BACKGROUNDCritically ill neonates are at high risk for adverse neurologic sequelae, but the bedside evaluation of a neonate's neurologic status, especially cortical functioning, is extremely limited. In such circumstances, continuous video EEG provides particularly useful information about brain

American clinical neurophysiology society standardized EEG terminology and categorization for the description of continuous EEG monitoring in neonates: report of the American Clinical Neurophysiology Society critical care monitoring committee.

Seizures are the most common neurological emergency in the neonatal period and in contrast to those in infancy and childhood, are often provoked seizures with an acute cause and may be electrographic-only. Hence, neonatal seizures may not fit easily into classification schemes for seizures and epilepsies primarily developed for older children and adults. A Neonatal Seizures Task Force was established by the International League Against Epilepsy (ILAE) to develop a modification of the 2017 ILAE Classification of Seizures and Epilepsies, relevant to neonates. The neonatal classification framework emphasizes the role of electroencephalography (EEG) in the diagnosis of seizures in the neonate and includes a classification of seizure types relevant to this age group. The seizure type is determined by the predominant clinical feature. Many neonatal seizures are electrographic-only with no evident clinical features; therefore, these are included in the proposed classification. Clinical events without an EEG correlate are not included. Because seizures in the neonatal period have been shown to have a focal onset, a division into focal and generalized is unnecessary. Seizures can have a motor (automatisms, clonic, epileptic spasms, myoclonic, tonic), non-motor (autonomic, behavior arrest), or sequential presentation. The classification allows the user to choose the level of detail when classifying seizures in this age group.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/epi.16815

The ILAE classification of seizures and the epilepsies: Modification for seizures in the neonate. Position paper by the ILAE Task Force on Neonatal Seizures.

Summary: Purpose: Partial seizures in early postnatal life may be catastrophic and associated with poor long-term out- come. Epilepsy surgery can alleviate partial seizures in older children and adults, but there is little experience with surgical therapy in infancy apart from hemispheric epilepsy syndromes. Methods: We analyzed the results of cortical resection to treat medically refractory partial epilepsy in 31 children (16 boys, 15 girls) aged 90% seizure reduction, and 6 had <90% reduction. There was no significant difference in seizure outcome between hemispherectomy/ multilobar resections and lobar resections or temporal versus extratemporal resection. Seizure outcome was independent of the amount of cortex removed in nonlesional patients. Only the presence

Epilepsy Surgery in the First Three Years of Life

Summary: The effect of gestational age on neonatal ictal and interictal durations has not been investigated. Sixty-eight neonates with 644 electrographic seizures were identified retrospectively. Thirty-five full-term (FT) neonates were compared with 33 preterm (PT) neonates. Eighteen older preterm infants (OPT) [>31 weeks estimated gestational age (EGA)] were also compared with 15 young preterm infants (YPT) of ≤31 weeks EGA. Ictal/ interictal durations were calculated for the total cohort with and without status epilepticus (SE). Statistical analyses were two-tailed t tests, chi-square calculations, and one-way analysis of variance (ANOVA) with Duncan's multiple-range test. Eleven of 35 (33%) FT had SE as compared with 3 of 33 (9%) PT (chi-square = 7.8, p < 0.05). The mean ictal duration was 14.2 min for FT infants as compared with 3.1 min for PT infants (p < 0.01); only borderline differences were noted after those with SE were excluded. Interictal durations were longer for OPT than YPT (p < 0.05). By ANOVA and Duncan's multiple-range tests, group differences included longer mean ictal durations for FT infants as compared with OPT infants (p = 0.06, ANOVA; p < 0.05, Duncan's), and longer mean interictal durations for FT infants versus OPT and OPT versus YPT (p = 0.02, ANOVA; p < 0.05, Duncan's). More developed neuronal networks result in longer ictal durations in FT than in PT neonates, including FT infants with SE. Inhibitory networks responsible for longer interictal periods are more dominant in OPT infants than in YPT infants, reflecting maturational changes that suppress seizure activity during the latter part of the third trimester before the infant reaches an FT corrected age.

ReSUMe

L'effet de l'âge gestationnel sur les durees des periodes intercritiques et critiques en periode neonatale n'a pas eteetudie. Soixante-huit nouveaux-nes ayant presente 644 crises electrographiques ont ete identifies de facon retrospective. Trente-cinq nouveaux-nes B terme (T) ont ete compares B 33 nouveaux-nes prematures (P). Dix-huit nouveaux-nes prematures âges (PA) (âge gestationnel estime >31 semaines) ont egalement ete compares avec 15 prematures jeunes (PJ) d'bge gestationnel estime3lsemaines.Les durees critiques intercritiques ont ete calculees pour la cohorte totale avec et sans etat de ma1 epiletique (EDM). Les analyses statistiques ont comporte les tests t, CHI2, et l'analyse de variance (ANOVA) avec le test de Duncan. Onze des 35 (33% T ont presente un EDM, contre 3 des 33 P (9%) (X2 = 7,8, p < 0,05). La duree critique moyenne etait de 14,2 minutes pour les nouveaux-nes T, contre 3,1 minute pour les nouveaux-nes P (p < 0,01); des differences limites ont ete notees apres exclusion des patients ayant presente un EDM. Les durees intercritiques etaient plus longues pour les PA que pour les PJ (p < 0,05). Apres ANOVA et Duncan, les differences constatees entre les groupes comprenaient: duree moyenne critique plus longue pour les nouveaux-nes T compares aux nouveaux-nes PA (p = 0,06 (ANOVA), p < 0,05 (Duncan)), durte intercritique moyenne plus longue pour les enfants T par rapport aux PA et pour les PA par rapport aux PJ (p = 0,02 (ANOVA), p < 0,05 (Duncan)). Des circuits neuronaux plus dtveloppes entrainent des durees critiques plus importantes chez les nouveaux-nes T que chez les nouveaux-nes P, y compris chez les nouveaux-nes T presentant un EDM. Les reseaux inhibiteurs responsables des periodes intercritiques plus longues dominent chez les nouveaux-nes PA par rapport aux nouveaux-nes PJ, ce qui traduit des modifications de maturation qui suppriment l'activite critique pendant la dernitre partie du troisieme trimestre, avant que le nouveau-ne atteigne l'âge du terme.

