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Characterisation of neonatal seizures and their treatment using continuous EEG monitoring: a multicentre experience
  1. Janet M Rennie1,
  2. Linda S de Vries2,
  3. Mats Blennow3,4,
  4. Adrienne Foran5,
  5. Divyen K Shah6,7,
  6. Vicki Livingstone8,9,
  7. Alexander C van Huffelen10,
  8. Sean R Mathieson8,9,
  9. Elena Pavlidis8,9,
  10. Lauren C Weeke2,
  11. Mona C Toet2,
  12. Mikael Finder3,
  13. Raga Mallika Pinnamaneni4,
  14. Deirdre M Murray8,9,
  15. Anthony C Ryan9,
  16. William P Marnane8,
  17. Geraldine B Boylan8,9
  1. 1 Institute of Women’s Health University College London, London, UK
  2. 2 University Medical Center Utrecht, Utrecht, The Netherlands
  3. 3 Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden
  4. 4 CLINTEC, Karolinska Institute, Solna, Sweden
  5. 5 Rotunda Hospital, Dublin, Ireland
  6. 6 Royal London Hospital, London, UK
  7. 7 Queen Mary University of London, London, UK
  8. 8 Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork, Ireland
  9. 9 Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
  10. 10 Clinical Neurophysiology, University Medical Center Utrecht, Utrecht, The Netherlands
  1. Correspondence to Professor Geraldine B Boylan, Department of Paediatrics and Child Health, Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland; g.boylan{at}ucc.ie

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

  • clin neurophysiology
  • neonatology
  • seizures
  • antiepileptic drug
  • EEG

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

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Footnotes

  • Contributors GBB, JMR and WPM conceptualised and designed the study, coordinated the study, coordinated and supervised data collection, analysed the data, drafted the initial manuscript and reviewed and revised the manuscript. VL helped to conceptualise and design the study, designed the data collection instruments, carried out statistical analysis and reviewed and revised the manuscript. LSdV, MB, BMM, ACR, AF, DKS and MCT helped to conceptualise and design the study, coordinated and supervised data collection, collected data and reviewed and revised the manuscript. Professor van Huffelen and EP and SRM helped to conceptualise and design EEG analysis protocol, carried out expert analysis of the EEG and reviewed and revised the manuscript. LCW, MF and RMP helped to conceptualise and design the study, collected data and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding This work was supported by a Wellcome Trust Strategic Translational Award (098983) and a Science Foundation Ireland (SFI) Research Centre Award (12/RC/2272).

  • Disclaimer The funders had no role in the collection, analysis and interpretation of data or the writing of this manuscript.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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