Yadav Bharti, Madaan Priyanka, Meena Jitendra, Kumar Jogender, Sahu Jitendra Kumar
Department of Neonatology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India.
Department of Pediatric Neurology, Amrita Institute of Medical Sciences, Faridabad, India.
Epilepsy Res. 2023 Oct 14;198:107244. doi: 10.1016/j.eplepsyres.2023.107244.
Electrographic seizures in neonates are commonly associated with poor neurodevelopmental outcomes. However, there is conflict in evidence whether control of electrographic seizures translate into improved neurodevelopmental outcome. We aimed to evaluate whether treating all electrographic seizures compared with treating clinical seizures leads to a better neurodevelopmental outcome at 18-24 months in neonates.
We searched four electronic databases (Medline, Cochrane Library, Embase, and Web of Science) for randomized controlled trials (RCTs) published until October 31, 2022. We included RCTs comparing the treatment of electrographic seizures with clinical seizures in neonates with or at risk of seizures. The Risk of Bias version 2 tool was used to assess the risk of bias. The random-effects meta-analysis was performed using RevMan 5.4 software.
Of the 2872 unique records identified by the database search, five trials involving 474 infants were eligible for the review. There was no significant difference in the incidence of neurodevelopmental disability at 18-24 months. Infants in the electrographic seizure group had lower scores in the cognitive domain (2 trials, 186 participants, MD: -5.4; 95% CI:-10.3 to -0.4, I-0%). There were no significant differences in scores in the motor and language domains, mortality, seizure burden, brain injury scores, antiseizure medication use, and post-neonatal epilepsy.
Having limitations of small number of trials and heterogeneity, the systematic review does not identify evidence demonstrating improved neurodevelopmental outcomes or improved survival in neonates treated for electrographic seizures versus clinical seizures.
新生儿的脑电图癫痫发作通常与不良的神经发育结局相关。然而，关于脑电图癫痫发作的控制是否能转化为改善的神经发育结局，证据存在冲突。我们旨在评估在新生儿18至24个月时，与治疗临床癫痫发作相比，治疗所有脑电图癫痫发作是否能带来更好的神经发育结局。
我们检索了四个电子数据库（Medline、Cochrane图书馆、Embase和科学网），以查找截至2022年10月31日发表的随机对照试验（RCT）。我们纳入了比较在有癫痫发作或有癫痫发作风险的新生儿中，治疗脑电图癫痫发作与临床癫痫发作的RCT。使用偏倚风险第2版工具评估偏倚风险。使用RevMan 5.4软件进行随机效应荟萃分析。
在数据库检索中识别出的2872条独特记录中，五项涉及474名婴儿的试验符合纳入综述的条件。18至24个月时神经发育残疾的发生率没有显著差异。脑电图癫痫发作组的婴儿在认知领域得分较低（2项试验，186名参与者，MD：-5.4；95%CI：-10.3至-0.4，I² = 0%）。在运动和语言领域得分、死亡率、癫痫发作负担、脑损伤评分、抗癫痫药物使用以及新生儿期后癫痫方面没有显著差异。
由于试验数量少和存在异质性，该系统评价未发现证据表明，与治疗临床癫痫发作相比，治疗脑电图癫痫发作的新生儿神经发育结局得到改善或生存率提高。
