The role of the continuous brain monitoring with video AEEG/EEG for neonates with suspected seizures

Background: Seizures affect 1.5 - 1.3/1000 live births at term and are associated with worse neurodevelopmental outcomes. 80-90% of neonatal seizures are subclinical. Amplitude integrated electroencephalography associated with raw EEG and video images (video aEEG/EEG) is an alternative for seizure assessment at the bedside.

Objective: To assess, among neonates with clinical suspicion of seizures, which had seizures confirmed by video aEEG/EEG and to evaluate the characteristics of these patients, clinical signs most often associated with seizures and early outcomes.

Methods: Retrospective and descriptive study including neonates monitored with video aEEG/EEG, whose indication was clinical suspicion of seizure between August 2017 and October 2021. Data was collected by medical record review. Categorical variables were described in absolute and relative numbers, and numerical variables were as median, 1st and 3rd interquartile range (IQR), or mean and standard deviation (SD).

Results: 80 monitoring of 66 newborns were included, 62% males and 53% born by cesarean section, with a median and IQR for birth weight of 2127 (1420-2960) grams. The mean monitoring duration was 38,3 (24-76,8) hours. The median gestational age was 35 (32-38) weeks. Newborns were divided into two groups, 13 (19.7%) with electrographic seizures and 53 (80.3%) without. Autonomic changes frequently led to the suspicion of a seizure in both groups, 10 (66.7%) in the seizures group and 27 (41.5%) in the non-seizure. The seizures group presented more than one sign in 7 (46.7%), while 16 (24.6%) were in the non-seizure group. In the seizure group, 1 (6.7%) had only clinical seizures, 3 (20%) had clinically followed by subclinical, and 11 (73.3%) were only subclinical. Phenobarbital was the most commonly used drug as a first-line treatment. Both groups had similar mortality, with 2 (15.4%) and 6 (11.3%) deaths in the seizure and non-seizure groups, respectively.

Conclusions: Diagnosis of neonatal seizures based on clinical signs is inaccurate. Video aEEG/EEG is an important tool to assess and monitor newborns at risk for brain injury. Brain monitoring makes the diagnosis accurate, avoiding the inadvertent administration of antiepileptic drugs in children with seizures and contributing to better long-term neurodevelopment.

 

MissingLinkText

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
18 September 2023