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Defining the gap between electrographic seizure burden, clinical expression and staff recognition of neonatal seizures.

Authors :
Murray DM
Boylan GB
Ali I
Ryan CA
Murphy BP
Connolly S
Source :
Archives of disease in childhood. Fetal and neonatal edition [Arch Dis Child Fetal Neonatal Ed] 2008 May; Vol. 93 (3), pp. F187-91. Date of Electronic Publication: 2007 Jul 11.
Publication Year :
2008

Abstract

Background: Neonatal seizures are often subclinical, making accurate diagnosis difficult.<br />Objective: To describe the clinical manifestations of electrographic seizures recorded on continuous video-EEG, and to compare this description with the recognition of clinical seizures by experienced neonatal staff.<br />Methods: Term infants, at risk of seizures, were monitored by continuous 12-channel video-EEG from <6 hours of birth for up to 72 hours. All clinical seizures were recorded by experienced neonatal staff on individual seizure charts. Video-EEG recordings were subsequently analysed. The number, duration and clinical expression of electrographic seizures were calculated (in seconds), and compared with the seizures clinically suspected by the neonatal staff.<br />Results: Of 51 infants enrolled, nine had electrographic seizures. A further three had clinically suspected seizures, without associated electrographic abnormality. Of the total 526 electrographic seizures, 179 (34%) had clinical manifestations evident on the simultaneous video recording. The clinical seizure activity corresponded to 18.8% of the total electrographic seizure burden. Overdiagnosis also occurred frequently. Of the 177 clinically suspected seizure episodes documented by staff, 48 (27%) had corresponding electrographic evidence of seizure activity Thus, only 9% (48/526) of electrographic seizures were accompanied by clinical manifestations, which were identified and documented by neonatal staff.<br />Conclusion: Only one-third of neonatal EEG seizures displays clinical signs on simultaneous video recordings. Moreover, two-thirds of these clinical manifestations are unrecognised, or misinterpreted by experienced neonatal staff. In the recognition and management of neonatal seizures clinical diagnosis alone is not enough.

Details

Language :
English
ISSN :
1468-2052
Volume :
93
Issue :
3
Database :
MEDLINE
Journal :
Archives of disease in childhood. Fetal and neonatal edition
Publication Type :
Academic Journal
Accession number :
17626147
Full Text :
https://doi.org/10.1136/adc.2005.086314