Research On The Clinical Analysis And Diagnostic Value Of Amplitude-integrated EEG In Neonatal Seizures

Part oneClinical Analysis of252cases with neonatal seizuresObjective:to analyze the clinical characteristics of neonatal seizure in the last10years, in order to provide clinical evidence for early diagnosis and prevention of neonatal seizures.Methods:Clinical datas of252cases of neonatal seizures between2001to2010were analyzed retrospectively.Results:From2001to2010, average incidence of neonatal seizure is0.89%(range:0.1%-1.7%), became higher in the recent years; Seizure types:multifoucal clonus the most,25.8%(65/252); subtle type,17.1%, and accured in most of the mixed type(60/252). Seizure type and Etiology:HIE in85cases (33.7%), cerebral hemorrhage and infarction in38cases (15.1%), metabolism disorders in49cases (19.2%), infections in32cases (12.7%), unknown causes in16cases (6.3%); other causes include cerebral dysplasia, epilepsy syndrome, family history, et al; HIE mainly manifested as subtle or multifocal clonus type; cerebral hemorrhage and infarction, infections, and metabolism disorders mainly showed as multifocal clonus and mixed type;61.9%of252neonatal seizure cases showed seizure with3days after birth, mainly seen in HIE and cerebral hemorrhage and infarction; and cases with metabolism disorders and infections have seizure more than three days after birth. Treatment and prognosis:75of them showed no seizure after hospitalized or treatment according to causes, without anticonvulsant treatment; the left177cases all received phenobarbitone at the first; some case, with controledwell, would be given other anticonvulsants, such as Valproate (10), clonazepam (7), diazepam (5), midazolam (5) and levetiracetam(2);8cases could not be controlled well with drugs above; poor prognosis included deaths (19), epilepsy (6), cerebral palsy (5), developmental delay(4) and blindness or deafness(3).Conclusion:The average incidence of neonatal seizure from2001to2010was0.89%inpatient neonate. The first cause remained HIE, and other causes were often seen in cerebral hemorrhage and infarction, metabolism disorders and infection. Neonatal seizures mainly showed as multifocal clonus and subtle type. Most of the seizures happened in three days after birth. The first choice of anticonvulsants treatment for neonatal seizures in our hospital still remained phenobarbitone.Part twoThe diagnostic value of amplitude EEG in neonatal seizuresObjective:characterize contemporary electrographic neonatal seizures by video EEG and assess the value and the limitations of double-channel (C3-C4/T3-T4) aEEG plus raw EEG signals used to diagnose neonatal seizure (with video EEG as a gold standard), with regard to both the background pattern and the recognition of electrical seizure activity in neonates who have (suspected) clinical seizures.Methods:66neonates with clinical or suspected clinical seizure were investigated and bedside VEEG was recorded for more than3hours. VEEG signals were transformed into aEEG signals. Background pattern and of aEEG and VEEG were analyzed independently and classified. aEEG background was classified according to Hellstrom-Westas’s classification, and EEG Pressler classification. Electrical seizure activity on VEEG was signed out with respect to its occurrence, duration, and localization of seizure onset, and aEEG seizure identification only. Status epilepticus (SE) was defined as recurrent seizure activity lasting50%of the time for a minimal duration of1hour.Results:A total of62traces were suitable for analysis. Background activity:(1) A CNV pattern on aEEG corresponded with a normal or a mild abnormal EEG in100%of the cases;(2)The positive predictive value for a severely abnormal aEEG (BS, CLV, FT) to correspond with a severely abnormal EEG was91.7%(negative predictive value,96%; sensitivity,84.6%; specificity,98%);(3)A DNV pattern on aEEG (24) mainly showed mildly (12) and moderate abnormal pattern(10). Eletrical seizure activity:(1) On VEEG, seizure activities were found in39patients,8SE and352non-status epilepticus (SE) electrical seizures in the other31patients (79.5%of which occurred over the centrotemporal region, only16%electrical ictal seizure activity associated with clinical seizures.);(2)8cases with SE on VEEG were all classified as SE on aEEG. The sensitivities of aEEG were49.1%(1-channel aEEG),54.5%(1-channel aEEG plus C3-C4raw EEG),81.3%(2-channel aEEG plus C3-C4/T3-T4raw EEG);(3)2-channel aEEG plus C3-C4/T3-T4raw EEG identified89.7%patients with≥1seizure activities, whereas1-channel aEEG and1-channel aEEG plus C3-C4raw EEG identified66.7%and74.4%patients with≥1seizure activity.Conclusions Seizure detection rate and identification of patients with seizures is much better with2-channel aEEG plus C3-C4/T3-T4raw EEG signals compared with1channel aEEG and1-channel aEEG with C3/C4raw EEG signals. aEEG is a reliable tool for monitoring background patterns especially normal and severely abnormal. When there is a DNV pattern on aEEG or a need for detail information about the seizure, Video EEG mornitoring is needed.