Wilhelmina Children's Hospital, Department of Neonatology, KE 04.123.1, PO Box 85090, 3508 AB Utrecht, Netherlands.
Pediatrics. 2010 Feb;125(2):e358-66. doi: 10.1542/peds.2009-0136. Epub 2010 Jan 25.
The goals were to investigate how many subclinical seizures in full-term neonates with hypoxic-ischemic encephalopathy (HIE) would be missed without continuous amplitude-integrated electroencephalography (aEEG) and whether immediate treatment of both clinical and subclinical seizures would result in a reduction in the total duration of seizures and a decrease in brain injury, as seen on MRI scans.
In this multicenter, randomized, controlled trial, term infants with moderate to severe HIE and subclinical seizures were assigned randomly to either treatment of both clinical seizures and subclinical seizure patterns (group A) or blinding of the aEEG registration and treatment of clinical seizures only (group B). All recordings were reviewed with respect to the duration of seizure patterns and the use of antiepileptic drugs (AEDs). MRI scans were scored for the severity of brain injury.
Nineteen infants in group A and 14 infants in group B were available for comparison. The median duration of seizure patterns in group A was 196 minutes, compared with 503 minutes in group B (not statistically significant). No significant differences in the number of AEDs were seen. Five infants in group B received AEDs when no seizure discharges were seen on aEEG traces. Six of 19 infants in group A and 7 of 14 infants in group B died during the neonatal period. A significant correlation between the duration of seizure patterns and the severity of brain injury in the blinded group, as well as in the whole group, was found.
In this small group of infants with neonatal HIE and seizures, there was a trend for a reduction in seizure duration when clinical and subclinical seizures were treated. The severity of brain injury seen on MRI scans was associated with a longer duration of seizure patterns.
本研究旨在探讨在不进行连续振幅整合脑电图（aEEG）监测的情况下，有多少患有缺氧缺血性脑病（HIE）的足月新生儿会漏诊亚临床发作，以及及时治疗临床和亚临床发作是否会减少总发作持续时间，并减少 MRI 扫描显示的脑损伤。
在这项多中心、随机、对照试验中，将中重度 HIE 合并亚临床发作的足月婴儿随机分为两组：一组为治疗临床发作和亚临床发作模式（A 组），另一组为 aEEG 记录和治疗临床发作（B 组）。所有记录均评估发作模式的持续时间和抗癫痫药物（AEDs）的使用情况。MRI 扫描评分用于评估脑损伤的严重程度。
A 组有 19 例婴儿和 B 组有 14 例婴儿可供比较。A 组的中位发作模式持续时间为 196 分钟，B 组为 503 分钟（无统计学意义）。两组 AED 使用率无显著差异。B 组中有 5 例婴儿在 aEEG 记录未见癫痫放电时使用了 AED。A 组的 19 例婴儿中有 6 例和 B 组的 14 例婴儿中有 7 例在新生儿期死亡。在盲法组和全组中，均发现发作模式持续时间与脑损伤严重程度之间存在显著相关性。
在这一小部分患有新生儿 HIE 和癫痫发作的婴儿中，当治疗临床和亚临床发作时，发作持续时间有缩短的趋势。MRI 扫描显示的脑损伤严重程度与发作模式持续时间较长有关。
