Characterisation of neonatal seizures and their treatment using continuous EEG monitoring: a multicentre experience

Janet M Rennie, Linda S de Vries, Mats Blennow, Adrienne Foran, Divyen K Shah, Vicki Livingstone, Alexander C van Huffelen, Sean R Mathieson, Elena Pavlidis, Lauren C Weeke, Mona C Toet, Mikael Finder, Raga Mallika Pinnamaneni, Deirdre M Murray, Anthony C Ryan, William P Marnane, Geraldine B Boylan, Janet M Rennie, Linda S de Vries, Mats Blennow, Adrienne Foran, Divyen K Shah, Vicki Livingstone, Alexander C van Huffelen, Sean R Mathieson, Elena Pavlidis, Lauren C Weeke, Mona C Toet, Mikael Finder, Raga Mallika Pinnamaneni, Deirdre M Murray, Anthony C Ryan, William P Marnane, Geraldine B Boylan

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.

Keywords: EEG; antiepileptic drug; clin neurophysiology; neonatology; seizures.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.

Figures

Figure 1
Figure 1
Flow diagram of recruitment, seizures and antiepileptic drug (AED) use in the cohort. EEG, electroencephalography.
Figure 2
Figure 2
Number of seizure episodes and use of antiepileptic drugs (AEDs). The first bar illustrates that 25 neonates experienced one seizure episode and of those, 7 neonates had the seizure episode treated appropriately. The third bar illustrates that 12 neonates experienced three seizure episodes and of those, 1 neonate had two episodes treated appropriately, 4 neonates had one episode treated appropriately and 7 had none of their three episodes treated appropriately.

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