Lack of response to treatment with levetiracetam in extreme preterm infants with seizures

The aim of this study was to evaluate the effectiveness of monotherapy with levetiracetam (LEV) in achieving seizure cessation in a retrospective cohort of extreme preterm infants with seizures. Charts of infants with a diagnosis of neonatal seizures admitted to the NICU between 2013 and 2017 were reviewed. Seizures were diagnosed using continuous video electroencephalography. All infants were initially started on LEV and reached a dose of 80 mg/kg/day. Other ASMs were added to LEV if seizures continued after 2 days. Data on additional clinical variables were collected for each infant. Sixty-one infants born <28 weeks of gestation met inclusion criteria. Seventy-four percent of patients did not respond to LEV monotherapy and required additional medications. LEV monotherapy stopped seizures in only a small portion of cases

Topiramate for Seizures in Preterm Infants and the Development of Necrotizing Enterocolitis

Neonatal seizures represent a significant health burden on the term and preterm neonatal population and are linked to poor long-term neurodevelopmental outcomes. Currently, there are no US Food and Drug Administration-approved antiepileptic drugs for neonates, and authors of the medical literature have yet to reach a consensus on the most adequate approach to neonatal seizures. Topiramate is readily used in the adult and older pediatric population for the management of migraines and partial-onset seizures. Topiramate continues to gain favor among pediatric neurologists who often recommend this medication as a third-line treatment of neonatal seizures. We report our recent experience with 4 preterm neonates, born between 2015 and 2017, who developed radiographic signs of necrotizing enterocolitis after receiving topiramate for seizures. Each was given oral topiramate for the treatment of electrographic and clinical seizures and developed the subsequent diagnosis of necrotizing enterocolitis, with abdominal distention, hemoccult-positive stools, and radiographic signs of intestinal distention and pneumatosis. More research regarding the risk factors of topiramate use in premature infants is needed

Detection of Electrographic Seizures by Critical Care Providers Using Color Density Spectral Array After Cardiac Arrest Is Feasible*

OBJECTIVE: To determine the accuracy and reliability of electroencephalographic seizure detection by critical care providers using color density spectral array (CDSA) electroencephalography (EEG). PARTICIPANTS: Critical care providers (attending physicians, fellow trainees and nurses.) INTERVENTIONS: A standardized powerpoint CDSA tutorial followed by classification of 200 CDSA images as displaying seizures or not displaying seizures. MEASUREMENTS AND MAIN RESULTS: Using conventional EEG recordings obtained from patients who underwent EEG monitoring after cardiac arrest, we created 100 CDSA images, 30% of which displayed seizures. The gold standard for seizure category was electroencephalographer determination from the full montage conventional EEG. Participants did not have access to the conventional EEG tracings. After completing a standardized CDSA tutorial, images were presented to participants in duplicate and in random order. Twenty critical care physicians (12 attendings and 8 fellows) and 19 critical care nurses classified the CDSA images as having any seizure(s) or no seizures. The 39 critical care providers had a CDSA seizure detection sensitivity of 70% [95% CI: 67%, 73%], specificity of 68% [95% CI: 67%, 70%], positive predictive value of 46%, and negative predictive value of 86%. The sensitivity of CDSA detection of status epilepticus was 72% [95% CI: 69%, 74%]. CONCLUSION: Determining which post-cardiac arrest patients experience electrographic seizures by critical care providers is feasible after a brief training. There is moderate sensitivity for seizure and status epilepticus detection and a high negative predictive value

Continuous EEG monitoring: A survey of neurophysiologists and neurointensivists

© 2014 International League Against Epilepsy. Objective: Continuous EEG monitoring (cEEG) of critically ill adults is being used with increasing frequency, and practice guidelines on indications for cEEG monitoring have recently been published. However, data describing the current practice of cEEG in critically ill adults is limited. We aimed to describe the current practice of cEEG monitoring in adults in the United States. Methods: A survey assessing cEEG indications and procedures was sent to one intensivist and one neurophysiologist responsible for intensive care unit (ICU) cEEG at 151 institutions in the United States. At some institutions only one physician could be identified. Results: One hundred thirty-seven physicians from 97 institutions completed the survey. Continuous EEG is utilized by nearly all respondents to detect nonconvulsive seizures (NCS) in patients with altered mental status following clinical seizures, intra cerebral hemorrhage (ICH), traumatic brain injury, and cardiac arrest, as well as to characterize abnormal movements suspected to be seizures. The majority of physicians monitor comatose patients for 24-48 h. In an ideal situation with unlimited resources, 18% of respondents would increase cEEG duration. Eighty-six percent of institutions have an on-call EEG technologist available 24/7 for new patient hookups, but only 26% have technologists available 24/7 in-house. There is substantial variability in who reviews EEG and how frequently it is reviewed as well as use of quantitative EEG. Significance: Although there is general agreement regarding the indications for ICU cEEG, there is substantial interinstitutional variability in how the procedure is performed

Consensus statement on continuous EEG in critically ill adults and children, part I: indications.

IntroductionCritical Care Continuous EEG (CCEEG) is a common procedure to monitor brain function in patients with altered mental status in intensive care units. There is significant variability in patient populations undergoing CCEEG and in technical specifications for CCEEG performance.MethodsThe Critical Care Continuous EEG Task Force of the American Clinical Neurophysiology Society developed expert consensus recommendations on the use of CCEEG in critically ill adults and children.RecommendationsThe consensus panel recommends CCEEG for diagnosis of nonconvulsive seizures, nonconvulsive status epilepticus, and other paroxysmal events, and for assessment of the efficacy of therapy for seizures and status epilepticus. The consensus panel suggests CCEEG for identification of ischemia in patients at high risk for cerebral ischemia; for assessment of level of consciousness in patients receiving intravenous sedation or pharmacologically induced coma; and for prognostication in patients after cardiac arrest. For each indication, the consensus panel describes the patient populations for which CCEEG is indicated, evidence supporting use of CCEEG, utility of video and quantitative EEG trends, suggested timing and duration of CCEEG, and suggested frequency of review and interpretation.ConclusionCCEEG has an important role in detection of secondary injuries such as seizures and ischemia in critically ill adults and children with altered mental status