Welcome to the 9th EAPS Congress Programme Scheduling

Abstract Body

Neonatal seizures are the most common neurological emergency in neonates and remain challenging to both clinicians and researchers as they are difficult to diagnose and difficult to treat requiring a multidisciplinary approach.
The new ILAE neonatal seizure classification provides a novel, evidence-based framework for the diagnosis and classification of neonatal seizures that integrates clinical signs and electroencephalographic findings to specify varying levels of diagnostic certainty. This classification uses the same framework and terminology as the 2017 ILAE seizure classification but is tailored towards neonates. All neonatal seizures are considered of focal onset and should be confirmed electrographically. Seizure types include motor events (automatisms, clonic, epileptic spasms, myoclonic, sequential, tonic) or non-motor events (autonomic, behavior arrest) or are electro-graphic only. It allows the user to choose the degree of detail when classifying seizures while taking underlying pathophysiological mechanisms into account.
There is substantial variability in management given limited data available to inform evidence-based management approaches. A clinical practice guideline working group of the ILAE is currently updating the WHO/ILAE Neonatal Seizure management guideline published in 2011 Recommendations include the choice of first-line and second-line treatment, duration of treatment, the effect of therapeutic hypothermia on seizure burden and use of pyridoxine. Results of these evidence and consensus-based recommendations will be presented which are expected to be published end of this year.

Abstract Body

The epilepsies are a group of heterogenous disorders across all ages, where epileptic seizures are the presenting symptom and have an impact on neurodevelopment, quality of life and mortality. They affect at least 6 million people in Europe; 65% individuals will respond to antiseizure drugs or enter spontaneous remission in their lifetime. Of the remaining two million, one third could benefit from a well conducted pre-surgical evaluation and epilepsy surgery. In addition, a significant number will have presented with a distinctive rare epilepsy syndrome/disease for which the prognosis for control of seizures and neurodevelopmental outcome is extremely poor. The International League Against Epilepsy recently released a series of publications on nosology of the epilepsies. Based on those publications we will present a review of current best practices in epilepsy care and treatment. Age at onset and aetiologies will be taken under consideration. Antiseizure medication characteristics and indications for early pre-surgical evaluation will be presented.

Background and Aims

Neonatal seizures are difficult to identify and pose diagnostic and management challenges. The aim was to see how the combination of a short duration EEG, rapid WGS and MRI influenced management.

Methods

A single centre, retrospective review was undertaken of infants aged 32 - 44 weeks corrected gestation admitted to a tertiary level neonatal unit between 2016 and 2021 with suspected clinical seizures. Only infants who had standard short duration EEG (1 hour), MRI and WGS were included in further analysis.

Results

Of 196 charts screened (Figure 1), 45 patients were stratified into 5 groups: suspected HIE (30/45); seizures of uncertain aetiology (7/45); perinatal stroke (1/45); infection (4/45); and congenital brain anomaly (3/45).

6/18 infants with suspected HIE demonstrated seizures on EEG, of which 4/6 had electrographic only seizures. MRI findings were confirmatory of HIE (14/30); normal (10/30), atypical for HIE (2/30) and haemorrhage (4/30).

In the group with seizures of uncertain aetiology (7/52), WGS identified genetic epilepsy (n=3), and metabolic diagnosis (n=1); EEG confirmed myoclonus (n=1); MRI identified positive findings in the remaining 2.

In the infant with perinatal stroke EEG was suggestive of a diagnosis. EEG identified seizures in 1/4 infants with infection and excluded seizures in all the infants with congenital brain anomaly.

Conclusions

In neonates with clinically suspected seizures, short duration EEG has a low diagnostic pick-up rate; continuous EEG is likely to improve diagnostic accuracy. Rapid WGS and MRI can help inform the diagnosis and subsequent management, especially when aetiology is unclear.