Article Text

other Versions

PDF
Defining the gap between electrographic seizure burden, clinical expression, and staff recognition of neonatal seizures
  1. Deirdre M Murray (d.murray{at}ucc.ie)
  1. University College Cork, Republic of Ireland
    1. Geraldine B Boylan (g.boylan{at}ucc.ie)
    1. University College Cork, Eire
      1. Imhad Ali (imdad.ali{at}newhamhealth.nhs.uk)
      1. Unified Maternity Services, Cork, Republic of Ireland
        1. C. Anthony Ryan (ryant01{at}eircom.net)
        1. Cork University Maternity Hospital, Republic of Ireland
          1. Brendan P Murphy (brendanpaul.murphy{at}mailp.hse.ie)
          1. University College Cork, Republic of Ireland
            1. Sean Connolly (sean.connolly{at}ucd.ie)
            1. St Vincent's Hospital, Dublin, Republic of Ireland

              Abstract

              Background: Neonatal seizures are often sub-clinical, making accurate diagnosis difficult. The aim of this study was to describe the clinical manifestations of electrographic seizures recorded on continuous video-EEG, and to compare this to 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 analyzed. The number, duration, and clinical expression of electrographic seizures were calculated (in seconds), and compared to the seizures clinically suspected by the neonatal staff.

              Results: Of 51 infants enrolled, 9 had electrographic seizures. A further 3 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 18.7% of the total electrographic seizure burden. Over-diagnosis 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 display clinical signs on simultaneous video recordings. Moreover, two-thirds of these clinical manifestations are unrecognised, or mis-interpreted by experienced neonatal staff. In the recognition and management of neonatal seizures clinical diagnosis alone is not enough.

              • hypoxic ischaemic encephalopathy
              • neonatal
              • seizure burden
              • seizures
              • video-EEG

              Statistics from Altmetric.com

              Request permissions

              If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

              Linked Articles

              • Fantoms
                Ben Stenson