Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
Division of Paediatric Neurology, Department of Paediatrics, Geneva University Hospital, Geneva, Switzerland.
J Clin Neurophysiol. 2022 Nov 1;39(7):616-624. doi: 10.1097/WNP.0000000000000825. Epub 2021 Feb 4.
The purpose of this study was to assess the prevalence, risk factors, and impact of electrographic seizures in neonates with complex congenital heart disease before cardiac surgery.
A cohort of 31 neonates with congenital heart disease monitored preoperatively with continuous video-EEG (cEEG) was first reviewed for electrographic seizure burden and EEG background abnormalities. Second, cEEG findings were correlated with brain MRI and 18-month outcomes.
Continuous video-EEG was recorded preoperatively for a median duration of 20.5 hours (range, 2.5-93.5 hours). The five neonates (16%; 95% confidence interval, 5.5% to 34%) with seizures detected on cEEG in the preoperative period had a diagnosis of transposition of the great arteries or similar physiology, detected in four of five postnatally. None of the 157 recorded electrographic seizures had a clinical correlate. The median time to first seizure was 65 minutes (range, 6-300 minutes) after cEEG hookup. The median maximum hourly seizure burden was 12.4 minutes (range, 7-23 minutes). Before the first electrographic seizure, a prolonged interburst interval (>10 seconds) was not associated with seizures (coefficient 1.2; 95% confidence interval, -1.1 to 3.6). MRI brain lesions were three times more common in neonates with seizures. Sharp wave transients on cEEG were associated with delayed opercular development.
In this cohort, preoperative electrographic seizures were common, were all subclinical, and were associated with MRI brain injury and postnatal diagnosis of transposition of the great arteries. The findings motivate further study of the mechanisms of preoperative brain injury, particularly among neonates with a postnatal diagnosis of transposition of the great arteries.
本研究旨在评估心脏手术前患有复杂先天性心脏病的新生儿中电癫痫发作的发生率、风险因素和影响。
首先回顾了一组 31 名接受连续视频脑电图 (cEEG) 监测的先天性心脏病新生儿，以评估电癫痫发作负担和脑电图背景异常。其次，将 cEEG 结果与脑 MRI 和 18 个月的结果相关联。
连续视频脑电图记录术前中位时间为 20.5 小时（范围，2.5-93.5 小时）。术前 cEEG 检测到的五例（16%；95%置信区间，5.5%至 34%）癫痫发作的新生儿患有大动脉转位或类似生理学的诊断，其中四例在产后检测到。记录的 157 次电癫痫发作中无一例具有临床相关性。首次癫痫发作的中位时间是在 cEEG 连接后 65 分钟（范围，6-300 分钟）。最大每小时癫痫发作负荷的中位数为 12.4 分钟（范围，7-23 分钟）。在首次电癫痫发作之前，爆发间隔延长（>10 秒）与癫痫发作无关（系数 1.2；95%置信区间，-1.1 至 3.6）。有癫痫发作的新生儿的 MRI 脑损伤更为常见。cEEG 上的尖波瞬态与外侧裂发育延迟有关。
在本队列中，术前电癫痫发作很常见，均为亚临床发作，与 MRI 脑损伤和产后大动脉转位诊断有关。这些发现促使进一步研究术前脑损伤的机制，特别是在产后诊断为大动脉转位的新生儿中。
