Major Philippe, Lortie Anne, Dehaes Mathieu, Lodygensky Gregory Anton, Gallagher Anne, Carmant Lionel, Birca Ala
Division of Neurology, CHU Sainte Justine, Department of Neurosciences and Paediatrics, University of Montreal, Montreal, Canada; CHU Sainte-Justine Research Center, Montreal, Canada.
Division of Neurology, CHU Sainte Justine, Department of Neurosciences and Paediatrics, University of Montreal, Montreal, Canada.
Seizure. 2017 Apr;47:13-16. doi: 10.1016/j.seizure.2017.03.002. Epub 2017 Mar 2.
Seizures are common in critically ill neonates. Both seizures and antiepileptic treatments may lead to short term complications and worsen the outcomes. Predicting the risks of seizure reoccurrence could enable individual treatment regimens and better outcomes. We aimed to identify EEG signatures of seizure reoccurrence by investigating periictal electrographic features and spectral power characteristics in hypothermic neonates with hypoxic-ischemic encephalopathy (HIE) with or without reoccurrence of seizures on rewarming.
We recruited five consecutive HIE neonates, submitted to continuous EEG monitoring, with high seizure burden (>20% per hour) while undergoing therapeutic hypothermia. Two of them had reoccurrence of seizures on rewarming. We performed quantitative analysis of fifteen artifact-free consecutive seizures to appreciate spectral power changes between the interictal, preictal and ictal periods, separately for each patient. Visual analysis allowed description of electrographic features associated with ictal events.
Every patient demonstrated a significant increase in overall spectral power from the interictal to preictal and ictal periods (p<0.01). Alpha power increase was more pronounced in the two patients with reoccurrence of seizures on rewarming and significant when comparing both interictal-to-preictal and interictal-to-ictal periods. This alpha activity increase could be also appreciated using visual analysis and distinguished neonates with and without seizure reoccurrence.
This distinct alpha activity preceding ictal onset could represent a biomarker of propensity for seizure reoccurrence in neonates. Future studies should be performed to confirm whether quantitative periictal characteristics and electrographic features allow predicting the risks of seizure reoccurrence in HIE neonates and other critically ill patients.
癫痫发作在危重新生儿中很常见。癫痫发作和抗癫痫治疗都可能导致短期并发症并使预后恶化。预测癫痫复发风险有助于制定个体化治疗方案并改善预后。我们旨在通过研究患有或未患有缺氧缺血性脑病（HIE）的低温新生儿在复温时癫痫复发与否的发作期周围脑电图特征和频谱功率特征，来确定癫痫复发的脑电图特征。
我们连续招募了5名HIE新生儿，在接受治疗性低温时进行连续脑电图监测，癫痫发作负担高（每小时>20%）。其中2名在复温时癫痫复发。我们对15次无伪迹的连续癫痫发作进行定量分析，以了解每位患者在发作间期、发作前期和发作期之间的频谱功率变化。视觉分析用于描述与发作事件相关的脑电图特征。
每位患者在从发作间期到发作前期和发作期时，整体频谱功率均显著增加（p<0.01）。在复温时癫痫复发的2名患者中，α波功率增加更为明显，在比较发作间期到发作前期和发作间期到发作期时均具有显著性。使用视觉分析也可观察到这种α波活动增加，并且可区分有无癫痫复发的新生儿。
发作开始前这种独特的α波活动可能代表新生儿癫痫复发倾向的生物标志物。未来应开展研究，以确认发作期周围定量特征和脑电图特征是否有助于预测HIE新生儿及其他危重症患者的癫痫复发风险。
