When newborns are deemed at-risk for seizures the optimum time for continuous video EEG monitoring ranges up to 120 hours, but Australian neurologists now suggest their new study might reduce that time.
In her presentation at the 73rd annual meeting of the American Epilepsy Society, Dr Emma Macdonald-Laurs, an epilepsy fellow at Royal Children’s Hospital in Melbourne, determined that if a child is going to have a seizure it is most likely going to occur within the first few hours after birth.
In her study, conducted while she was at Starship Children’s Hospital in Auckland, New Zealand, 97% of the children end up having their first event within 24 hours.
Dr Macdonald-Laurs said that of the 266 children in the study, 98 had seizures, and 55 of them – 56% had the first seizure within the first hour of monitoring. About 88% of the children experienced their first seizure within 10 hours.
“We wanted to determine if the first hour of video EEG monitoring at-risk babies was predictive of whether they would have a seizures,” she said at her poster presentation.
“The first hour of continuous EEG monitoring in term neonates at-risk of seizures predicts or detect neonates who will have seizures over the next 24 to 120 hours of monitoring. The majority of monitored neonates who have seizures do so early on.”
The study included babies who were considered at risk because they already had what was believed to be a seizure or because they had been diagnosed with hypoxic ischaemic encephalopathy. Of the 266 neonates in the study population, 173 were diagnosed with hypoxic ischemic encephalopathy.
“Standard of care for these children is to monitor them for 24-hours to 120 hours,” said Dr Macdonald-Laurs.
“It is important to detect the first seizure because it is at the time of the first seizure when you decide whether to treat them. The first hour was strongly, but not perfectly predictive of having seizures. One hour monitoring gives you good data. It tells you of this baby is at high risk or low risk. It helps us stratify the data a bit more.”
Commenting on the study, Dr Julia Jacobs, associate professor of pediatric neurology and director of the pediatric epilepsy program, at the University of Calgary, Alberta, Canada, said: “We are now looking at monitoring these babies for at least the first 48 hours, and discontinuing the monitoring if the EEG is normal after 48 hours. We have a technician watching these babies online continuously with a physician on-call.
“Whether we can shorten the window of observation has been a very big discussion at our center,” Dr Jacobs said.
“We might be thinking about shortening that period from 48 hours especially in the cases of the babies who have normal EEGs without seizures for the first 48 hours.
“It is important that we can take them off monitoring as soon as it is safe because for the families and caregivers, it is a lot of stress to have to see their baby with these leads on their heads, which can also disturb the skin. Our general feeling is that it might be safe to stop monitoring earlier than we do now. But we haven’t systematically done that yet,” she said.