ZUSAMMENFASSUNG

Die Auswirkung des Gestationsalters auf die iktale und interiktale Dauer bei Neugeborenen ist bislang noch nicht untersucht. Es wurden 68 Neugeborene mit 644 elektroencephalographis-chen Anfallen retrospektiv identifiziert. 35 Termingeborene (FT) wurden rnit 33 Frtihgeborenen (PT) verglichen. 18 altere Fruhgeborene (OPT) (>31 geschatzte Gestationswochen EGA) wurden ebenso mit 15 jungen fruhgeborenen Kindern (YPT)(>31 geschatzte Gestationswochen EGA verglichen. Die iktale/interiktale Dauer wurde fur die Gesamtgruppe mit und ohne Status epilepticus (SE) berechnet. Die statistischen Analysen bestanden aus zweiteiligen t-Tests, chi2-Tests und Einwegvarianzanalyse (ANOVA) rnit Duncan's multiplem Rangtest. 11 (33%) der 35 Reifgeborenen hatten einen SE verglichen mit 3 (9%) von 33 Fruhgeborenen (chi2= 7,8, p < 0,05). Die mittlere iktale Dauer betrug 14,2 Minuten fur Reifgeborene verglichen rnit 3, l Minuten fur Fruhgeborene (p < 0,01); es bestanden nur geringfugige Unterschiede nach Ausschluβ der Kinder rnit Status epilepticus. Die interiktale Dauer war bei alteren Fruhgeborenen langer als bei jungen Fruhgeborenen (p < 0,05). Mit ANOVA und Duncan's multiplem Rangtest schlossen die Gruppenunterschiede folgendes rnit ein: Die mittlere iktale Dauer war bei Reifgeborenen langer als bei alteren Fruhgeborenen (p = 0,06 ANOVA, p < 0.05 Duncan's), das mittlere interiktale Dauer war bei Reifgeborenen langer als bei alteren Fruhgeborenen und bei alteren Fruhgeborenen langer als bei jungen Fruhgeborenen (p = 0,02 ANOVA, p < 0,05 Duncan's). Das weiter entwickelte neuronale “Netzwerk” fuhrt bei Reifgeborenen zu lungerer iktaler Dauer als bei Fruhgeborenen, einschlieplich der Reifgeborenen mit Status epilepticus. Inhibitorische Schaltkreise, die fur langere interiktale Perioden verantwortlich sind, sind bei alteren Fruhgeborenen dominierender als bei jungen Fruhgeborenen. Dies gibt Reifungsveranderungen wieder, die die Anfallsaktivitat wahrend des letzten Teils des 3. Trimesters unterdrucken, bevor die Kinder ein korrigiertes Reifgeborenenalter erreichen.

Ictal and Interictal Electrographic Seizure Durations in Preterm and Term Neonates

Automated neonatal seizure detection mimicking a human observer reading EEG.

Despite the clinical and basic scientific importance of neonatal seizures, a standard operational definition of them is lacking. Virtually all quantitative studies of phenomenology, prevalence, treatment efficacy, and prognosis have been undermined by inadequate or inconsistent criteria for the object of investigation. This is not so much a fault of the studies, however, as a consequence of the very nature of neonatal seizures themselves, which seem to defy universally applicable definitions and criteria for quantification. The main obstacles to formulating such definitions are reviewed, and directions for further research are suggested.

What is a neonatal seizure? Problems in definition and quantification for investigative and clinical purposes.

Coma prognosis in children. Part II: clinical application.

Prediction of outcome from coma is a frequent and important task of neurologists. It is difficult enough in adult patients and even more difficult in children. Part I of this review considers some of the methodological problems and caveats besetting clinical research in this field: the very definition of coma, definition of the study population and outcome variables, study design, the fallacy of self-fulfilling prophecy, early death rate from nonneurologic causes resulting in low statistical power, and invalid attempts to compensate for that by combining outcome categories, lumping together age groups, short and inhomogeneous follow-up, and failure to provide confidence intervals. Part II reviews the clinical pediatric coma-prognosis literature, first according to etiology and then according to electrodiagnostic tests.

Coma prognosis in children. Part I: definitional and methodological challenges.

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What is a neonatal seizure? Problems in definition and quantification for investigative and clinical purposes.

Coma prognosis in children. Part II: clinical application.

Coma prognosis in children. Part I: definitional and methodological challenges.