From the Divisions of Child Neurology and Pediatrics (Neonatology) (C.J.W.) and Division of Neonatal & Developmental Medicine, Department of Pediatrics (S.L.B.), Stanford University; Quantitative Sciences Unit (V.S.), Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (N.S.A., S.L.M.), Pediatrics (N.S.A., S.L.M.), and Anesthesia & Critical Care Medicine (N.S.A.), University of Pennsylvania Perelman School of Medicine; Department of Pediatrics (Division of Neurology) (N.S.A., S.L.M.), Children's Hospital of Philadelphia, PA; Departments of Pediatrics and Population Health Sciences (M.E.L.), Duke University School of Medicine, Durham, NC; Department of Pediatrics (C.T.), College of Medicine, Division of Neurology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH; Departments of Epidemiology and Biostatistics (C.E.M., H.C.G.) and Pediatrics (E.E.R.) and Department of Neurology and Weill Institute for Neuroscience and Department of Pediatrics, UCSF Benioff Children's Hospital (H.C.G.), University of California San Francisco; Neurology (T.C.), George Washington University School of Medicine, Children's National Hospital, Washington, DC; Department of Neurology (J.S.S.), Boston Children's Hospital, Harvard Medical School, MA; Department of Neurology (C.J.C.), Massachusetts General Hospital, Harvard Medical School, Boston; Division of Pediatric Neurology (M.R.C.), Department of Pediatrics, Saint-Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium; and Division of Pediatric Neurology (R.A.S.), Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor.
Neurology. 2021 Aug 10;97(6):e587-e596. doi: 10.1212/WNL.0000000000012293. Epub 2021 Jun 2.
To determine whether screening continuous EEG monitoring (cEEG) is associated with greater odds of treatment success for neonatal seizures.
We included term neonates with acute symptomatic seizures enrolled in the Neonatal Seizure Registry (NSR), a prospective, multicenter cohort of neonates with seizures. We compared 2 cEEG approaches: (1) screening cEEG, initiated for indications of encephalopathy or paralysis without suspected clinical seizures; and (2) confirmatory cEEG, initiated for the indication of clinical events suspicious for seizures, either alone or in addition to other indications. The primary outcome was successful response to initial seizure treatment, defined as seizures resolved without recurrence within 30 minutes after initial loading dose of antiseizure medicine. Multivariable logistic regression analyses assessed the association between cEEG approach and successful seizure treatment.
Among 514 neonates included, 161 (31%) had screening cEEG and 353 (69%) had confirmatory cEEG. Neonates with screening cEEG had a higher proportion of successful initial seizure treatment than neonates with confirmatory cEEG (39% vs 18%; < 0.0001). After adjusting for covariates, there remained a greater odds ratio (OR) for successful initial seizure treatment in the screening vs confirmatory cEEG groups (adjusted OR 2.44, 95% confidence interval 1.45-4.11, = 0.0008).
These findings provide evidence from a large, contemporary cohort of neonates that a screening cEEG approach may improve odds of successful treatment of acute seizures.
This study provides Class III evidence that for neonates a screening cEEG approach, compared to a confirmatory EEG approach, increases the probability of successful treatment of acute seizures.
确定新生儿癫痫发作的连续脑电图监测（cEEG）筛查是否与治疗成功率的提高有关。
我们纳入了急性症状性癫痫发作的足月新生儿，这些新生儿均来自新生儿癫痫发作登记处（NSR），这是一项前瞻性、多中心的癫痫发作新生儿队列研究。我们比较了两种 cEEG 方法：（1）筛查 cEEG，根据脑病或瘫痪的指征而启动，而无可疑的临床癫痫发作；（2）确认性 cEEG，根据临床可疑癫痫发作的指征而启动，无论是单独或另外还有其他指征。主要结局是初始抗癫痫治疗成功，定义为初始负荷剂量抗癫痫药物后 30 分钟内癫痫发作得到缓解且无复发。多变量逻辑回归分析评估了 cEEG 方法与成功治疗癫痫发作之间的关联。
在纳入的 514 例新生儿中，有 161 例（31%）接受了筛查 cEEG，353 例（69%）接受了确认性 cEEG。与接受确认性 cEEG 的新生儿相比，接受筛查 cEEG 的新生儿初始癫痫治疗成功率更高（39% vs 18%；<0.0001）。在调整了协变量后，筛查组与确认性 cEEG 组相比，初始癫痫治疗成功的优势比（OR）仍然更高（调整后的 OR 2.44，95%置信区间 1.45-4.11，=0.0008）。
这些发现为来自大型当代新生儿队列的证据提供了支持，即筛查 cEEG 方法可能提高急性癫痫发作治疗成功的几率。
本研究提供了 III 级证据，对于新生儿，与确认性脑电图方法相比，筛查 cEEG 方法可提高急性癫痫发作治疗成功的概率。
