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Hajipour S, Khombi Shooshtari M, Farbood Y, Ali Mard S, Sarkaki A, Moradi Chameh H, Sistani Karampour N, Ghafouri S. Fingolimod administration following hypoxia induced neonatal seizure can restore impaired long-term potentiation and memory performance in adult rats. Neuroscience 2023; 519:107-119. [PMID: 36990271 DOI: 10.1016/j.neuroscience.2023.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 02/18/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023]
Abstract
Neonatal seizures commonly caused by hypoxia can lead to long-term neurological outcomes. Early inflammation plays an important role in the pathology of these outcomes. Therefore, in the current study, we explored the long-term effects of Fingolimod (FTY720), an analog of sphingosine and potentsphingosine 1-phosphate(S1P) receptors modulator, as an anti-inflammatory and neuroprotective agent in attenuating anxiety, memory impairment, and possible alterations in gene expression of hippocampal inhibitory and excitatory receptors following hypoxia-induced neonatal seizure (HINS). Seizure was induced in 24 male and female pups (6 in each experimental group) at postnatal day 10 (P10) by premixed gas (5% oxygen/ 95% nitrogen) in a hypoxic chamber for 15 minutes. Sixty minutes after the onset of hypoxia, FTY720 (0.3 mg/kg) or saline (100 µl) was administered for 12 days (from P10 up to P21). Anxiety-like behavior and hippocampal memory function were assessed at P90 by elevated plus maze (EPM) and novel object recognition (NOR), respectively. Long-term potentiation (LTP) was recorded from hippocampal dentate gyrus region (DG) following stimulation of perforant pathway (PP). In addition, the hippocampal concentration of superoxide dismutase activity (SOD), malondialdehyde (MDA), and thiol as indices of oxidative stress were evaluated. Finally, the gene expression of NR2A subunit of N-Methyl-D-aspartic acid (NMDA) receptor, GluR2 subunit of (α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid) AMPA receptor and γ2 subunit of γ-Aminobutyric acid (GABAA) receptor were assessed at P90 by the quantitative real-time PCR. FTY720 significantly reduced later-life anxiety-like behavior, ameliorated object recognition memory and increased the amplitude and slope of the field excitatory postsynaptic potential (fEPSP) in the rats following HINS. These effects were associated with restoration of the hippocampal thiol content to the normal values and the regulatory role of FTY720 in the expression of hippocampal GABA and glutamate receptors subunits. In conclusion, FTY720 could restore the dysregulated gene expression of excitatory and inhibitory receptors. It also increased the reduced hippocampal thiol content, which was accompanied with attenuation of HINS-induced anxiety, reduced the impaired hippocampal related memory, and prevented hippocampal LTP deficits in later life following HINS.
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Khlif MS, Mesbah M, Colditz PB, Boashash B. Neonatal EEG seizure detection using a new signal structural complexity measure based on matching pursuit decomposition with nonstationary dictionary. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 224:107014. [PMID: 35849896 DOI: 10.1016/j.cmpb.2022.107014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/20/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE In newborns, it is often difficult to accurately differentiate between seizure and non-seizure based solely on clinical manifestations. This highlights the importance of electroencephalogram (EEG) in the recognition and management of neonatal seizures. This paper proposes an effective algorithm for the detection of neonatal seizure using multichannel EEG. METHODS Neonatal EEG changes morphology as it alternates between seizure and non-seizure states. A new signal complexity measure based on matching pursuit (MP) decomposition is proposed and used to detect transitions between these two states. The new measure, referred to as weighted structural complexity (WSC), was used for the detection of seizures in 30 newborn EEG records. Multiple IIR filters and an MP-based filter were designed and used to remove artifacts from the EEG data. Geometrical correlation between the EEG data channels was applied to reduce the number of false detections caused by remnant artifacts. The seizure detector's performance was assessed using several epoch-based (e.g., accuracy) and event-based (GDR = good detection rate and FD/h = false detections per hour) metrics. RESULTS Compared to the neurologist marking, the proposed detector was able to detect EEG seizures with 94% accuracy, 90.9% GDR, and 0.14 FD/h (95% CI: [0.06, 0.34]). CONCLUSIONS The high performance of the MP-based detector may have significant implications for the accurate diagnosis of neonatal seizures and the appropriate use of anticonvulsants and ongoing clinical assessment and care of the newborn.
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Affiliation(s)
- Mohamed Salah Khlif
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, 30 Royal Parade, Parkville, VIC 3052, Australia; University of Queensland Centre for Clinical Research, The University of Queensland, Building 71/918, Royal Brisbane & Women's Hospital Campus, Herston, QLD 4029, Australia
| | - Mostefa Mesbah
- Department of Electrical and Computer Engineering, College of Engineering, Sultan Qaboos University, PO Box 33 PC 123, Al-Khoud, Muscat, Oman; University of Queensland Centre for Clinical Research, The University of Queensland, Building 71/918, Royal Brisbane & Women's Hospital Campus, Herston, QLD 4029, Australia.
