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

doi:10.1136/archdischild-2018-315624

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

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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.

Original language	English
Pages (from-to)	F493-F501
Journal	Archives of Disease in Childhood Fetal and Neonatal Edition
Volume	104
Issue number	5
Early online date	24 Nov 2018
DOIs	https://doi.org/10.1136/archdischild-2018-315624
Publication status	Published - Sept 2019

Keywords

Journal Article
neonatology
antiepileptic drug
EEG
seizures
clin neurophysiology
Seizures/diagnosis
Stroke/complications
Metabolism, Inborn Errors/complications
Electroencephalography/methods
Humans
Male
Monitoring, Physiologic/methods
Anticonvulsants/therapeutic use
Hypoxia-Ischemia, Brain/complications
Europe/epidemiology
Neurologic Examination/statistics & numerical data
Infant, Newborn, Diseases/diagnosis
Female
Retrospective Studies
Infant, Newborn
Cohort Studies

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Rennie, J. M., de Vries, L. S., Blennow, M., Foran, A., Shah, D. K., Livingstone, V., van Huffelen, A. C., Mathieson, S. R., Pavlidis, E., Weeke, L. C., Toet, M. C., Finder, M., Pinnamaneni, R. M., Murray, D. M., Ryan, A. C., Marnane, W. P., & Boylan, G. B. (2019). Characterisation of neonatal seizures and their treatment using continuous EEG monitoring: a multicentre experience. Archives of Disease in Childhood Fetal and Neonatal Edition, 104(5), F493-F501. https://doi.org/10.1136/archdischild-2018-315624

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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.",

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

note = "{\textcopyright} Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.",

year = "2019",

month = sep,

doi = "10.1136/archdischild-2018-315624",

language = "English",

volume = "104",

pages = "F493--F501",

journal = "Archives of Disease in Childhood Fetal and Neonatal Edition",

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number = "5",

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Rennie, JM, de Vries, LS, Blennow, M, Foran, A, Shah, DK, Livingstone, V, van Huffelen, AC, Mathieson, SR, Pavlidis, E, Weeke, LC, Toet, MC, Finder, M, Pinnamaneni, RM, Murray, DM, Ryan, AC, Marnane, WP & Boylan, GB 2019, 'Characterisation of neonatal seizures and their treatment using continuous EEG monitoring: a multicentre experience', Archives of Disease in Childhood Fetal and Neonatal Edition, vol. 104, no. 5, pp. F493-F501. https://doi.org/10.1136/archdischild-2018-315624

TY - JOUR

T1 - Characterisation of neonatal seizures and their treatment using continuous EEG monitoring

T2 - a multicentre experience

AU - Rennie, Janet M

AU - de Vries, Linda S

AU - Blennow, Mats

AU - Foran, Adrienne

AU - Shah, Divyen K

AU - Livingstone, Vicki

AU - van Huffelen, Alexander C

AU - Mathieson, Sean R

AU - Pavlidis, Elena

AU - Weeke, Lauren C

AU - Toet, Mona C

AU - Finder, Mikael

AU - Pinnamaneni, Raga Mallika

AU - Murray, Deirdre M

AU - Ryan, Anthony C

AU - Marnane, William P

AU - Boylan, Geraldine B

N1 - © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.

PY - 2019/9

Y1 - 2019/9

N2 - 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.

AB - 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.

KW - Journal Article

KW - neonatology

KW - antiepileptic drug

KW - EEG

KW - seizures

KW - clin neurophysiology

KW - Seizures/diagnosis

KW - Stroke/complications

KW - Metabolism, Inborn Errors/complications

KW - Electroencephalography/methods

KW - Humans

KW - Male

KW - Monitoring, Physiologic/methods

KW - Anticonvulsants/therapeutic use

KW - Hypoxia-Ischemia, Brain/complications

KW - Europe/epidemiology

KW - Neurologic Examination/statistics & numerical data

KW - Infant, Newborn, Diseases/diagnosis

KW - Female

KW - Retrospective Studies

KW - Infant, Newborn

KW - Cohort Studies

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U2 - 10.1136/archdischild-2018-315624

DO - 10.1136/archdischild-2018-315624

M3 - Article

C2 - 30472660

SN - 1359-2998

VL - 104

SP - F493-F501

JO - Archives of Disease in Childhood Fetal and Neonatal Edition

JF - Archives of Disease in Childhood Fetal and Neonatal Edition

IS - 5

ER -

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

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