scholarly journals Seizure Control in Neonates Undergoing Screening vs Confirmatory EEG Monitoring

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012293
Author(s):  
Courtney J. Wusthoff ◽  
Vandana Sundaram ◽  
Nicholas S. Abend ◽  
Shavonne L. Massey ◽  
Monica E. Lemmon ◽  
...  
Keyword(s):  
Successful Treatment ◽  
Treatment Success ◽  
Neonatal Seizure ◽  
Eeg Monitoring ◽  
Class Iii ◽  
Acute Seizures ◽  
Clinical Events ◽  
Continuous Eeg ◽  
Continuous Eeg Monitoring ◽  
Symptomatic Seizures

Objective:To determine whether screening continuous EEG monitoring (cEEG) is associated with greater odds of treatment success for neonatal seizures.Methods:We included term neonates with acute symptomatic seizures enrolled in the Neonatal Seizure Registry (NSR), a prospective, multicenter cohort of neonates with seizures. We compared two cEEG approaches: (1) Screening cEEG, initiated for indications of encephalopathy or paralysis without suspected clinical seizures, and (2) Confirmatory cEEG, initiated for the indication of clinical events suspicious for seizures, either alone or in addition to other indications. The primary outcome was successful response to initial seizure treatment, defined as seizures resolved without recurrence within 30 minutes after initial loading dose of anti-seizure medicine. Multivariable logistic regression analyses assessed the association between cEEG approach and successful seizure treatment.Results:Among 514 neonates included, 161 (31%) had screening cEEG and 353 (69%) had confirmatory cEEG. Neonates with screening cEEG had a higher proportion of successful initial seizure treatment than neonates with confirmatory cEEG (39% versus 18%; p<0.0001). After adjusting for covariates, there remained a greater odds ratio (OR) for successful initial seizure treatment in the screening vs. confirmatory cEEG groups (adjusted OR 2.44, 95% CI: 1.45-4.11, p=0.0008).Conclusions:These findings provide evidence from a large, contemporary cohort of neonates that a screening cEEG approach may improve odds of successful treatment of acute seizures.Classification of Evidence:This study provides Class III evidence that for neonates a screening CEEG approach, compared to a confirmatory EEG approach, increases the probability of successful treatment of acute seizures

Abstract TMP99: Pediatric Intracerebral Hemorrhage: Acute Symptomatic Seizures and Epilepsy

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Lauren A Beslow ◽  
Nicholas S Abend ◽  
Melissa C Gindville ◽  
Rachel A Bastian ◽  
Daniel J Licht ◽  
...  
Keyword(s):  
Risk Factor ◽  
Intracerebral Hemorrhage ◽  
Tertiary Care ◽  
Rank Test ◽  
Eeg Monitoring ◽  
Free Survival ◽  
Continuous Eeg ◽  
Continuous Eeg Monitoring ◽  
Symptomatic Seizures ◽  
Acute Symptomatic Seizures

Background and Objectives: We aimed to define the incidence of acute symptomatic seizures and of remote symptomatic seizures and epilepsy after spontaneous pediatric intracerebral hemorrhage (ICH). Methods: Pediatric patients with spontaneous ICH presenting between 2007 and 2012 at three tertiary care centers were prospectively identified. Acute symptomatic seizures were defined as seizures occurring from presentation to 7 days after ICH. Survival analysis was used to assess development of a first remote symptomatic seizure and epilepsy (2 or more unprovoked seizures >7 days after ICH). Log-rank tests were used to examine putative risk factors for development of remote symptomatic seizures and epilepsy. Results: Seventy-three pediatric subjects with spontaneous ICH were identified, including 20 perinatal (≥37 weeks gestation to 28 days) and 53 childhood subjects (>28 days to <18 years). Acute symptomatic seizures occurred in 12 (60%) perinatal and 23 (43%) childhood subjects, p=.29, Fisher’s exact. Median age of childhood subjects with acute symptomatic seizures was younger than those without (2.2 versus 10.8 years, p=.006, rank-sum). Electrographic-only seizures occurred in 28% of 32 subjects who had continuous EEG monitoring. Follow-up was not different between perinatal and childhood subjects (median 371 versus 340 days), p=.68, rank-sum. One and two-year remote symptomatic seizure-free survival were 82% (95% CI 68-91%) and 67% (95% CI 46-82%). One and two-year epilepsy-free survival were 96% (95% CI 83-99%) and 87% (95% CI 65-95%). Elevated intracranial pressure (ICP) requiring urgent intervention was a risk factor for remote symptomatic seizures and epilepsy (p=.024 and p=.037, log-rank test). Conclusions: Acute symptomatic seizures are common in both perinatal and childhood ICH. Continuous EEG monitoring may identify electrographic-only seizures in some subjects. By two-years after ICH it is estimated that about one-third of patients will have a single remote symptomatic seizures and that about 13% will develop epilepsy. Elevated ICP requiring intervention is a risk factor for remote symptomatic seizures and epilepsy.