| | - Paul B Colditz
- University of Queensland Centre for Clinical Research, The University of Queensland, Building 71/918, Royal Brisbane & Women's Hospital Campus, Herston, QLD 4029, Australia
| | - Boualem Boashash
- University of Queensland Centre for Clinical Research, The University of Queensland, Building 71/918, Royal Brisbane & Women's Hospital Campus, Herston, QLD 4029, Australia
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Westergren H, Marell Hesla H, Altman M, Wickström R. Validation of central nervous system-induced seizures and other neurological variables in the Swedish Neonatal Quality Register. Acta Paediatr 2022; 111:1331-1337. [PMID: 35298855 PMCID: PMC9314797 DOI: 10.1111/apa.16336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 03/06/2022] [Accepted: 03/15/2022] [Indexed: 12/03/2022]
Abstract
Aim We sought to validate neurological variables and relevant International Classification of Diseases, Tenth Revision (ICD‐10) codes in the Swedish Neonatal Quality (SNQ) Register. Methods Register data were collected for 351 neonates, born between January 2009 and December 2016, who were treated at a neonatal unit in the Stockholm region on 385 occasions. They were eligible if the check‐box for central nervous system (CNS)‐induced seizures was ticked. The Register data, including relevant ICD‐10 codes, were validated by checking the patients' electronic medical charts. Results Most of the neonates were born at term (76%) and weighed >2500 g (80%). The variable CNS‐induced seizures had a positive predictive value of 46%. The ICD‐10 diagnosis P90.9A had a positive predictive value of 90%. This comprises seizures validated with electroencephalography, amplitude‐integrated electroencephalography or continuous function monitoring. The majority of the associated neurological variables in the Register had positive predictive values above 85%. Conclusion When the check‐box was ticked for central nervous system‐induced seizures, most of the neurological variables in the Register had high validity. However, the CNS‐induced seizures variable per se had a lower positive predictive value. Future SNQ Register‐based studies of such neonatal seizures should also include ICD‐10 P90.9A.
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Affiliation(s)
- Hanna Westergren
- Neuropaediatric Unit Department of Women´s and Children´s Health Karolinska Institute Solna Sweden
| | - Helena Marell Hesla
- Neuropaediatric Unit Department of Women´s and Children´s Health Karolinska Institute Solna Sweden
| | - Maria Altman
- Paediatric Rheumatology Unit Department of Clinical Epidemiology Unit Department of Medicine Karolinska Institute Solna Sweden
| | - Ronny Wickström
- Neuropaediatric Unit Department of Women´s and Children´s Health Karolinska Institute Solna Sweden
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Frassineti L, Lanata A, Mandredi C. HRV analysis: a non-invasive approach to discriminate between newborns with and without seizures . ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:52-55. [PMID: 34891237 DOI: 10.1109/embc46164.2021.9629741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Early neonatal seizures detection is one of the most challenging issues in Neonatal Intensive Care Units. Several EEG-based Neonatal Seizure Detectors were proposed to support the clinical staff. However, less invasive and more easily interpretable methods than EEG are still missing. In this work, we investigated if Heart Rate Variability analysis and related measures as input features of supervised classifiers could be a valid support for discriminating between newborns with seizures and seizure-free ones. The proposed methods were validated on 52 subjects (33 with seizures and 19 seizure-free) of a public dataset collected at the Helsinki University Hospital. Encouraging results are achieved using a Linear Support Vector Machine, obtaining about 87% Area Under ROC Curve. This suggests that Heart Rate Variability analysis might be a non-invasive pre-screening tool to identify newborns with seizures.Clinical Relevance- Heart Rate Variability analysis for detecting newborns with seizures in NICUs could speed up the diagnosis process and appropriate treatments for a better neurodevelopmental outcome of the infant.
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Frassineti L, Manfredi C, Olmi B, Lanata A. A Generalized Linear Model for an ECG-based Neonatal Seizure Detector. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:471-474. [PMID: 34891335 DOI: 10.1109/embc46164.2021.9630841] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Seizures represent one of the most challenging issues of the neonatal period's neurological emergency. Due to the heterogeneity of etiologies and clinical characteristics, seizures recognition is tricky and time-consuming. Currently, the gold standard for seizure diagnosis is Electroencephalography (EEG), whose correct interpretation requires a highly specialized team. Thus, to speed up and facilitate the detection of ictal events, several EEG-based Neonatal Seizure Detectors (NSDs) have been proposed in the literature. Research is currently exploiting more simple and less invasive approaches, such as Electrocardiography (ECG). This work aims at developing an ECG-based NSD using a Generalized Linear Model with features extracted from Heart Rate Variability (HRV) measures as input. The method is validated on a public dataset of 52 subjects (33 with seizures and 19 seizure-free). Achieved encouraging results show 69% Concatenated Area Under the ROC Curve (AUCcc) for the automatic detection of windows with seizure events, confirming that HRV features can be useful to catch the cardio-regulatory system alterations due to neonatal seizure events, particularly those related to Hypoxic-Ischaemic Encephalopathies. Thus, results suggest the use of ECG-based NSDs in clinical practice, especially when a timely diagnosis is needed and EEG technologies are not readily available.Clinical Relevance- An ECG-based Neonatal Seizure Detector could be a valid support to speed up the diagnosis of neonatal seizures, especially when EEG technologies for infants' neurological assessment are not readily available.
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Frassineti L, Lanatà A, Olmi B, Manfredi C. Multiscale Entropy Analysis of Heart Rate Variability in Neonatal Patients with and without Seizures. Bioengineering (Basel) 2021; 8:122. [PMID: 34562944 PMCID: PMC8469929 DOI: 10.3390/bioengineering8090122] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 11/16/2022] Open
Abstract
The complex physiological dynamics of neonatal seizures make their detection challenging. A timely diagnosis and treatment, especially in intensive care units, are essential for a better prognosis and the mitigation of possible adverse effects on the newborn's neurodevelopment. In the literature, several electroencephalographic (EEG) studies have been proposed for a parametric characterization of seizures or their detection by artificial intelligence techniques. At the same time, other sources than EEG, such as electrocardiography, have been investigated to evaluate the possible impact of neonatal seizures on the cardio-regulatory system. Heart rate variability (HRV) analysis is attracting great interest as a valuable tool in newborns applications, especially where EEG technologies are not easily available. This study investigated whether multiscale HRV entropy indexes could detect abnormal heart rate dynamics in newborns with seizures, especially during ictal events. Furthermore, entropy measures were analyzed to discriminate between newborns with seizures and seizure-free ones. A cohort of 52 patients (33 with seizures) from the Helsinki University Hospital public dataset has been evaluated. Multiscale sample and fuzzy entropy showed significant differences between the two groups (p-value < 0.05, Bonferroni multiple-comparison post hoc correction). Moreover, interictal activity showed significant differences between seizure and seizure-free patients (Mann-Whitney Test: p-value < 0.05). Therefore, our findings suggest that HRV multiscale entropy analysis could be a valuable pre-screening tool for the timely detection of seizure events in newborns.
