephalopathyWan-Hsuan Chen0Oi-Wa Chan1Jainn-Jim Lin2Ming-Chou Chiang3Shao-Hsuan Hsia4Huei-Shyong Wang5En-Pei Lee6Yi-Shan Wang7Cheng-Yen Kuo8Kuang-Lin Lin9on the behalf of the iCNS Group10Department of Pediatrics, Chiayi Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Chiayi 613, TaiwanDivision of Pediatric Critical Care and Pediatric Neurocritical Care Center, Chang Gung Children’s Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 333, TaiwanDivision of Pediatric Critical Care and Pediatric Neurocritical Care Center, Chang Gung Children’s Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 333, TaiwanDivision of Neonatology, Chang Gung Children’s Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 333, TaiwanDivision of Pediatric Critical Care and Pediatric Neurocritical Care Center, Chang Gung Children’s Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 333, TaiwanDivision of Pediatric Neurology, Chang Gung Children’s Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 333, TaiwanDivision of Pediatric Critical Care and Pediatric Neurocritical Care Center, Chang Gung Children’s Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 333, TaiwanDivision of Pediatric Neurology, Chang Gung Children’s Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 333, TaiwanDivision of Pediatric Neurology, Chang Gung Children’s Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 333, TaiwanDivision of Pediatric Neurology, Chang Gung Children’s Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 333, TaiwanStudy Group for Intensive and Integrated Care of Pediatric Central Nervous System, Department of Pediatrics (iCNS Study Group), Chang Gung Memorial Hospital, Taoyuan 333, TaiwanBackground: 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%) (<i>p</i> = 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%, <i>p</i> < 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.https://www.mdpi.com/2227-9067/9/6/770continuouselectroencephalographic monitoringelectrographic seizureneonatea high risk of encephalopathy |
| spellingShingle | Wan-Hsuan Chen Oi-Wa Chan Jainn-Jim Lin Ming-Chou Chiang Shao-Hsuan Hsia Huei-Shyong Wang En-Pei Lee Yi-Shan Wang Cheng-Yen Kuo Kuang-Lin Lin on the behalf of the iCNS Group Electrographic Seizures in Neonates with a High Risk of Encephalopathy Children continuous electroencephalographic monitoring electrographic seizure neonate a high risk of encephalopathy |
| title | Electrographic Seizures in Neonates with a High Risk of Encephalopathy |
| title_full | Electrographic Seizures in Neonates with a High Risk of Encephalopathy |
| title_fullStr | Electrographic Seizures in Neonates with a High Risk of Encephalopathy |
| title_full_unstemmed | Electrographic Seizures in Neonates with a High Risk of Encephalopathy |
| title_short | Electrographic Seizures in Neonates with a High Risk of Encephalopathy |
| title_sort | electrographic seizures in neonates with a high risk of encephalopathy |
| topic | continuous electroencephalographic monitoring electrographic seizure neonate a high risk of encephalopathy |
| url | https://www.mdpi.com/2227-9067/9/6/770 |
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