scholarly journals Continuous EEG Monitoring in the Intensive Care Unit

1998 ◽  
Vol 25 (S1) ◽  
pp. S12-S15 ◽  
Author(s):  
John Kay
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Eeg Monitoring ◽  
General Icus ◽  
Continuous Eeg ◽  
Nonconvulsive Seizures ◽  
Continuous Eeg Monitoring ◽  
Clinical Problems

AbstractBackground:Electroencephalography (EEG) is playing an increasingly important role in the management of comatose patients in the intensive care unit.Methods:The techniques of EEG monitoring are reviewed. Initially, standard, discontinuous recordings were performed in intensive care units (ICUs). Later, continuous displays of “raw EEG” (CEEG) were used. More recently, the addition of quantitative techniques allowed for more effective reading.Results and Conclusions:Applications of continuous EEG to clinical problems are discussed. The most useful role of CEEG appears to be the detection and management of nonconvulsive seizures. There is a need for controlled studies to assess the role for CEEG in neuro-ICUs and general ICUs.

Predictive Value of Early Continuous Electroencephalogram Monitoring in Ventilated Preterm Infants With Intraventricular Hemorrhage

PEDIATRICS ◽  
1988 ◽  
Vol 82 (3) ◽  
pp. 337-343
Author(s):  
J. Connell ◽  
L. de Vries ◽  
R. Oozeer ◽  
R. Regev ◽  
L. M.S. Dubowitz ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Intraventricular Hemorrhage ◽  
Eeg Monitoring ◽  
Mechanically Ventilated ◽  
Functional Correlation ◽  
Continuous Eeg ◽  
Continuous Eeg Monitoring ◽  
A Prospective Study ◽  
Ultrasound Evidence ◽  
Significant Data

The contribution of early continuous fourchannel EEG monitoring to the evaluation of intraventricular hemorrhage in acutely ill preterm infants mechanically ventilated for acute respiratory distress was assessed in a prospective study of 54 infants of less than 34 weeks' gestation. Early abnormal EEG results correlated significantly with later outcome. They often preceded ultrasound evidence of hemorrhage and provided prognostically significant functional correlation with the grade of hemorrhage. Continuous EEG monitoring allows collection of significant data with minimal interference and could contribute to clinical management of high-risk preterm infants.

Continuous EEG Monitoring and Quantitative EEG Techniques

2019 ◽  
pp. 79-109
Author(s):  
Naiara Garcia-Losarcos ◽  
Aditya Vuppala ◽  
Kenneth Loparo
Keyword(s):  
Quantitative Eeg ◽  
Eeg Monitoring ◽  
Continuous Eeg ◽  
Continuous Eeg Monitoring

EEG Trend Analysis in the ICU

2016 ◽  
pp. 209-221
Author(s):  
Amy Z. Crepeau
Keyword(s):  
Seizure Detection ◽  
Quantitative Eeg ◽  
Eeg Monitoring ◽  
Multiple Sources ◽  
Periodic Patterns ◽  
Continuous Eeg ◽  
Continuous Eeg Monitoring ◽  
It Support ◽  
Special Environment ◽  
Epilepsy Monitoring

Continuous EEG monitoring can increase the detection of subclinical seizures, and is important in managing nonconvulsive status epilepticus. In the ICU it presents challenges not routinely encountered in the outpatient EEG laboratory or the epilepsy monitoring unit: multiple sources of artifact, and the need for imaging-compatible electrodes and a robust IT support system. Rhythmic and periodic patterns of indeterminate significance are encountered. There is much debate as to the true significance of these patterns, and clinical correlation is always required. Special techniques can be employed in the application and analysis of ICU EEG monitoring. EEG has been useful in monitoring for ischemia, prognosis, and depth of medication-induced suppression. Quantitative EEG can also be utilized to assist in rapid seizure detection, and to monitor for subtle gradual changes in cerebral function and seizure detection. The special environment, however, requires close attention to technical considerations, and thoughtful interpretations of indeterminate patterns.

Continuous EEG Monitoring Predicts a Clinically Meaningful Recovery Among Adult Inpatients

2019 ◽  
Vol 36 (5) ◽  
pp. 358-364 ◽  
Author(s):  
Olga Selioutski ◽  
Debra Roberts ◽  
Ross Hamilton ◽  
Hia Ghosh ◽  
Jean Nickels ◽  
...  
Keyword(s):  
Eeg Monitoring ◽  
Continuous Eeg ◽  
Continuous Eeg Monitoring

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

2018 ◽  
Vol 104 (5) ◽  
pp. F493-F501 ◽  
Author(s):  
Janet M Rennie ◽  
Linda S de Vries ◽  
Mats Blennow ◽  
Adrienne Foran ◽  
Divyen K Shah ◽  
...  
Keyword(s):  
Genetic Disorders ◽  
Genetic Disorder ◽  
Median Number ◽  
Eeg Monitoring ◽  
Neonatal Seizures ◽  
Continuous Electroencephalography ◽  
Continuous Eeg ◽  
Continuous Eeg Monitoring ◽  
Electrographic Seizures ◽  
Median Maximum

ObjectiveThe 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.MethodsNeonates 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.ResultsOf 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.ConclusionsOur results show that even with access to cEEG monitoring, neonatal seizures are frequent, difficult to recognise and difficult to treat.Oberservation study numberNCT02160171

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