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Affiliation(s)
- Lorenzo Frassineti
- Department of Information Engineering, Università degli Studi di Firenze, Via Santa Marta 3, 50139 Firenze, Italy; (A.L.); (B.O.); (C.M.)
- Department of Medical Biotechnologies, Università di Siena, 53100 Siena, Italy
| | - Antonio Lanatà
- Department of Information Engineering, Università degli Studi di Firenze, Via Santa Marta 3, 50139 Firenze, Italy; (A.L.); (B.O.); (C.M.)
| | - Benedetta Olmi
- Department of Information Engineering, Università degli Studi di Firenze, Via Santa Marta 3, 50139 Firenze, Italy; (A.L.); (B.O.); (C.M.)
| | - Claudia Manfredi
- Department of Information Engineering, Università degli Studi di Firenze, Via Santa Marta 3, 50139 Firenze, Italy; (A.L.); (B.O.); (C.M.)
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Frassineti L, Parente A, Manfredi C. Multiparametric EEG analysis of brain network dynamics during neonatal seizures. J Neurosci Methods 2020; 348:109003. [PMID: 33249182 DOI: 10.1016/j.jneumeth.2020.109003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 11/06/2020] [Accepted: 11/15/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND One of the most challenging issues in paediatric neurology is the diagnosis of neonatal seizures, whose delayed treatment may affect the neurodevelopment of the newborn. Formulation of the correct diagnosis is conditioned by the high number of perceptually or automatically detected false positives. NEW METHOD New methodologies are proposed to assess neonatal seizures trend over time. Our approach is based on the analysis of standardized trends of two properties of the brain network: the Synchronizabilty (S) and the degree of phase synchronicity given by the Circular Omega Complexity (COC). Qualitative and quantitative methods based on network dynamics allow differentiating seizure events from interictal periods and seizure-free patients. RESULTS The methods were tested on a public dataset of labelled neonatal seizures. COC shows significant differences among seizure and non-seizure events (p-value <0.001, Cohen's d 0.86). Combining S and COC in standardized temporal instants provided a reliable description of the physiological behaviour of the brain's network during neonatal seizures. COMPARISON WITH EXISTING METHOD(S) Few of the existing network methods propose an operative way for carrying their analytical approach into the diagnostic process of neonatal seizures. Our methods offer a simple representation of brain network dynamics easily implementable and understandable also by less experienced staff. CONCLUSIONS Our findings confirm the usefulness of the evaluation of brain network dynamics over time for a better understanding and interpretation of the complex mechanisms behind neonatal seizures. The proposed methods could also reliably support existing seizure detectors as a post-processing step in doubtful cases.
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Affiliation(s)
- Lorenzo Frassineti
- Department of Information Engineering, Universita' degli Studi di Firenze, Firenze, Italy; Department of Medical Biotechnologies, Universita' degli Studi di Siena, Siena, Italy.
| | - Angela Parente
- School of Engineering, Universita' degli Studi di Firenze, Firenze, Italy.
| | - Claudia Manfredi
- Department of Information Engineering, Universita' degli Studi di Firenze, Firenze, Italy.
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Zavadenko AN, Medvedev MI, Degtyareva MG. [Assessment of neurodevelopment in children of different gestational age with neonatal seizures]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 118:35-42. [PMID: 30585602 DOI: 10.17116/jnevro201811811135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To assess psychomotor development in infants with neonatal seizures (NS) born with different gestational age, by means of Bayley-III scales of infant and toddler development, in their corrected age of 1 year. MATERIAL AND METHODS The study included 52 infants, who had NS and were born with different gestational age: 28 weeks or less (n=26) - group I, 29-32 weeks (n=16) - group II, 33-36 weeks (n=3) - group III, 37-41 weeks (n=7) - group IV. The infants' neurodevelopment was evaluated in their corrected age of 1 year by means of N. Bayley scales of infant and toddler development, third edition: Cognitive, Language, Motor, Social-Emotional, and Adaptive Behavior. RESULTS AND CONCLUSION Only 17 (32,7%) of 52 examined infants did not demonstrate any developmental delay on each of five Bayley-III scales. Significant developmental delay (composite score <70) on at least one scale was revealed in 23 (44,2%) patients, including 12 (46,2%) in group I, 5 (31,3%) in group II, 6 (60%) of 10 in the combined group III-IV. In most cases, neurodevelopmental delays were attributed to only one domain and could be indicated as partial. The conclusion about global developmental retardation (the composite scores 55 or less on all five scales) was done in 3 patients, each of whom had a co-morbidity of cerebral palsy and epilepsy.
