Murray D M, Boylan G B, Ali I, Ryan C A, Murphy B P, Connolly S
Unified Maternity and Neonatal Services, Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.
Arch Dis Child Fetal Neonatal Ed. 2008 May;93(3):F187-91. doi: 10.1136/adc.2005.086314. Epub 2007 Jul 11.
Neonatal seizures are often subclinical, making accurate diagnosis difficult.
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.
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.
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.
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.
新生儿惊厥常为亚临床发作，难以准确诊断。
描述连续视频脑电图记录的电惊厥发作的临床表现，并将此描述与经验丰富的新生儿医护人员对临床惊厥的识别进行比较。
对有惊厥风险的足月儿自出生后6小时内开始进行连续12通道视频脑电图监测，最长监测72小时。所有临床惊厥均由经验丰富的新生儿医护人员记录在个人惊厥图表上。随后对视频脑电图记录进行分析。计算电惊厥发作的次数、持续时间和临床症状（以秒为单位），并与新生儿医护人员临床怀疑的惊厥进行比较。
在纳入的51例婴儿中，9例有脑电图惊厥发作。另有3例有临床怀疑的惊厥发作，但无相关脑电图异常。在总共526次脑电图惊厥发作中，179次（34%）在同步视频记录中有明显的临床表现。临床惊厥活动相当于总脑电图惊厥负荷的18.8%。过度诊断也经常发生。在工作人员记录的177次临床怀疑的惊厥发作中，48次（27%）有相应的惊厥活动脑电图证据。因此，只有9%（48/526）的脑电图惊厥发作伴有临床表现，且被新生儿医护人员识别并记录。
只有三分之一的新生儿脑电图惊厥发作在同步视频记录上显示临床体征。此外，这些临床表现中有三分之二未被经验丰富的新生儿医护人员识别或误判。在新生儿惊厥的识别和管理中，仅靠临床诊断是不够的。
