EEG diagnoses of neonatal seizures: Clinical correlations and outcome

doi:10.1016/0887-8994(89)90004-0

Pediatric Neurology

Volume 5, Issue 1, January–February 1989, Pages 17-24

https://doi.org/10.1016/0887-8994(89)90004-0 Get rights and content

Abstract

Electroencephalographic seizures were evaluated in 112 neonates. The first portion of the study involved 80 neonates with clinically identified abnormal movements, 8 of whom (10%) had electroencephalographic evidence of seizures coincident with this activity. Patients with abnormal movements (90%) had no concurrent electrical seizures. In the second part of the study, 40 infants who had electrical seizures were investigated. Eight of these infants had been identified during the first part of the study. Two-thirds of the patients (25) were premature. Sixteen patients (40%) died; 90% had brain lesions documented by computed tomography and/or postmortem study. Cerebral infarction and intraventricular hemorrhage were the most common lesions. One-third of the survivors (8 of 24 patients) were normal at a mean age of 3 years, while two-thirds had significant neurologic and developmental abnormalities. Neonatal seizures often are subtle, not associated with observable clinical expression, and associated with adverse development. Electroencephalographic confirmation is important in the evaluation of neonatal seizures.

References (39)

JB Burke
Prognostic significance of neonatal convulsions
Arch Dis Child
(1954)
AL Rose et al.
Neonatal seizure states: A study of clinical, pathological, and electroencephalographic features in 137 full-term babies with a long-term follow-up
Pediatrics
(1970)
JK Brown et al.
Clinical and chemical correlates in convulsions of the newborn
Lancet
(1972)
KR Holden et al.
Neonatal seizures and their treatment
Clin Perinatol
(1975)
AR Seay et al.
Significance of seizures in infants weighing less than 2,500 gm
Arch Neurol
(1977)
TA Knauss et al.
Seizures in a neonatal intensive care unit
Dev Med Child Neurol
(1977)
LR Ment et al.
Neonates with seizures attributed to perinatal complications
Am J Dis Child
(1982)
KR Holden et al.
Neonatal seizures, I. Correlation of prenatal and perinatal events with outcomes
Pediatrics
(1982)
I Bergman et al.
Outcome in neonates with convulsions treated in an intensive care unit
Ann Neurol
(1983)
C Dreyfus-Brisac et al.
Electroclinical studies of status epilepticus and convulsions in the newborn

K Watanabe et al.

Electroclinical studies of seizures in the newborn

Folia Psychiatry Neurol Jpn

(1977)

GM Fenichel

Neonatal neurology

JJ Volpe

Neonatal seizures

F Staudt et al.

The usefulness of electroencephalography in curarized newborns

Electroencephalogr Clin Neurophysiol

(1981)

JA Eyre et al.

Continuous electroencephalographic recording to detect seizures in paralyzed newborns

Br Med J

(1983)

RN Goldberg et al.

Detection of seizure activity in the paralyzed neonate using continuous monitoring

Pediatrics

(1982)

BR Tharp et al.

The incidence of FEG abnormalities and outcome of infants paralyzed with neuromuscula: blocking agents

Crit Care Med

(1983)

RW Coen et al.

Continuous monitoring of the electroencephalogram following perinatal asphyxia

J Pediatr

(1982)

MF Radvanyi-Bouvet et al.

Seizures and electrical discharges in premature in fants

Neuropediatrics

(1985)

Cited by (81)