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Affiliation(s)
- A N Zavadenko
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - M I Medvedev
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - M G Degtyareva
- Pirogov Russian National Research Medical University, Moscow, Russia
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Carrasco M, Stafstrom CE. How Early Can a Seizure Happen? Pathophysiological Considerations of Extremely Premature Infant Brain Development. Dev Neurosci 2019; 40:417-436. [PMID: 30947192 DOI: 10.1159/000497471] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 02/04/2019] [Indexed: 11/19/2022] Open
Abstract
Seizures in neonates represent a neurologic emergency requiring prompt recognition, determination of etiology, and treatment. Yet, the definition and identification of neonatal seizures remain challenging and controversial, in part due to the unique physiology of brain development at this life stage. These issues are compounded when considering seizures in premature infants, in whom the complexities of brain development may engender different clinical and electrographic seizure features at different points in neuronal maturation. In extremely premature infants (< 28 weeks gestational age), seizure pathophysiology has not been explored in detail. This review discusses the physiological and structural development of the brain in this developmental window, focusing on factors that may lead to seizures and their consequences at this early time point. We hypothesize that the clinical and electrographic phenomenology of seizures in extremely preterm infants reflects the specific pathophysiology of brain development in that age window.
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Affiliation(s)
- Melisa Carrasco
- Division of Pediatric Neurology, Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Carl E Stafstrom
- Division of Pediatric Neurology, Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,
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Kharod SC, Carter BM, Kadam SD. Pharmaco-resistant Neonatal Seizures: Critical Mechanistic Insights from a Chemoconvulsant Model. Dev Neurobiol 2018; 78:1117-1130. [PMID: 30136373 PMCID: PMC6214781 DOI: 10.1002/dneu.22634] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 07/10/2018] [Accepted: 07/24/2018] [Indexed: 12/18/2022]
Abstract
Neonatal seizures are harmful to the developing brain and are associated with mortality and long-term neurological comorbidities. Hypoxic-ischemic encephalopathy (HIE) seizures represent a significant proportion of such seizures. Phenobarbital (PB) remains the first line anti-seizure drug (ASD) treatment but fails ~50% of the time. Translational models of neonatal seizures are crucial to investigating mechanisms underlying PB-resistance. A model of PB-resistant ischemic seizures in postnatal day 7 (P7) CD-1 mice reported K-Cl cotransporter 2 (KCC2) degradation that has been shown to be due to activation of the TrkB pathway. We investigated PB-efficacy in a pentylenetetrazole (PTZ) model of neonatal seizures in the same strain and age using identical treatment protocols to gain insights into mechanisms underlying PB-resistance. A single dose of PTZ (80 mg/kg; IP) consistently induced repetitive seizures that did not progress to status epilepticus (SE). PB (25 mg/kg; IP, single dose) significantly suppressed the PTZ-induced seizures. This was associated with significant KCC2 upregulation and stable Na-K-Cl cotransporter 1 (NKCC1) expression at 24h. The TrkB pathway was not activated. PTZ seizure burdens were significantly higher than those reported for ischemic seizures, indicating seizure severity did not dictate the differences in PB-efficacy. Bumetanide (BTN) (0.1-0.2 mg/kg; IP) did not work as an anti-seizure agent, similar to the ischemic model. When investigating mechanisms underlying the emergence of PB-resistance in translational models, the method by which seizures are induced may dictate mechanisms underlying emergence of PB-resistance.
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Affiliation(s)
- Shivani C. Kharod
- Neuroscience Laboratory, Johns Hopkins University School of Medicine; Baltimore, MD 21205
| | - Brandon M. Carter
- Neuroscience Laboratory, Johns Hopkins University School of Medicine; Baltimore, MD 21205
| | - Shilpa D. Kadam
- Neuroscience Laboratory, Johns Hopkins University School of Medicine; Baltimore, MD 21205
- Hugo Moser Research Institute at Kennedy Krieger; Department of Neurology, Johns Hopkins University School of Medicine; Baltimore, MD 21205
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Özalkaya E, Topcuoglu S, Karatepe H, Tüten A, Gokmen T, Karatekin G. Efficacy of levetiracetam in premature infants: our experience and review of the literature. J Matern Fetal Neonatal Med 2018; 32:4093-4096. [PMID: 29804480 DOI: 10.1080/14767058.2018.1481946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Objective: To evaluate levetiracetam (LEV) efficacy in preterm infants admitted in NICU.Study design: Clinical characteristics of 26 preterm infants treated with LEV were evaluated retrospectively. The results were compared with those of 44 preterm infants from the literature who were given LEV.Result: The mean gestational week of the infants receiving LEV was found as 26.7 ± 3.3 weeks, mean birth weight as 938 ± 561 g and mean dose of LEV as 17 ± 9.23 mg/kg. Overall seizure control rate with LEV was found as 65%, while seizure control was achieved by 11.5% when it was used as the first drug, 35% as the second drug and 15.3% as the third drug. The incidence of sepsis and intraventricular hemorrhage in seizure etiology was 73% in infants who received LEV. There was no side effect observed during LEV treatment.Conclusions: Seizure control was better achieved with LEV given as the 2nd antiepileptic in premature infants. Further studies with randomization of LEV and other antiepileptics in seizure control are needed.
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Affiliation(s)
- Elif Özalkaya
- Zeynep Kamil Maternity and Children Research and Training Hospital, İstanbul, Turkey
| | - Sevilay Topcuoglu
- Zeynep Kamil Maternity and Children Research and Training Hospital, İstanbul, Turkey
| | - Hande Karatepe
- Zeynep Kamil Maternity and Children Research and Training Hospital, İstanbul, Turkey
| | - Abdülhamit Tüten
- Zeynep Kamil Maternity and Children Research and Training Hospital, İstanbul, Turkey
| | - Tulin Gokmen
- Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
| | - Guner Karatekin
- Zeynep Kamil Maternity and Children Research and Training Hospital, İstanbul, Turkey
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Han JY, Moon CJ, Youn YA, Sung IK, Lee IG. Efficacy of levetiracetam for neonatal seizures in preterm infants. BMC Pediatr 2018; 18:131. [PMID: 29636029 PMCID: PMC5892045 DOI: 10.1186/s12887-018-1103-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 03/27/2018] [Indexed: 11/13/2022] Open
Abstract
Background Neonatal seizures remain a significant clinical problem, and therapeutic options are still not diverse with limited efficacy. Levetiracetam (LEV) is a relatively new and wide spectrum anti-seizure medication with favorable pharmacokinetics and safety profile. In the recent decades, LEV has been increasingly used for the treatment of neonatal seizures. The aim of this study was to describe the experience of using LEV as the first line anti-seizure medication for preterm infants. Methods A retrospective analysis of 37 preterm infants who were treated with LEV as the first-line anti-seizure medication was performed. Results Mean gestational age of the 37 preterm infants was 31.5 ± 1.9 weeks (range, 26 to 36+ 6 weeks). Twenty-one infants (57%) were seizure-free while given LEV at the end of the first week, and no additional anti-seizure medication was required. Loading doses of LEV ranged from 40 to 60 mg/kg (mean 56 mg/kg) and the maintenance dose ranged from 20 to 30 mg/kg (mean 23 mg/kg). No adverse effect was observed. Conclusions Levetiracetam can be a good and safe choice for treatment of neonatal seizures in preterm infants. Prospective double blind controlled studies are needed in the future.
