TY - JOUR
T1 - Effect of Treatment of Subclinical Neonatal Seizures Detected With aEEG: Randomized, Controlled Trial
AU - van Rooij, Linda G. M.
AU - Toet, Mona C.
AU - van Huffelen, Alexander C.
AU - Groenendaal, Floris
AU - Laan, Wijnand
AU - Zecic, Alexandra
AU - de Haan, Timo
AU - van Straaten, Irma L. M.
AU - Vrancken, Sabine
AU - van Wezel, Gerda
AU - van der Sluijs, Jaqueline
AU - ter Horst, Henk J.
AU - Gavilanes, Danilo
AU - Laroche, Sabrina
AU - Naulaers, Gunnar
AU - de Vries, Linda S.
PY - 2010/2
Y1 - 2010/2
N2 - OBJECTIVES: The goals were to investigate how many subclinical seizures in full-term neonates with hypoxic-ischemic encephalopathy (HIE) would be missed without continuous amplitude-integrated electroencephalography (aEEG) and whether immediate treatment of both clinical and subclinical seizures would result in a reduction in the total duration of seizures and a decrease in brain injury, as seen on MRI scans. METHODS: In this multicenter, randomized, controlled trial, term infants with moderate to severe HIE and subclinical seizures were assigned randomly to either treatment of both clinical seizures and subclinical seizure patterns (group A) or blinding of the aEEG registration and treatment of clinical seizures only (group B). All recordings were reviewed with respect to the duration of seizure patterns and the use of antiepileptic drugs (AEDs). MRI scans were scored for the severity of brain injury. RESULTS: Nineteen infants in group A and 14 infants in group B were available for comparison. The median duration of seizure patterns in group A was 196 minutes, compared with 503 minutes in group B (not statistically significant). No significant differences in the number of AEDs were seen. Five infants in group B received AEDs when no seizure discharges were seen on aEEG traces. Six of 19 infants in group A and 7 of 14 infants in group B died during the neonatal period. A significant correlation between the duration of seizure patterns and the severity of brain injury in the blinded group, as well as in the whole group, was found. CONCLUSIONS: In this small group of infants with neonatal HIE and seizures, there was a trend for a reduction in seizure duration when clinical and subclinical seizures were treated. The severity of brain injury seen on MRI scans was associated with a longer duration of seizure patterns. Pediatrics 2010;125:e358-e366
AB - OBJECTIVES: The goals were to investigate how many subclinical seizures in full-term neonates with hypoxic-ischemic encephalopathy (HIE) would be missed without continuous amplitude-integrated electroencephalography (aEEG) and whether immediate treatment of both clinical and subclinical seizures would result in a reduction in the total duration of seizures and a decrease in brain injury, as seen on MRI scans. METHODS: In this multicenter, randomized, controlled trial, term infants with moderate to severe HIE and subclinical seizures were assigned randomly to either treatment of both clinical seizures and subclinical seizure patterns (group A) or blinding of the aEEG registration and treatment of clinical seizures only (group B). All recordings were reviewed with respect to the duration of seizure patterns and the use of antiepileptic drugs (AEDs). MRI scans were scored for the severity of brain injury. RESULTS: Nineteen infants in group A and 14 infants in group B were available for comparison. The median duration of seizure patterns in group A was 196 minutes, compared with 503 minutes in group B (not statistically significant). No significant differences in the number of AEDs were seen. Five infants in group B received AEDs when no seizure discharges were seen on aEEG traces. Six of 19 infants in group A and 7 of 14 infants in group B died during the neonatal period. A significant correlation between the duration of seizure patterns and the severity of brain injury in the blinded group, as well as in the whole group, was found. CONCLUSIONS: In this small group of infants with neonatal HIE and seizures, there was a trend for a reduction in seizure duration when clinical and subclinical seizures were treated. The severity of brain injury seen on MRI scans was associated with a longer duration of seizure patterns. Pediatrics 2010;125:e358-e366
KW - neonatal seizures
KW - subclinical seizures
KW - amplitude-integrated electroencephalography
KW - antiepileptic drugs
U2 - 10.1542/peds.2009-0136
DO - 10.1542/peds.2009-0136
M3 - Article
C2 - 20100767
SN - 0031-4005
VL - 125
SP - E358-E366
JO - Pediatrics
JF - Pediatrics
IS - 2
ER -