Long-Term Video Electroencephalographic Monitoring in <30-Week Gestational Age Infants With High-Grade Intraventricular Hemorrhage
2024, Pediatric Neurology
Despite recognizing high seizure risk, the current consensus guidelines on evaluating seizures in preterm neonates are based on limited data. We chose to investigate the seizure risk in high-risk preterm (<30 weeks gestation) asymptomatic (without a clinical concern for seizures) infants with high-grade intraventricular hemorrhage who underwent long-term video electroencephalographic monitoring.
We performed a comprehensive retrospective review on all infants of <30-week gestational age admitted to the University of Alabama at Birmingham Regional Neonatal Intensive Care Unit from June 2018 to October 2022. We selected those patients who underwent electroencephalographic monitoring without a prior clinical concern for seizures. We recorded gender, gestational age, APGAR scores (one and five minutes), intraventricular hemorrhage (grade, age at diagnosis), and electroencephalographic monitoring (timing and duration) data.
Among 37 premature infants, six had seizures detected on electroencephalographic monitoring. All six infants had subclinical seizures. Only two of six patients had a clinical correlation (although not identified by the providers) with some of their seizures. Patients with seizures were significantly younger in chronological age (median age 6.5 days vs 9 days, P value 0.009) at the time of the electroencephalographic monitoring initiation and were more likely to have subsequent monitoring studies (P value 0.0418).
Long-term video electroencephalographic monitoring performed after the diagnosis of high-grade intraventricular hemorrhage captured seizures in ∼16% of asymptomatic premature neonates of <30 weeks’ gestation. Patients identified to have seizures were significantly younger (chronological age) at the time of the electroencephalographic monitoring initiation and were more likely to be remonitored.
Electroencephalographic monitoring for seizure identification and prognosis in term neonates
2018, Seminars in Fetal and Neonatal Medicine
Citation Excerpt :
Each of these problems is discussed below. A major issue with clinical diagnosis of seizures is the high incidence of EEG-only (non-convulsive, subclinical, occult) seizures in neonates [7–14]. Numerous studies have indicated that about 80–90% of EEG seizures in neonates have no associated clinical correlate, and therefore would not be identified without continuous EEG monitoring even by expert and observant bedside clinicians [3,9,13,15–18].
Seizures represent a manifestation of neurological disease in the neonatal period. Historically, neonatal seizures were identified by direct clinical observation. However, since most seizures are electroencephalographic (EEG)-only (subclinical, non-convulsive) and clinical manifestations may be subtle, many clinicians place increasing importance on EEG data including conventional EEG or amplitude-integrated EEG to identify seizures in neonates. Beyond seizure identification, the EEG is a robust source of information about brain function that can be useful for neurobehavioral prognostication in some neonates. This review summarizes the available data regarding EEG for neonatal seizure diagnosis and brain function assessment.
Neonatal Seizures
2018, Volpe's Neurology of the Newborn
Seizures represent the most distinctive and frequent manifestations of neurological disease in the neonatal period. Compared with seizures in older patients, neonatal seizures have different clinical appearances, electrographic characteristics, etiologies, and management approaches. Because most neonatal seizures are acute symptomatic seizures occurring because of a brain insult or brain dysfunction, neonatal seizures indicate the presence of underlying disorders that may require specific therapy. Problematically, neonatal seizure diagnosis is difficult because the clinical manifestations of seizures may be subtle and difficult to reliably identify. Furthermore, most neonatal seizures are EEG-only (subclinical, nonconvulsive) and have no clinically evident manifestations. Thus, EEG monitoring plays an increasingly important role in neonatal seizure identification and management. Treatment of neonatal seizures is generally considered necessary because experimental and human evidence suggest seizures may lead to secondary brain injury and are associated with less favorable outcomes. However, antiseizure medications may have associated risks, and there are few data to guide evidence-based management. This chapter reviews the pathophysiology and clinical aspects of neonatal seizures with emphasis on the influence of the developmental characteristics of the perinatal brain; viewed in this context, the manifestations, causes, and effects of neonatal seizures become more understandable.
Certain secondary antiepileptic drugs can rescue hippocampal injury following a critical growth period despite poor anticonvulsant activity and cognitive deficits
2013, Epilepsy and Behavior
Citation Excerpt :
Children are at a particularly high risk for seizures which can occur in association with cerebral palsy, mental retardation, epilepsy, and general cognitive impairment, as well as a high mortality rate following neonatal seizures [1–7].
Clinical and experimental studies have shown that many common secondary antiepileptic drugs (AEDs) are ineffective at blocking seizures in adulthood; however, some afford neuroprotection. In early development, certain AEDs cause apoptosis; however, it is unknown whether these drugs are neurotoxic to the juvenile brain following a developmentally regulated proapoptotic period and whether they alter the seizure threshold, seizure-induced neuronal vulnerability, and/or cognitive function. Lamotrigine (LTG), carbamazepine (CBZ), phenytoin (PHT), valproate (VPA), and topiramate (TPM) were systemically administered to rat pups for 7 days beginning on postnatal (P) day 14 (P14), then half the animals were injected with kainate (KA) to trigger seizures, an age when the CA1 subregion becomes preferentially sensitive to status epilepticus. Histological outcome, seizure severity, and learning and memory were determined with an electroencephalograph (EEG), silver impregnation, and a water-maze swim task. None of the AEDs tested significantly attenuated behavioral or electrographic seizures. Phenytoin increased mortality, identifying a detrimental side effect of this drug. The other drugs (LTG, VPA, TPM, and CBZ) afforded different amounts of protection to the CA1 subregion but not to the CA3 subregion or extrahippocampal structures. With the exception of VPA, AED-treated animals lagged behind during swim task acquisition. All groups improved in the water-maze swim task over time, particularly on the last trials; however, the average escape latency was still impaired for TPM-treated animals and all AED + KA-treated groups. Thus, while certain AEDs demonstrated some neuroprotective effects, poor antiepileptic activity, memory impairment, and other deleterious side effects were observed with these drugs suggesting that the search for potentially more effective and tolerated agents is essential for improving clinical outcome in children and adolescents with epilepsy.
Neonatal seizure recognition - Comparative study of continuous-amplitude integrated EEG versus short conventional EEG recordings
2011, Clinical Neurophysiology
Citation Excerpt :
The incidence of seizures in the neonatal period is considerably higher than in any other age group (Hauser et al., 1996; Levene, 2002). Clinical diagnosis of neonatal seizures is difficult in view of the paucity of clinical correlates, normal neonatal behaviours mimicking seizure activity and, sometimes, the absence of any significant clinical event (Clancy and Legido, 1988; Scher et al., 1989; Shany et al., 2006; Bye et al., 2000). Early and aggressive treatment of neonatal seizures is considered beneficial, as seizures may contribute to the cerebral insult of an already-compromised central nervous system (van Rooij et al., 2010; Glass et al., 2009).
This study aims to detect seizures by amplitude-integrated electroencephalography (EEG) (aEEG) as compared with conventional EEG (cEEG) by clinicians with different levels of expertise.
Simultaneous 10 min aEEG/cEEG recordings were time-locked and assessed for seizure activity. aEEG was assessed by a neonatologist, a fellow and a medical student and cEEG by two child neurologists and a neonatologist.
A total of 265 paired epochs from 38 simultaneous recording were assessed. Forty-one seizure episodes were diagnosed in 31 epochs in the cEEG recordings of 10 infants. Sensitivity and specificity ranged from 68% to 84% and from 71% to 84%, respectively, per detection of epochs with seizures and from 71% to 84% and from 36% to 96% per detection of individual seizures. No agreement was found between the observations of the student, and those of the fellow or neonatologist. Substantial agreement was found between the fellow and neonatologist. Before cEEG was commenced, seizures were detected by aEEG in 22 infants.
aEEG has high sensitivity and specificity in the hands of experienced users. Inexperienced new users may have a high rate of misdiagnosed seizures. Early recording of high-risk infants can help in the early diagnosis and treatment of seizures.
Diagnosis and treatment of seizures in aEEG should be carried out by experienced users and should be supplemented with cEEG when available.
The Long-Term Effects of Neonatal Seizures
2009, Clinics in Perinatology
Citation Excerpt :
Consequently, the prognosis for the infants is usually poor. Death, postneonatal epilepsy, behavioral problems, and mental retardation are common outcomes.23–27 However, outcome studies are somewhat difficult to interpret because of the uncertainty of diagnosis in some series.

