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Defining the gap between electrographic seizure burden, clinical expression and staff recognition of neonatal seizures
  1. D M Murray1,2,
  2. G B Boylan1,2,
  3. I Ali1,2,
  4. C A Ryan1,2,
  5. B P Murphy1,2,
  6. S Connolly1,2
  1. 1
    Unified Maternity and Neonatal Services, Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
  2. 2
    Department of Clinical Neurophysiology, St Vincent’s University Hospital, Dublin, Ireland
  1. Professor C A Ryan, Cork University Maternity Hospital, Wilton, Cork, Ireland; ryant01{at}eircom.net

Abstract

Background: Neonatal seizures are often subclinical, making accurate diagnosis difficult.

Objective: To describe the clinical manifestations of electrographic seizures recorded on continuous video-EEG, and to compare this description with the recognition of clinical seizures by experienced neonatal staff.

Methods: Term infants, at risk of seizures, were monitored by continuous 12-channel video-EEG from <6 hours of birth for up to 72 hours. All clinical seizures were recorded by experienced neonatal staff on individual seizure charts. Video-EEG recordings were subsequently analysed. The number, duration and clinical expression of electrographic seizures were calculated (in seconds), and compared with the seizures clinically suspected by the neonatal staff.

Results: Of 51 infants enrolled, nine had electrographic seizures. A further three had clinically suspected seizures, without associated electrographic abnormality. Of the total 526 electrographic seizures, 179 (34%) had clinical manifestations evident on the simultaneous video recording. The clinical seizure activity corresponded to 18.8% of the total electrographic seizure burden. Overdiagnosis also occurred frequently. Of the 177 clinically suspected seizure episodes documented by staff, 48 (27%) had corresponding electrographic evidence of seizure activity Thus, only 9% (48/526) of electrographic seizures were accompanied by clinical manifestations, which were identified and documented by neonatal staff.

Conclusion: Only one-third of neonatal EEG seizures displays clinical signs on simultaneous video recordings. Moreover, two-thirds of these clinical manifestations are unrecognised, or misinterpreted by experienced neonatal staff. In the recognition and management of neonatal seizures clinical diagnosis alone is not enough.

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Footnotes

  • Funding: This study was funded by a grant from the Irish Institute of Clinical Neuroscience and an interdisciplinary grant from the Health Research Board of Ireland.

  • Competing interests: None.

  • Ethical approval: Approved by the ethical committee of Cork University Hospital.

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