Pediatric neurology briefs
Investigators from the University of California, San Francisco studied the yield of continuous video EEG (vEEG) in diagnosing electrographic seizures in their neonatal intensive care unit. Over a 4.5 year period, 595 neonates were evaluated, of which 66% were term and 67% referred from an outside hospital. Therapeutic hypothermia was completed in 25%. There was a 14% mortality rate. Neonates with electrographic seizures were identified by reviewing clinical vEEG reports.
vEEG was clinically indicated for 400/595 (67%) of the neonates, with approximately equal proportions for two or more of the following indications: event concerning for seizure, encephalopathy, or high risk for seizures. Continuous vEEG was performed for a median of 49 hours (interquartile range 22-87). All neonates undergoing therapeutic hypothermia received vEEG until rewarmed. Electrographic seizures were detected in 105/400 (26%), and of those 25/105 (24%) had only electrographic seizures, with no clinical seizures even prior to vEEG. No seizures were detected on vEEG in 52/400 (13%) of those with events concerning for seizure. Phenobarbital was given prior to vEEG in 38/51 (75%) of those patients and to 93/400 (23%) of the entire study population.
The indication for vEEG did not affect the likelihood of seizure diagnosis. There was some variability in seizure diagnosis based on etiology. Arterial and venous strokes had the highest proportion with seizures in 58%, and hypoxic-ischemic encephalopathy, intracranial hemorrhage and infection all around 29% and lower rates with brain malformation or genetic syndromes.
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Tammy Tsuchida. (2015) Diagnostic Yield of Continuous Video EEG for Neonatal Seizures. Pediatric Neurology Briefs, 29(8):63. http://dx.doi.org/10.15844/pedneurbriefs-29-8-6.