View all citing articles on Scopus

^☆: This study was supported in part by a Clinical Investigator Development Award to Mark S. Scher from the National Institute of Neurological and Communicative Disorders and Stroke (NS01110), and a research grant from the Twenty-five Club of Magee-Women's Hospital.

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Original articleEEG diagnoses of neonatal seizures: Clinical correlations and outcome☆

Abstract

Prognostic significance of neonatal convulsions

Arch Dis Child

Neonatal seizure states: A study of clinical, pathological, and electroencephalographic features in 137 full-term babies with a long-term follow-up

Pediatrics

Clinical and chemical correlates in convulsions of the newborn

Lancet

Neonatal seizures and their treatment

Clin Perinatol

Significance of seizures in infants weighing less than 2,500 gm

Arch Neurol

Seizures in a neonatal intensive care unit

Dev Med Child Neurol

Neonates with seizures attributed to perinatal complications

Am J Dis Child

Neonatal seizures, I. Correlation of prenatal and perinatal events with outcomes

Pediatrics

Outcome in neonates with convulsions treated in an intensive care unit

Ann Neurol

Electroclinical studies of status epilepticus and convulsions in the newborn

Electroclinical studies of seizures in the newborn

Folia Psychiatry Neurol Jpn

Neonatal neurology

Neonatal seizures

The usefulness of electroencephalography in curarized newborns

Electroencephalogr Clin Neurophysiol

Continuous electroencephalographic recording to detect seizures in paralyzed newborns

Br Med J

Detection of seizure activity in the paralyzed neonate using continuous monitoring

Pediatrics

The incidence of FEG abnormalities and outcome of infants paralyzed with neuromuscula: blocking agents

Crit Care Med

Continuous monitoring of the electroencephalogram following perinatal asphyxia

J Pediatr

Seizures and electrical discharges in premature in fants

Neuropediatrics

Original article
EEG diagnoses of neonatal seizures: Clinical correlations and outcome☆