Effect of Treatment of Clinical Seizures vs Electrographic Seizures in Full-Term and Near-Term Neonates

Hunt, Rod W; Liley, Helen; Wagh, Deepika; Schembri, Rachel; Lee, Katherine J.; Shearman, A.D.; Francis-Pester, Samantha; deWaal, Koert; Cheong, Jeanie L.Y.; Olischar, Monika; Badawi, Nadia; Wong, Flora Yuen-Wait; Osborn, David A; Rajadurai, Victor Samuel; Dargaville, Peter A.; Headley, Bevan M.; Wright, Ian; Colditz, Paul B.; Wong, Connie; Yeomans, Emma; Elsayed, Kristy; Macey, Judith; Stewart, Jan; Simmer, Karen; Kok, Yen; Black, Robert W.; McKeown, Lisa; Roberts, Nicky; Visruthan, Nirmal Kavalloor; Puerta, Rowena Dela; Worthington, Stacey

doi:10.1001/jamanetworkopen.2021.39604

Cited by 28 publications

(40 citation statements)

References 40 publications

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“…48) How ever, a recent study reported no difference in mortality or longterm morbidity in neonates treated after clinical or electrical events with some concern with worse cognitive function in those with electrographic seizures. 49) Briefly, the threshold for escalation of therapy to decrease seizure burden remains an area of active research.…”

Section: Treatmentmentioning

confidence: 99%

“…The treatment of electrographic seizures is ideally time-critical, as infants treated within 1 hour of seizure onset had the lowest seizure burden and fewer seizures over the subsequent 24 hours [ 48 ]. However, a recent study reported no difference in mortality or long-term morbidity in neonates treated after clinical or electrical events with some concern with worse cognitive function in those with electrographic seizures [ 49 ]. Briefly, the threshold for escalation of therapy to decrease seizure burden remains an area of active research.…”

Section: Treatmentmentioning

confidence: 99%

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Neonatal seizures: stepping outside the comfort zone

Hashish

Bassiouny

2022

Clin Exp Pediatr

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Seizures are the most common neurological disorders in newborns. Managing neonatal seizures is challenging, especially for neurologists who are not neonatal specialists. Acute brain injury during ischemic insult is a key component of seizure occurrence, while genetic and metabolic disorders play less prevalent but more severe roles. The diagnosis of neonatal seizure is ambiguous, as the subjective differentiation between seizure and nonepileptic events is difficult; therefore, electrographic recording is the gold standard for diagnosis. The detection of electrographic seizures by neonatologists is currently facilitated by amplitude-integrated electroencephalography availability in many neonatal intensive care units. Although it is less sensitive than conventional electroencephalography, it is better to record all risky neonates to filter the abnormal events as early as possible to enable the initiation of dedicated therapy at proper dose and time and facilitate the initial response to antiepileptic drugs. This, in turn, helps maintain the balance between unnecessary drug use and their neurotoxic effects. Moreover, the early treatment of electrographic seizures plays a vital role in the suppression of subsequent abnormal brain electricity (status epilepticus) and shortening the hospital stay. An explicit understanding of seizure etiology and pathophysiology should direct attention to the proper prescription of short- and long-term antiepileptic medications to solve the challenging issue of whether neonatal seizures progress to postneonatal epilepsy and long-term cognitive deficits. This review addresses recent updates in different aspects of neonatal seizures, particularly electrographic discharge, including their definition, etiology, classification, diagnosis, management, and neurodevelopmental outcomes.

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Section: Treatmentmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Neonatal seizures: stepping outside the comfort zone

Hashish

Bassiouny

2022

Clin Exp Pediatr

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“… A key goal of neonatal neurocritical care is improved outcomes, and brain monitoring plays an essential role. The recent NEST trial 1 reported no outcome benefits using aEEG monitoring compared to clinical seizure identification among neonates treated for seizures. However, the study failed to prove the effects of monitoring on seizure treatment in the first place.…”

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confidence: 99%

Why monitor the neonatal brain—that is the important question

et al. 2022

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“…The aim of this trial was to evaluate whether aggressive treatment of electrographic seizures in addition to clinical seizures improved neurodevelopmental outcomes compared to treatment of only clinical seizures 1 . Authors took a pragmatic approach to seizure diagnosis by utilizing amplitude‐integrated EEGs (aEEG).…”

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confidence: 99%

“…Following this publication, the diagnosis and treatment of seizures in neonates has shifted dramatically, and standard of care has since evolved to treatment of all electrographic seizures when possible 9 . Subsequent recruitment for the study by Hunt et al had to end prematurely due to slow enrolment secondary to loss of equipoise of treating clinicians 1 . Thus, the study is ultimately unable to make definitive conclusions on the impact of treatment of electrographic versus clinical seizure treatment on neurodevelopmental outcomes.…”

mentioning

confidence: 99%