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Affiliation(s)
- Ji Yoon Han
- Department of Pediatrics, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul, 137-701, South Korea
| | - Chung Joon Moon
- Department of Pediatrics, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul, 137-701, South Korea
| | - Young Ah Youn
- Department of Pediatrics, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul, 137-701, South Korea
| | - In Kyung Sung
- Department of Pediatrics, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul, 137-701, South Korea
| | - In Goo Lee
- Department of Pediatrics, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul, 137-701, South Korea.
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McNally MA, Hartman AL. Variability in Preferred Management of Electrographic Seizures in Neonatal Hypoxic Ischemic Encephalopathy. Pediatr Neurol 2017; 77:37-41. [PMID: 28982530 DOI: 10.1016/j.pediatrneurol.2017.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 06/05/2017] [Accepted: 06/13/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND Seizures may cause added harm in neonates with hypoxic-ischemic encephalopathy (HIE). Specific recommendations about seizure treatment in this context are lacking. We sought to determine the scope of practice regarding management of non-status epilepticus electrographic-only seizures in this setting. METHODS A case-based survey was distributed to members of the Child Neurology Society. Providers were asked about their preferred management strategy for sequential clinical scenarios. RESULTS A total of 177 child neurologists responded to the survey. Seventy-seven percent of providers would treat 20 seconds or less of electrographic seizure activity. In a neonate with mild HIE and an electrographic-only seizure, there was no agreement among providers regarding whether to start maintenance therapy in addition to a one-time anti-seizure drug load. In a neonate with moderate HIE on phenobarbital for early electro-clinical seizures, most providers would escalate treatment for ongoing electrographic-only seizures by increasing phenobarbital dosing. In a neonate with severe HIE complicated by status epilepticus on phenobarbital who subsequently develops recurrent electrographic-only seizures, providers varied substantially in their management preferences. For all three cases, 75% to 85% of providers would not change their management preferences based on the absence of a clinical correlate with the electrographic seizure. CONCLUSIONS We found marked variability among providers regarding preferred management of non-status epilepticus electrographic-only seizures after HIE. Our results identified specific aspects of electrographic-only seizure management in neonatal HIE where there is limited consensus. These discrepancies may serve as opportunities for future investigation.
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Affiliation(s)
- Melanie A McNally
- Division of Pediatric Neurology, Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Adam L Hartman
- Division of Pediatric Neurology, Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland; Division of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland.
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Sedighi M, Asadi F, Moradian N, Vakiliamini M, Moradian M. Efficacy and safety of levetiracetam in the management of seizures in neonates. ACTA ACUST UNITED AC 2017; 21:232-5. [PMID: 27356654 PMCID: PMC5107289 DOI: 10.17712/nsj.2016.3.20150726] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of levetiracetam (LEV) in the management of seizures in neonates. METHODS A prospective non-blind, single arm clinical trial conducted in the Department of Neonatology and Pediatric Intensive Care, Mohamad Kermanshahi, and Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran from May 2014 to December 2014. Fifty out of 60 newborns with gestational age >/=30 weeks with clinically diagnosed seizures were included. Levetiracetam was administered orally with an initial dose of 10 mg/kg twice a day. The patients were observed continuously by Neuro Intensive Care nurses, and visited daily by a neuropediatrician in the first 7 days and then at days 14, 30, and 90 after the start of LEV administration. Clinical examination was performed for every patient, and seizure number, antiepileptic medication, and adverse events were detailed at every visit. RESULTS 47 infants were seizure free under LEV at the end of the first week, 47 remained seizure free at 4 weeks, and 46 remained seizure free at 11 weeks. No immediate and long-term side effects were noted in our patients. CONCLUSION This study investigated the efficacy and safety of LEV in neonatal seizure control but confirmation with further randomized controlled trials is required.
