An in-depth characterisation of neonatal seizures by early continuous video-EEG analysis

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dc.check.embargoformatNot applicableen
dc.check.infoNo embargo requireden
dc.check.opt-outNot applicableen
dc.check.reasonNo embargo requireden
dc.check.typeNo Embargo Required
dc.contributor.advisorBoylan, Geraldine B.en
dc.contributor.advisorRyan, C. Anthonyen
dc.contributor.authorLow, Evonne
dc.contributor.funderWellcome Trusten
dc.date.accessioned2016-12-20T12:44:42Z
dc.date.available2016-12-20T12:44:42Z
dc.date.issued2016
dc.date.submitted2016
dc.description.abstractIntroduction Seizures are harmful to the neonatal brain; this compels many clinicians and researchers to persevere further in optimizing every aspects of managing neonatal seizures. Aims To delineate the seizure profile between non-cooled versus cooled neonates with hypoxic-ischaemic encephalopathy (HIE), in neonates with stroke, the response of seizure burden to phenobarbitone and to quantify the degree of electroclinical dissociation (ECD) of seizures. Methods The multichannel video-EEG was used in this research study as the gold standard to detect seizures, allowing accurate quantification of seizure burden to be ascertained in term neonates. The entire EEG recording for each neonate was independently reviewed by at least 1 experienced neurophysiologist. Data were expressed in medians and interquartile ranges. Linear mixed models results were presented as mean (95% confidence interval); p values <0.05 were deemed as significant. Results Seizure burden in cooled neonates was lower than in non-cooled neonates [60(39-224) vs 203(141-406) minutes; p=0.027]. Seizure burden was reduced in cooled neonates with moderate HIE [49(26-89) vs 162(97-262) minutes; p=0.020] when compared with severe HIE. In neonates with stroke, the background pattern showed suppression over the infarcted side and seizures demonstrated a characteristic pattern. Compared with 10 mg/kg, phenobarbitone doses at 20 mg/kg reduced seizure burden (p=0.004). Seizure burden was reduced within 1 hour of phenobarbitone administration [mean (95% confidence interval): -14(-20 to -8) minutes/hour; p<0.001], but seizures returned to pre-treatment levels within 4 hours (p=0.064). The ECD index in cooled, non-cooled neonates with HIE, stroke and in neonates with other diagnoses were 88%, 94%, 64% and 75% respectively. Conclusions Further research exploring the treatment effects on seizure burden in the neonatal brain is required. A change to our current treatment strategy is warranted as we continue to strive for more effective seizure control, anchored with use of the multichannel EEG as the surveillance tool.en
dc.description.sponsorshipWellcome Trust (Grant 85249/z/08/z)en
dc.description.statusNot peer revieweden
dc.description.versionAccepted Version
dc.format.mimetypeapplication/pdfen
dc.identifier.citationLow, E. 2016. An in-depth characterisation of neonatal seizures by early continuous video-EEG analysis. PhD Thesis, University College Cork.en
dc.identifier.endpage276en
dc.identifier.urihttps://hdl.handle.net/10468/3400
dc.languageEnglishen
dc.language.isoenen
dc.publisherUniversity College Corken
dc.rights© 2016, Evonne Low.en
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/3.0/en
dc.subjectEEGen
dc.subjectNeonatal seizuresen
dc.subjectBrain monitoringen
dc.subjectDeveloping neonatal brainen
dc.subjectElectroclinical dissociation of seizuresen
dc.subjectMulti-channel EEGen
dc.subjectNeonatal strokeen
dc.subjectPhenobarbitoneen
dc.subjectSeizure burdenen
dc.subjectTherapeutic hypothermiaen
dc.subjectTreatmenten
dc.thesis.opt-outfalse
dc.titleAn in-depth characterisation of neonatal seizures by early continuous video-EEG analysisen
dc.typeDoctoral thesisen
dc.type.qualificationlevelDoctoral Degree (Structured)en
dc.type.qualificationnamePhD (Medicine and Health)en
ucc.workflow.supervisorg.boylan@ucc.ie
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