Defining the gap between electrographic seizure burden, clinical expression and staff recognition of neonatal seizures

• Published in: Archives of disease in childhood. Fetal and neonatal edition Vol. 93; no. 3; pp. F187 - F191
• Main Authors: Murray, D M, Boylan, G B, Ali, I, Ryan, C A, Murphy, B P, Connolly, S
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health 01.05.2008; BMJ Publishing Group LTD
• Subjects: Babies; Clinical Competence; Convulsions & seizures; Electrodes; Electroencephalography; Electroencephalography - methods; Epilepsy; Female; Humans; Infant, Newborn; Infants; Intensive care; Intensive Care, Neonatal; Ireland; Male; Medical Staff, Hospital; Metabolic disorders; Monitoring, Physiologic - methods; Nursing; Nursing Staff, Hospital; Retrospective Studies; Seizures - diagnosis; Ireland
• ISSN: 1359-2998; 1468-2052
• DOI: 10.1136/adc.2005.086314

Background:Neonatal seizures are often subclinical, making accurate diagnosis difficult.Objective:To describe the clinical manifestations of electrographic seizures recorded on continuous video-EEG, and to compare this description with the recognition of clinical seizures by experienced neonatal staff.Methods:Term infants, at risk of seizures, were monitored by continuous 12-channel video-EEG from <6 hours of birth for up to 72 hours. All clinical seizures were recorded by experienced neonatal staff on individual seizure charts. Video-EEG recordings were subsequently analysed. The number, duration and clinical expression of electrographic seizures were calculated (in seconds), and compared with the seizures clinically suspected by the neonatal staff.Results:Of 51 infants enrolled, nine had electrographic seizures. A further three had clinically suspected seizures, without associated electrographic abnormality. Of the total 526 electrographic seizures, 179 (34%) had clinical manifestations evident on the simultaneous video recording. The clinical seizure activity corresponded to 18.8% of the total electrographic seizure burden. Overdiagnosis also occurred frequently. Of the 177 clinically suspected seizure episodes documented by staff, 48 (27%) had corresponding electrographic evidence of seizure activity Thus, only 9% (48/526) of electrographic seizures were accompanied by clinical manifestations, which were identified and documented by neonatal staff.Conclusion:Only one-third of neonatal EEG seizures displays clinical signs on simultaneous video recordings. Moreover, two-thirds of these clinical manifestations are unrecognised, or misinterpreted by experienced neonatal staff. In the recognition and management of neonatal seizures clinical diagnosis alone is not enough.