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Affiliation(s)
- Mostafa Sedighi
- Department of Neurology, Mohamad Kermanshahi Hospital, Kermanshah, Islamic Republic of Iran
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16
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Low E, Stevenson NJ, Mathieson SR, Livingstone V, Ryan AC, Rennie JM, Boylan GB. Short-Term Effects of Phenobarbitone on Electrographic Seizures in Neonates. Neonatology 2016; 110:40-6. [PMID: 27027306 PMCID: PMC5079066 DOI: 10.1159/000443782] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 01/04/2016] [Accepted: 01/04/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Phenobarbitone is the most common first-line anti-seizure drug and is effective in approximately 50% of all neonatal seizures. OBJECTIVE To describe the response of electrographic seizures to the administration of intravenous phenobarbitone in neonates using seizure burden analysis techniques. METHODS Multi-channel conventional EEG, reviewed by experts, was used to determine the electrographic seizure burden in hourly epochs. The maximum seizure burden evaluated 1 h before each phenobarbitone dose (T-1) was compared to seizure burden in periods of increasing duration after each phenobarbitone dose had been administered (T+1, T+2 to seizure offset). Differences were analysed using linear mixed models and summarized as means and 95% CI. RESULTS Nineteen neonates had electrographic seizures and met the inclusion criteria for the study. Thirty-one doses were studied. The maximum seizure burden was significantly reduced 1 h after the administration of phenobarbitone (T+1) [-14.0 min/h (95% CI: -19.6, -8.5); p < 0.001]. The percentage reduction was 74% (IQR: 36-100). This reduction was temporary and not significant within 4 h of administrating phenobarbitone. Subgroup analysis showed that only phenobarbitone doses at 20 mg/kg resulted in a significant reduction in the maximum seizure burden from T-1 to T+1 (p = 0.002). CONCLUSIONS Phenobarbitone significantly reduced seizures within 1 h of administration as assessed with continuous multi-channel EEG monitoring in neonates. The reduction was not permanent and seizures were likely to return within 4 h of treatment.
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Affiliation(s)
- Evonne Low
- Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research, Department of Paediatrics and Child Health, University College Cork, Cork University Maternity Hospital, Cork, Ireland
| | - Nathan J. Stevenson
- Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research, Department of Paediatrics and Child Health, University College Cork, Cork University Maternity Hospital, Cork, Ireland
| | - Sean R. Mathieson
- Academic Research Department of Neonatology, Institute for Women's Health, University College London, London, UK
| | - Vicki Livingstone
- Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research, Department of Paediatrics and Child Health, University College Cork, Cork University Maternity Hospital, Cork, Ireland
| | - Anthony C. Ryan
- Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research, Department of Paediatrics and Child Health, University College Cork, Cork University Maternity Hospital, Cork, Ireland
| | - Janet M. Rennie
- Academic Research Department of Neonatology, Institute for Women's Health, University College London, London, UK
| | - Geraldine B. Boylan
- Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research, Department of Paediatrics and Child Health, University College Cork, Cork University Maternity Hospital, Cork, Ireland
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Multiscale Entropy of Electroencephalogram as a Potential Predictor for the Prognosis of Neonatal Seizures. PLoS One 2015; 10:e0144732. [PMID: 26658680 PMCID: PMC4676749 DOI: 10.1371/journal.pone.0144732] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 11/23/2015] [Indexed: 01/08/2023] Open
Abstract
Objective Increasing animal studies supported the harmful effects of prolonged or frequent neonatal seizures in developing brain, including increased risk of later epilepsy. Various nonlinear analytic measures had been applied to investigate the change of brain complexity with age. This study focuses on clarifying the relationship between later epilepsy and the changes of electroencephalogram (EEG) complexity in neonatal seizures. Methods EEG signals from 19 channels of the whole brain from 32 neonates below 2 months old were acquired. The neonates were classified into 3 groups: 9 were normal controls, 9 were neonatal seizures without later epilepsy, and 14 were neonatal seizures with later epilepsy. Sample entropy (SamEn), multiscale entropy (MSE) and complexity index (CI) were analyzed. Results Although there was no significant change in SamEn, the CI values showed significantly decreased over Channels C3, C4, and Cz in patients with neonatal seizures and later epilepsy compared with control group. More multifocal epileptiform discharges in EEG, more abnormal neuroimaging findings, and higher incidence of future developmental delay were noted in the group with later epilepsy. Conclusions Decreased MSE and CI values in patients with neonatal seizures and later epilepsy may reflect the mixed effects of acute insults, underlying brain immaturity, and prolonged seizures-related injuries. The analysis of MSE and CI can therefore provide a quantifiable and accurate way to decrypt the mystery of neonatal seizures, and could be a promising predictor.
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Handa D, Barclay N, Rehrauer D, Lakshminrusimha S. Case 2: Early Neonatal Seizures. Neoreviews 2015; 16:e645. [PMID: 27004045 PMCID: PMC4798245 DOI: 10.1542/neo.16-11-e645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Deepali Handa
- Department of Pediatrics, University at Buffalo, State University of New York and Neonatal Intensive Care Unit, Women and Children's Hospital of Buffalo, NY
| | - Nancy Barclay
- Department of Pediatrics, University at Buffalo, State University of New York and Neonatal Intensive Care Unit, Women and Children's Hospital of Buffalo, NY
| | - David Rehrauer
- Department of Pediatrics, University at Buffalo, State University of New York and Neonatal Intensive Care Unit, Women and Children's Hospital of Buffalo, NY
| | - Satyan Lakshminrusimha
- Department of Pediatrics, University at Buffalo, State University of New York and Neonatal Intensive Care Unit, Women and Children's Hospital of Buffalo, NY
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Hellström‐Westas L, Boylan G, Ågren J. Systematic review of neonatal seizure management strategies provides guidance on anti-epileptic treatment. Acta Paediatr 2015; 104:123-9. [PMID: 25251733 DOI: 10.1111/apa.12812] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 07/11/2014] [Accepted: 09/19/2014] [Indexed: 11/28/2022]
Abstract
UNLABELLED There is a lack of scientific evidence to support the best management of neonatal seizures. Current strategies for neonatal seizure management were investigated by analysis of all surveys published during the time period 2000-2012. Methods for seizure diagnosis and availability of electroencephalogram (EEG), including monitoring, varied. Phenobarbital was the drug of first choice, and the use of off-label drugs and treatment times varied. CONCLUSION We conclude that there is an urgent need for more evidence-based studies to guide neonatal seizure management.
