Jan Saber, Northington Frances J, Parkinson Charlamaine M, Stafstrom Carl E
Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Dev Neurosci. 2017;39(1-4):82-88. doi: 10.1159/000454855. Epub 2017 Jan 17.
Electroencephalogram (EEG) monitoring techniques for neonatal hypoxia-ischemia (HI) are evolving over time, and the specific type of EEG utilized could influence seizure diagnosis and management. We examined whether the type of EEG performed affected seizure treatment decisions (e.g., the choice and number of antiseizure drugs [ASDs]) in therapeutic hypothermia-treated neonates with HI from 2007 to 2015 in the Johns Hopkins Hospital Neonatal Intensive Care Unit. During this period, 3 different EEG monitoring protocols were utilized: Period 1 (2007-2009), single, brief conventional EEG (1 h duration) at a variable time during therapeutic hypothermia treatment, i.e., ordered when a seizure was suspected; Period 2 (2009-2013), single, brief conventional EEG followed by amplitude-integrated EEG for the duration of therapeutic hypothermia treatment and another brief conventional EEG after rewarming; and Period 3 (2014-2015), continuous video-EEG (cEEG) for the duration of therapeutic hypothermia treatment (72 h) plus for an additional 12 h during and after rewarming. One hundred and sixty-two newborns were included in this retrospective cohort study. As a function of the type and duration of EEG monitoring, we assessed the risk (likelihood) of receiving no ASD, at least 1 ASD, or ≥2 ASDs. We found that the risk of a neonate being prescribed an ASD was 46% less during Period 3 (cEEG) than during Period 1 (brief conventional EEG only) (95% CI 6-69%, p = 0.03). After adjusting for initial EEG and MRI results, compared with Period 1, there was a 38% lower risk of receiving an ASD during Period 2 (95% CI: 9-58%, p = 0.02) and a 67% lower risk during Period 3 (95% CI: 23-86%, p = 0.01). The risk ratio of receiving ≥2 ASDs was not significantly different across the 3 periods. In conclusion, in addition to the higher sensitivity and specificity of continuous video-EEG monitoring, fewer infants are prescribed an ASD when undergoing continuous forms of EEG monitoring (aEEG or cEEG) than those receiving conventional EEG. We recommend that use of continuous video-EEG be considered whenever possible, both to treat seizures more specifically and to avoid overtreatment.
新生儿缺氧缺血性脑病（HI）的脑电图（EEG）监测技术随时间不断发展，所采用的EEG具体类型可能会影响癫痫的诊断和治疗。我们研究了2007年至2015年在约翰霍普金斯医院新生儿重症监护病房接受治疗性低温治疗的HI新生儿中，EEG检查类型是否会影响癫痫治疗决策（例如抗癫痫药物[ASD]的选择和数量）。在此期间，采用了3种不同的EEG监测方案：第1阶段（2007 - 2009年），在治疗性低温治疗期间的可变时间进行单次简短的常规EEG（持续1小时），即在怀疑癫痫发作时进行检查；第2阶段（2009 - 2013年），在治疗性低温治疗期间先进行单次简短的常规EEG，然后进行振幅整合EEG，复温后再进行另一次简短的常规EEG；第3阶段（2014 - 2015年），在治疗性低温治疗期间（72小时）及复温期间和复温后额外12小时进行持续视频脑电图（cEEG）监测。这项回顾性队列研究纳入了162例新生儿。根据EEG监测的类型和持续时间，我们评估了未接受ASD、至少接受1种ASD或≥2种ASD的风险（可能性）。我们发现，第3阶段（cEEG）新生儿接受ASD治疗的风险比第1阶段（仅简短常规EEG）低46%（95%CI 6 - 69%，p = 0.03）。在调整初始EEG和MRI结果后，与第1阶段相比，第2阶段接受ASD治疗的风险降低了38%（95%CI：9 - 58%，p = 0.02），第3阶段降低了67%（95%CI：23 - 86%，p = 0.01）。在这3个阶段中，接受≥2种ASD治疗的风险比无显著差异。总之，除了持续视频EEG监测具有更高的敏感性和特异性外，与接受常规EEG监测的婴儿相比，接受持续形式EEG监测（aEEG或cEEG）的婴儿接受ASD治疗的较少。我们建议尽可能考虑使用持续视频EEG，以便更精准地治疗癫痫并避免过度治疗。
