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Pediatric Neurology

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Seizure Burden, EEG, and Outcome in Neonates With Acute Intracranial Infections: A Prospective Multicenter Cohort Study - 08/11/22

Doi : 10.1016/j.pediatrneurol.2022.09.001 
Nehali Mehta, MD a, Renée A. Shellhaas, MD, MS b, Charles E. McCulloch, PhD c, Taeun Chang, MD d, Courtney J. Wusthoff, MD, MS e, f, Nicholas S. Abend, MD, MSCE g, h, i, Monica E. Lemmon, MD j, Catherine J. Chu, MD, MMSc k, Shavonne L. Massey, MD, MSCE g, h, Linda S. Franck, RN, PhD, FAAN l, Cameron Thomas, MD, MS m, Janet S. Soul, MDCM n, Elizabeth Rogers, MD o, Adam Numis, MD a, o, Hannah C. Glass, MDCM, MAS a, c, o, ⁎
a Department of Neurology and Weill Institute for Neuroscience, University of California San Francisco, San Francisco, California 
b Department of Pediatrics, University of Michigan, Ann Arbor, Michigan 
c Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California 
d Department of Neurology, Children's National Hospital, George Washington University School of Medicine, Washington, District of Columbia 
e Department of Neurology, Stanford University, Palo Alto, California 
f Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Palo Alto, California 
g Department of Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 
h Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 
i Department of Anesthesia and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 
j Departments of Pediatrics and Population Health Sciences, Duke University School of Medicine, Durham, North Carolina 
k Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 
l Department of Family Health Care Nursing, University of California San Francisco, San Francisco, California 
m Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio 
n Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts 
o Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California 

∗Communications should be addressed to: Dr. Glass; Department of Neurology; University of California, San Francisco, 675 Nelson Rising Ln, PO Box 0663; San Francisco, CA 94143.Department of NeurologyUniversity of California, San Francisco675 Nelson Rising LnPO Box 0663San FranciscoCA94143

Abstract

Background

Limited data exist regarding seizure burden, electroencephalogram (EEG) background, and associated outcomes in neonates with acute intracranial infections.

Methods

This secondary analysis was from a prospective, multicenter study of neonates enrolled in the Neonatal Seizure Registry with seizures due to intracranial infection. Sites used continuous EEG monitoring per American Clinical Neurophysiology Society guidelines. High seizure burden was defined a priori as seven or more EEG-confirmed seizures. EEG background was categorized using standardized terminology. Primary outcome was neurodevelopment at 24-months corrected age using Warner Initial Developmental Evaluation of Adaptive and Functional Skills (WIDEA-FS). Secondary outcomes were postneonatal epilepsy and motor disability.

Results

Twenty-seven of 303 neonates (8.9%) had seizures due to intracranial infection, including 16 (59.3%) bacterial, 5 (18.5%) viral, and 6 (22.2%) unknown. Twenty-three neonates (85%) had at least one subclinical seizure. Among 23 children with 24-month follow-up, the WIDEA-FS score was, on average, 23 points lower in children with high compared with low seizure burden (95% confidence interval, [−48.4, 2.1]; P = 0.07). After adjusting for gestational age, infection etiology, and presence of an additional potential acute seizure etiology, the effect size remained unchanged (β = −23.8, P = 0.09). EEG background was not significantly associated with WIDEA-FS score. All children with postneonatal epilepsy (n = 4) and motor disability (n = 5) had high seizure burden, although associations were not significant.

Conclusion

High seizure burden may be associated with worse neurodevelopment in neonates with intracranial infection and seizures. EEG monitoring can provide useful management and prognostic information in this population.

Le texte complet de cet article est disponible en PDF.

Keywords : Meningitis, Encephalitis, Seizures, Epilepsy, Neurocritical care, Central nervous system, Neonates


Plan


 Funding: This work was supported by the Patient-Centered Outcomes Research Institute, United States (grant number 2015C2-1507-31187).
 Disclosures: Dr. Mehta has no disclosures. Dr. Shellhaas receives research support from NIH, the Pediatric Epilepsy Research Foundation, and the University of Michigan. She receives royalties from UpToDate for authorship of topics related to neonatal seizures, serves as a consultant for the Epilepsy Study Consortium, and is an Associate Editor for Neurology. Dr. McCulloch has no disclosures. Dr. Chang has no disclosures. Dr. Wustoff has no disclosures. Dr. Abend has no disclosures. Dr. Lemmon receives salary support from NIH (K23NS116453). Dr. Chu receives research support from Biogen Inc, NIMH, and NINDS. She consults for Ovid Pharmaceuticals and Biogen Inc. Dr. Massey has no disclosures. Dr. Franck has no disclosures. Dr. Thomas receives research support through NIH and UCB. Dr. Soul has no disclosures. Dr. Rogers has no disclosures. Dr. Numis has no disclosures. Dr. Glass receives research support from NIH.


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