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Affiliation(s)
| | - Geraldine Boylan
- Department of Paediatrics & Child Health University College Cork Cork Ireland
| | - Johan Ågren
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
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Role of intravenous levetiracetam for acute seizure management in preterm neonates. Pediatr Neurol 2013; 49:340-3. [PMID: 23921284 DOI: 10.1016/j.pediatrneurol.2013.05.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 05/13/2013] [Accepted: 05/24/2013] [Indexed: 01/02/2023]
Abstract
BACKGROUND Neonatal seizures are common in the first month of life and may impair neurodevelopmental outcome. Current antiepileptic drugs used in the treatment of neonatal seizures have limited efficacy and undesirable side effects. Intravenous levetiracetam is increasingly being used in the neonatal period to treat seizures. Presently, insufficient data about the efficacy and safety of intravenous levetiracetam in preterm neonates exist. METHODS We retrospectively analyzed data from preterm neonates who were treated with intravenous levetiracetam at our institution between January 2007 and December 2011. Data were acquired from review of our institution's electronic medical record regarding patients who were treated with intravenous levetiracetam during the neonatal period (0 to 28 days) and were born at preterm gestation (<37 weeks). RESULTS Twelve patients received a levetiracetam load of 25 to 50 mg/kg for neonatal seizures. Nine of 11 patients (82%) reached seizure cessation within 24 hours of receiving levetiracetam. No serious side effects were evident. Seven patients (59%) were discharged on oral levetiracetam alone, four patients (33%) were discharged on no oral antiepileptic drug, and one patient (8%) was discharged on levetiracetam and phenobarbital. Eleven of 12 patients were followed up to 6 months after receiving intravenous levetiracetam. Of these, six patients (55%) had achieved seizure freedom and been completely weaned off of all antiepileptic drugs. Three patients (27%) had achieved seizure freedom while still on oral levetiracetam. CONCLUSIONS Intravenous levetiracetam appears to be efficacious for seizure management in preterm neonates.
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Gaynor JW, Jarvik GP, Gerdes M, Kim DS, Rajagopalan R, Bernbaum J, Wernovsky G, Nicolson SC, Spray TL, Clancy RR. Postoperative electroencephalographic seizures are associated with deficits in executive function and social behaviors at 4 years of age following cardiac surgery in infancy. J Thorac Cardiovasc Surg 2013; 146:132-7. [PMID: 23768805 DOI: 10.1016/j.jtcvs.2013.04.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 04/03/2013] [Accepted: 04/09/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The occurrence of an electroencephalographic (EEG) seizure after surgery for complex congenital heart defects has been associated with worse neurodevelopmental (ND) outcomes. We previously identified postoperative seizures documented by 48-hour EEG monitoring in 11% of 178 neonates and infants. Evaluation at 1 year of age did not identify an adverse effect of an EEG seizure on ND outcomes. The current study was undertaken to determine if testing in the preschool period would identify deficits that become apparent as children develop. METHODS The ND outcomes assessed at 4 years of age included cognition, language, attention, impulsivity, executive function, behavior problems, academic achievement, and visual and fine motor skills. RESULTS Developmental evaluations were performed in 132 (87%) of 151 survivors. For the entire cohort, the Full-Scale IQ was 95.0 ± 18.5. IQ was 95.1 ± 18.7 for patients without a history of seizure and 93.6 ± 16.7 for those with a history of seizure. After covariate adjustment, occurrence of an EEG seizure was associated with worse executive function (P = .037) and impaired social interactions/restricted behavior (P = .05). Seizures were not significantly associated with worse performance for cognition, language, attention, impulsivity, academic achievement, or motor skills (all P > .1). CONCLUSIONS The occurrence of a postoperative seizure is a biomarker of brain injury. This study confirms that postoperative EEG seizures are associated with worse ND outcomes, characterized by impairments of executive function and a higher prevalence of deficits in social interactions and repetitive/restricted behaviors in preschool survivors of cardiac surgery in infancy. However, EEG seizures were not associated with worse cognitive, language, or motor skills.
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Affiliation(s)
- J William Gaynor
- Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
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Aceves J, Khan O, Mungall D, Fonkem E, Wright C, Wenner A, Kirmani B. Efficacy and tolerability of intravenous levetiracetam in childrens. Front Neurol 2013; 4:120. [PMID: 23966977 PMCID: PMC3743038 DOI: 10.3389/fneur.2013.00120] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 08/02/2013] [Indexed: 11/13/2022] Open
Abstract
Intractable epilepsy in children poses a serious medical challenge. Acute repetitive seizures and status epilepticus leads to frequent emergency room visits and hospital admissions. Delay of treatment may lead to resistance to the first-line anticonvulsant therapies. It has been shown that these children continue to remain intractable even after acute seizure management with approved Food and Drug Administration (FDA) agents. Intravenous levetiracetam, a second-generation anticonvulsant was approved by the FDA in 2006 in patients 16 years and older as an alternative when oral treatment is not an option. Data have been published showing that intravenous levetiracetam is safe and efficacious, and can be used in an acute inpatient setting. This current review will discuss the recent data about the safety and tolerability of intravenous levetiracetam in children and neonates, and emphasize the need for a larger prospective multicenter trial to prove the efficacy of this agent in acute seizure management.
