Continuous Video Electroencephalographic (EEG) Monitoring for Electrographic Seizure Diagnosis in Neonates:  A Single-Center Study

Wietstock, So O.; Bonifacio, SL; Sullivan, Je E.; Nash, K.B.; Glass, HC

doi:10.1177/0883073815592224

Cited by 43 publications

(30 citation statements)

References 26 publications

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“…6 We note that patients monitored for ANE at our site had a slightly lower incidence of seizure compared to prior studies, which have reported seizures in 30%-65% of children with ANE. The study is limited in its scope as a single-center study and observational study design.…”

Section: Discussioncontrasting

confidence: 49%

“…[1][2][3][4] Due to developing neurophysiology and immature movements, neonates are at high risk of subclinical seizures and misidentified seizures, 5,6 necessitating the use of continuous electroencephalography (cEEG) monitoring to accurately diagnose seizures. [1][2][3][4] Due to developing neurophysiology and immature movements, neonates are at high risk of subclinical seizures and misidentified seizures, 5,6 necessitating the use of continuous electroencephalography (cEEG) monitoring to accurately diagnose seizures.…”

Section: Introductionmentioning

confidence: 99%

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The probability of seizures during continuous EEG monitoring in high‐risk neonates

et al. 2019

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Objective: We evaluated the impact of monitoring indication, early electroencephalography (EEG), and clinical features on seizure risk in all neonates undergoing continuous EEG (cEEG) monitoring following a standardized monitoring protocol. Methods: All cEEGs from unique neonates 34-48 weeks postmenstrual age monitored from 1/2011-10/2017 (n = 291) were included. We evaluated the impact of cEEG monitoring indication (acute neonatal encephalopathy [ANE], suspicious clinical events [SCEs], or other high-risk conditions [OHRs]), age, medication status, and early EEG abnormalities (including the presence of epileptiform discharges and abnormal background continuity, amplitude, asymmetry, asynchrony, excessive sharp transients, and burst suppression) on time to first seizure and overall seizure risk using Kaplan-Meier survival curves and multivariable Cox proportional hazards models. Results: Seizures occurred in 28% of high-risk neonates. Discontinuation of monitoring after 24 hours of seizure-freedom would have missed 8.5% of neonates withseizures. Overall seizure risk was lower in neonates monitored for ANE compared to OHR (P = .004) and trended lower compared to SCE (P = .097). The time course of seizure presentation varied by group, where the probability of future seizure was less than 1% after 17 hours of seizure-free monitoring in the SCE group, but required 42 hours in the OHR group, and 73 hours in the ANE group. The presence of early epileptiform discharges increased seizure risk in each group (ANE: adjusted hazard ratio [aHR] 4.32, 95% confidence interval [CI] 1.23-15.13, P = .022; SCE: aHR 10.95, 95% CI 4.77-25.14, P < 1e-07; OHR: aHR 56.90, 95% CI 10.32-313.72, P < 1e-05). Significance: Neonates who undergo cEEG are at high risk for seizures, and risk varies by monitoring indication and early EEG findings. Seizures are captured in nearly all neonates undergoing monitoring for SCE within 24 hours of cEEG monitoring.

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Section: Discussioncontrasting

confidence: 49%

Section: Introductionmentioning

confidence: 99%

The probability of seizures during continuous EEG monitoring in high‐risk neonates

et al. 2019

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“…Data from these 7 centers following ACNS guidelines add to the literature that supports the ACNS recommendations to monitor at-risk neonates with conventional video-EEG for at least 24 hours of continuous monitoring to identify subclinical seizures and confirm electrographic correlates of paroxysmal events 9,14 . High frequency of subclinical seizures has been reported in several previous studies of neonates, 3,15,16 and our much larger study population supports and extends this finding.…”

Section: Discussionmentioning

confidence: 92%

Contemporary Profile of Seizures in Neonates: A Prospective Cohort Study

Glass

Shellhaas

Wusthoff

et al. 2016

The Journal of Pediatrics

251

213

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Objective To determine the contemporary etiology, burden, and short-term outcomes of seizures in neonates monitored with continuous video-electroencephalogram (cEEG). Study design We prospectively collected data from 426 consecutive neonates (56% male, 88% term) ≤44 weeks postmenstrual age with clinically suspected seizures and/or electrographic seizures. Subjects were assessed between January 2013 and April 2015 at seven U.S. tertiary care pediatric centers following American Clinical Neurophysiology Society (ACNS) guidelines for cEEG for at risk neonates. Seizure etiology, burden, management and outcome were determined by chart review using a case report form designed at study onset. Results The most common seizure etiologies were hypoxic-ischemic encephalopathy (38%), ischemic stroke (18%), and intracranial hemorrhage (11%). Seizure burden was high, with 59% having ≥7 electrographic seizures and 16% having status epilepticus; 52% received ≥2 anti-seizure medications. During the neonatal admission, 17% died; 49% of survivors had abnormal neurological examination at hospital discharge. In an adjusted analysis, high seizure burden was a significant risk factor for mortality, length of hospital stay, and abnormal neurological examination at discharge. Conclusions In this large contemporary profile of consecutively enrolled newborns with seizures treated at centers using cEEG per ACNS guidelines, about half had high seizure burden, received ≥2 anti-seizure medications, and/or died or had abnormal examination at discharge. Higher seizure burden was associated with increased morbidity and mortality. These findings underscore the importance of accurate determination of neonatal seizure frequency and etiology, and a potential for improved outcome if seizure burden is reduced.

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“…Given the absence of an occipital lesion or abnormal findings on dilated funduscopic exam, such a finding is unlikely to be related to a visual field deficit. Continuous video scalp EEG is frequently used in newborn infants, has a high sensitivity, is the gold standard for seizure monitoring in this age group [7,8,9,10] and is significantly more accurate than clinical detection [8]. Although the reported incidence of localized EEG ictal onset is somewhat low for frontal-lobe epilepsy [11], this is in part due to the fact that medial temporal lobe foci are relatively inaccessible to scalp EEG, while dorsolateral foci including the frontal eye fields are detected more frequently by scalp EEG [12].…”

Section: Discussionmentioning

confidence: 99%

Transient Horizontal Gaze Palsy in a One-Month-Old Boy after a Fall

Bourne

Duhaime²

2015

Pediatr Neurosurg

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A 1-month-old boy was evaluated after a fall from a height of 3 feet and found to have right parietal skull fracture as well as right and left frontal traumatic hemorrhage. Ten days after the injury, he represented with a persistent left gaze preference. Further workup including MRI and EEG determined that this finding was most likely due to a small, focal, left-frontal eye field lesion. We review the horizontal gaze pathway and demonstrate that this is present at this very young age, and that a very focal and relatively minor injury can cause gaze disturbance.

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Continuous Video Electroencephalographic (EEG) Monitoring for Electrographic Seizure Diagnosis in Neonates: A Single-Center Study

Cited by 43 publications

References 26 publications

The probability of seizures during continuous EEG monitoring in high‐risk neonates

The probability of seizures during continuous EEG monitoring in high‐risk neonates

Contemporary Profile of Seizures in Neonates: A Prospective Cohort Study

Transient Horizontal Gaze Palsy in a One-Month-Old Boy after a Fall

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