Neonatal Seizures: Is there a relationship between ictal electro-clinical features and etiology? – A critical appraisal based on a systematic literature review

Abstract The aim of this study was to evaluate whether specific etiologies of neonatal seizures have distinct ictal electro- clinical features. A systematic review of English articles using the PubMed database since 2004 (last update 9/26/16). Search terms included text words and MeSH terms related to neonatal seizures. Eligible articles included reports of neonates with seizures with a full description of seizure semiology and electroclinical findings. Independent extraction of data was performed by two authors using predefined data fields, including study quality indicators. Data was collected for every individual patient described in the articles. The dataset was analyzed with the Fisher?s exact test. The initial search led to 8507 titles; using filters, 2910 titles and abstracts were identified, with 177 full texts selected to be read. Fifty seven studies were included in the analysis with 151 neonates (37.7 male and 62.9% term). Genetic etiologies (51%) and sequential seizures (41.1%) predominated in this sample and hypoxic ischemic encephalopathy (HIE) accounted for only 4%. The low prevalence of HIE observed was probably due to a publication bias. A significant association was found between etiology and seizure type: hemorrhage with autonomic seizures (p=0.003), CNS infection and stroke with clonic seizures (p=0.042, pPeer reviewe

Automatic Detection of Epileptic Seizures in Neonatal Intensive Care Units through EEG, ECG and Video Recordings: A Survey

In Neonatal Intensive Care Units (NICUs), the early detection of neonatal seizures is of utmost importance for a timely, effective and efficient clinical intervention. The continuous video electroencephalogram (v-EEG) is the gold standard for monitoring neonatal seizures, but it requires specialized equipment and expert staff available 24/24h. The purpose of this study is to present an overview of the main Neonatal Seizure Detection (NSD) systems developed during the last ten years that implement Artificial Intelligence techniques to detect and report the temporal occurrence of neonatal seizures. Expert systems based on the analysis of EEG, ECG and video recordings are investigated, and their usefulness as support tools for the medical staff in detecting and diagnosing neonatal seizures in NICUs is evaluated. EEG-based NSD systems show better performance than systems based on other signals. Recently ECG analysis, particularly the related HRV analysis, seems to be a promising marker of brain damage. Moreover, video analysis could be helpful to identify inconspicuous but pathological movements. This study highlights possible future developments of the NSD systems: a multimodal approach that exploits and combines the results of the EEG, ECG and video approaches and a system able to automatically characterize etiologies might provide additional support to clinicians in seizures diagnosis

“EPINEO” Monocentric Retrospective Study on Neonatal Seizures: Incidence, ILAE Seizure Type, Epileptic Syndrome, EEG and Etiology

Purpose: In the last decade important updates have occurred in the management of neonatal seizures (NS) that may have changed NS epidemiology. The International League Against Epilepsy (ILAE) has published a new classification for neonatal seizures. The aim of our study was to determine the current incidence of NS and the correlation between ILAE seizure type, epileptic syndrome, EEG and etiology. Materials and methods: This is a retrospective single-center cohort study on consecutive neonates with neurophysiological confirmation of NS from 2009 to 2022 performed in a tertiary neonatal center. Clinical information including medical history, neurological examination, EEG/aEEG, neuroimaging, laboratory tests were inserted on a specifically designed Redcap database. Seizure type and epileptic syndromes were classified according to the new ILAE classification andEEG/aEEG with INNESCO score. Results and conclusions: 145 neonates presented with NS: 101 term (69.7%) and 44 preterm (30.3). Incidence in the overall population at our center was 1.59/1000, in the inborn population 1.11/1000, increasing with earlier gestational age up to 17 times. In comparison with previous studies, we found a reduction in HIE-related NS and a higher contribution of genetic etiology to NS mediated by different mechanisms: functional epilepsy, metabolic epilepsy, structural epilepsy and acute provoked seizures (metabolic or vascular etiology) having a genetic etiology as primary cause triggering the cascade of events finally leading to seizures. Our study confirms the usefulness of the new ILAE classification for neonates to address etiology, confirming the association previously found between seizure type and etiology. A problematic issue is represented by the high risk of inter-operator variability regarding the use of the “sequential seizure” term. Specific types of sequential seizures with tonic-onset or tonic-clonic sequence patterns, often with alternating side onset within the same seizure or different seizures, are highly related to epileptic channelopathies

Neonatal seizures: Is there a relationship between ictal electroclinical features and etiology? A critical appraisal based on a systematic literature review

The aim of this study was to evaluate whether specific etiologies of neonatal seizures have distinct ictal electroclinical features. A systematic review of English articles using the PubMed database since 2004 (last update 9/26/16). Search terms included text words and Medical Subject Headings (MeSH) terms related to neonatal seizures. Eligible articles included reports of neonates with seizures with a full description of seizure semiology and electroclinical findings. Independent extraction of data was performed by 2 authors using predefined data fields, including study quality indicators. Data were collected for every individual patient described in the articles. The dataset was analyzed with the Fisher exact test. The initial search led to 8507 titles; using filters, 2910 titles and abstracts were identified, with 177 full texts selected to be read. Fifty‐seven studies were included in the analysis with 151 neonates (37.7 male and 62.9% term). Genetic etiologies (51%) and sequential seizures (41.1%) predominated in this sample and hypoxic‐ischemic encephalopathy (HIE) accounted for only 4%. The low prevalence of HIE observed was probably due to a publication bias. A significant association was found between etiology and seizure type: hemorrhage with autonomic seizures (P = 0.003), central nervous system (CNS) infection and stroke with clonic seizures (P = 0.042, P < 0.001, respectively), metabolic/vitamin‐related disorders, and inborn errors of metabolism with myoclonic seizures (P < 0.001). There were also specific electroencephalography (EEG) patterns seen with certain etiologies: vascular disorders and electrolyte imbalance with focal ictal discharges (P < 0.001, P = 0.049 respectively), vitamin‐related disorders with multifocal (P = 0.003), and all categories of genetic disorders with burst‐suppression (P < 0.001). Clonic and autonomic seizures were more frequently present with focal EEG abnormalities (P = 0.001 and P < 0.001), whereas tonic and myoclonic seizures present with burst‐suppression (P = 0.001, P = 0.005). In conclusion, our data suggest that specific associations of etiologies of neonatal seizures with distinct clinical features and EEG patterns might help in the decision to establish appropriate treatment