Department of Neurology, Stanford University School of Medicine, Palo Alto, CA, USA.
Departments of Neurology and Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA.
Pediatr Int. 2021 Jun;63(6):631-635. doi: 10.1111/ped.14654. Epub 2021 May 22.
Neonatal seizures present a unique diagnostic challenge with clinical manifestations often subtle or absent to the bedside observer. Seizures can be overdiagnosed in newborns with unusual paroxysmal movements and underdiagnosed in newborns without clinical signs of seizures. Electroclinical "uncoupling" also adds to the diagnostic challenge. Reliable diagnosis requires additional tools; continuous electroencephalogram (EEG) monitoring is the gold standard for diagnosis of neonatal seizures. Certain high-risk neonatal populations with known brain injury, such as stroke or hypoxic-ischemic encephalopathy, are most likely to benefit from continuous EEG. Studies have shown that risk stratification for continuous EEG has positive impact on care, including rapid and accurate diagnosis and treatment of neonatal seizures, which leads to reduced use of antiseizure medicines and length of hospital stay. This review describes common clinical manifestations of neonatal seizures, and clinical situations in which EEG monitoring to screen for seizures should be considered.
新生儿发作呈现出独特的诊断挑战，其临床表现常常在床边观察者中细微或缺失。在有不寻常阵发性运动的新生儿中，发作可能被过度诊断，而在没有临床发作迹象的新生儿中，发作可能被漏诊。电临床“脱耦”也增加了诊断挑战。可靠的诊断需要额外的工具；连续脑电图（EEG）监测是新生儿发作诊断的金标准。某些具有已知脑损伤的高危新生儿人群，如中风或缺氧缺血性脑病，最有可能从连续 EEG 中受益。研究表明，对连续 EEG 进行风险分层对护理具有积极影响，包括对新生儿发作的快速和准确诊断和治疗，这导致抗癫痫药物的使用减少和住院时间缩短。本文综述了新生儿发作的常见临床表现，以及应考虑进行 EEG 监测以筛查发作的临床情况。
