Department of Neurology, University of California at San Francisco, San Francisco, California 94143-0663, USA.
Pediatr Neurol. 2012 Feb;46(2):111-5. doi: 10.1016/j.pediatrneurol.2011.11.006.
Neonatal seizures are common clinical conditions in both term and preterm neonates, yet no clinical management guidelines for direct care exist. We surveyed 193 international neurologists, neonatologists, and specialists in neonatal neurology or neonatal neurocritical care to assess management practices for seizures in preterm and term neonates. We found high reported rates of electroencephalogram and amplitude-integrated electroencephalogram (aEEG) monitoring to detect neonatal seizures, prevalent use of older anticonvulsant agents, and high rates of neuroimaging. Overall, responses were similar for term and preterm neonates. However, term neonates were likelier to be more heavily investigated, with higher use of magnetic resonance imaging and of electroencephalogram and aEEG monitoring of at-risk neonates. Continuous monitoring and cranial imaging of neonatal seizures now comprise the standard of care in many centers, although management practices vary widely. Early recognition and management of neonatal seizures and possible underlying injury may lead to increased opportunities for stopping seizures, protecting the brain, and improving developmental outcomes in at-risk neonates. The need for collaboration among neonatologists and neurologists is urgent, to address gaps in knowledge regarding management of neonatal seizures in term and preterm neonates.
新生儿癫痫是足月和早产儿常见的临床病症,但目前尚无直接护理的临床管理指南。我们调查了 193 位国际神经科医生、新生儿科医生以及新生儿神经科或新生儿神经重症监护方面的专家,以评估对早产儿和足月儿癫痫发作的治疗方法。我们发现,有相当高的比例报告使用脑电图和振幅整合脑电图(aEEG)监测来检测新生儿癫痫,广泛使用较旧的抗癫痫药物,神经影像学检查的使用率也很高。总的来说,足月儿和早产儿的反应相似。然而,足月儿更有可能接受更深入的检查,更频繁地使用磁共振成像以及对高危新生儿进行脑电图和 aEEG 监测。目前,许多中心都将新生儿癫痫的连续监测和头颅影像学检查作为标准治疗方法,尽管治疗方法存在很大差异。早期识别和管理新生儿癫痫发作以及可能存在的潜在损伤,可能会增加停止癫痫发作、保护大脑和改善高危新生儿发育结局的机会。因此,新生儿科医生和神经科医生之间迫切需要合作,以解决关于足月儿和早产儿癫痫管理方面的知识差距问题。