Neonatal Seizures: Relation of Ictal Video-Electroencephalography (EEG) Findings With Neurodevelopmental Outcome

Abstract

Neonatal electroencephalographic background activity has been found to be a predictive factor of the neurodevelopmental outcome. The aim of our study was to identify if the electrical ictal findings present on the first electroencephalography (EEG) recording are related to the outcome of newborns with neonatal seizures. The study is based on the prospective evaluation of newborns consecutively admitted to the Neonatal Intensive Care Unit at the University of Parma between September 2001 and September 2004. Thirty-eight subjects were enrolled in the study on the basis of the following inclusion criteria: presence on the first EEG of at least 1 seizure, neurodevelopmental follow-up until 18 months of corrected age, and performance of several ultrasound brain scans during the neonatal period and of at least 1 cerebral MRI within the first year of life. For each seizure, the following were considered: onset topography, morphology of the epileptiform discharges, spread of the discharge, number of electrographic regions of seizure onset, number of seizures per hour, duration of the seizures, and the Ictal Fraction (= total duration of the seizures/duration of the EEG recording x hour). At the last follow-up, the unfavorable neurodevelopmental outcome seems significantly related to the moderate/severe background activity abnormalities (p = .006), to the spread of ictal discharge to the contralateral hemisphere (p = .02), and to the Ictal Fraction, when it exceeds 10 minutes (p = .036). In conclusion, the analysis of the propagation of the ictal discharge and of the Ictal Fraction might suggest significant prognostic information since the first hours of life.

Seizure burden and neurodevelopmental outcome in neonates with hypoxic–ischemic encephalopathy

“…The importance of neonatal seizure burden for outcome has been highlighted by many researchers,2, 7, 9, 22 but in HIE it has not been fully quantified for long‐term outcome 7, 12, 14. In critically ill children with diseases of mixed aetiologies, including neonates with HIE, MSB of more than 12 minutes per hour was found to be associated with an increase in short‐term neurological decline, independent of the diagnosis or severity of illness 22.…”

“…In addition, many assessed only short‐term outcome, analysed cohorts of mixed aetiology, or did not control for confounding variables. Owing to the difficulty of separating the severity of the underlying injury from the effect of seizures themselves, debate persists about the impact of seizures on brain injury and outcome 8, 9…”

Follow-up of Full-term Neonatal Seizures: Prognostic Factors for Neurodevelopmental Sequelae

“…그 밖에 경련 지속증(status epi l epti cus) 여부, 신경학적 진찰 소견, 경련 조절에 필요한 항경련제의 수, 신경 영상검사 소견 등 이 예후 관련 요인으로 거론되고 있다 2,3,6,11) . 재태연령과 출생체중 도 신생아 경련의 예후와 관련이 있는데, 미숙아나 저체중 출생아 는 만삭아에 비하여 예후가 불량하다 1) .…”

Electroencephalographic characteristics of epileptic seizures in preterm neonates

“…(Boylan et al, 1999;Mizrahi and Kellaway, 1987) Seizures in term as well as preterm neonates were associated with a significantly worse neurodevelopmental outcome. (Brunquell et al, 2002;Bye et al, 1997;Davis et al, 2010;Painter et al, 2012;Pisani et al, 2008b;Pisani et al, 2016) Diagnosing seizures can be challenging, even in term neonates. Clinical manifestations are often subtle and similar behaviours can be observed in healthy newborns, making clinical diagnosis unreliable.…”