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Affiliation(s)
- Jose Aceves
- Department of Pediatrics, Division of Pediatric Neurology, Texas A&M Health Science Center College of Medicine, Scott & White Hospital , Temple, TX , USA
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Lim SJ, Jun JK, Youn YA, Moon CJ, Kim SJ, Lee JY, Lee HS, Lee JH, Kim SY, Sung IK. Follow-up of Full-term Neonatal Seizures: Prognostic Factors for Neurodevelopmental Sequelae. NEONATAL MEDICINE 2013. [DOI: 10.5385/nm.2013.20.1.97] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Soo Jung Lim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ja Kyung Jun
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Ah Youn
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chung Joon Moon
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soon Ju Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ju Young Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Seung Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Hyun Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - So Young Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In Kyung Sung
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Jun JK, Moon CJ, Kim SJ, Youn YA, Lee JY, Lee HS, Lee JH, Sung IK, Kim SY. Partial Seizures Manifesting as Apnea Only in Preterm Infant. NEONATAL MEDICINE 2013. [DOI: 10.5385/nm.2013.20.1.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Ja Kyung Jun
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Cheong Jun Moon
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soon Ju Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Ah Youn
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ju Young Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Seung Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Hyun Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In Kyung Sung
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - So Young Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Stevenson N, O’Toole J, Rankine L, Boylan G, Boashash B. A nonparametric feature for neonatal EEG seizure detection based on a representation of pseudo-periodicity. Med Eng Phys 2012; 34:437-46. [PMID: 21925920 DOI: 10.1016/j.medengphy.2011.08.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Revised: 06/23/2011] [Accepted: 08/09/2011] [Indexed: 11/25/2022]
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van der Heide MJ, Roze E, van der Veere CN, Ter Horst HJ, Brouwer OF, Bos AF. Long-term neurological outcome of term-born children treated with two or more anti-epileptic drugs during the neonatal period. Early Hum Dev 2012; 88:33-8. [PMID: 21835564 DOI: 10.1016/j.earlhumdev.2011.06.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2011] [Revised: 06/23/2011] [Accepted: 06/28/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Neonatal seizures may persist despite treatment with multiple anti-epileptic drugs (AEDs). OBJECTIVE To determine in term-born infants with seizures that required two or more AEDs, whether treatment efficacy and/or the underlying disorder were related to neurological outcome. DESIGN/METHODS We included 82 children (born 1998-2006) treated for neonatal seizures. We recorded mortality, aetiology of seizures, the number of AEDs required, achievement of seizure control, and amplitude-integrated-EEG (aEEG) background patterns. Follow-up consisted of an age-adequate neurological examination. Surviving children were classified as normal, having mild neurological abnormalities, or cerebral palsy (CP). RESULTS Forty-seven infants (57%) had status epilepticus. The number of AEDs was not related to neurological outcome. Treatment with three or four AEDs as opposed to two showed a trend towards an increased risk of a poor outcome, i.e., death or CP, odds ratio (OR) 2.74; 95% confidence interval (CI) 0.98-7.69; P=.055. Failure to achieve seizure control increased the risk of poor outcome, OR 6.77; 95%-CI 1.42-32.82, P=.016. Persistently severely abnormal aEEG background patterns also increased this risk, OR 3.19; 95%-CI 1.90-5.36; P<.001. In a multivariate model including abnormal aEEG background patterns, failure to achieve seizure control nearly reached significance towards an increased risk of poor outcome, OR 5.72, 95%-CI 0.99-32.97, P=.051. We found no association between seizure aetiology and outcome. CONCLUSIONS In term-born infants with seizures that required two or more AEDs outcome was poorer if seizure control failed. The number of AEDs required to reach seizure control and seizure aetiology had limited prognostic value.
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Affiliation(s)
- Mariska J van der Heide
- Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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van den Broek MP, Huitema AD, van Hasselt JG, Groenendaal F, Toet MC, Egberts TC, de Vries LS, Rademaker CM. Lidocaine (Lignocaine) Dosing Regimen Based upon a Population Pharmacokinetic Model for Preterm and Term Neonates with Seizures. Clin Pharmacokinet 2011; 50:461-9. [DOI: 10.2165/11589160-000000000-00000] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Use of intravenous levetiracetam for management of acute seizures in neonates. Pediatr Neurol 2011; 44:265-9. [PMID: 21397167 DOI: 10.1016/j.pediatrneurol.2010.11.005] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 10/11/2010] [Accepted: 11/10/2010] [Indexed: 01/02/2023]
Abstract
Antiepileptic drugs used for the treatment of neonatal seizures have limited efficacy and undesirable side effects, leading to increased off-label use in neonates. Intravenous levetiracetam became available in August 2006 for use in patients above 16 years of age. Insufficient data are available about the efficacy and safety of intravenous levetiracetam in neonates. Data captured from our institution's electronic medical records were retrospectively analyzed for neonates treated with intravenous levetiracetam between January 2007 and December 2009. Data were acquired by reviewing our electronic medical records. Twenty-two patients received a levetiracetam load of 10-50 mg/kg for neonatal seizures. Nineteen of 22 patients (86%) demonstrated immediate seizure cessation at 1 hour. Seven of 22 patients (32%) achieved complete seizure cessation after administration of the loading dose, 14 (64%) achieved seizure cessation by 24 hours, 19 (86%) by 48 hours, and all 22 (100%) by 72 hours. No serious side effects were evident. Nineteen patients (86%) were discharged on oral levetiracetam, and only two patients (9%) were discharged with an additional oral antiepileptic drug. Intravenous levetiracetam can be used as monotherapy and adjunctively in acute seizure management during the neonatal period.
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Cooper R, Hebden JC, O'Reilly H, Mitra S, Michell A, Everdell N, Gibson A, Austin T. Transient haemodynamic events in neurologically compromised infants: A simultaneous EEG and diffuse optical imaging study. Neuroimage 2011; 55:1610-6. [DOI: 10.1016/j.neuroimage.2011.01.022] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 12/20/2010] [Accepted: 01/08/2011] [Indexed: 11/24/2022] Open
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Ramantani G, Ikonomidou C, Walter B, Rating D, Dinger J. Levetiracetam: safety and efficacy in neonatal seizures. Eur J Paediatr Neurol 2011; 15:1-7. [PMID: 21094062 DOI: 10.1016/j.ejpn.2010.10.003] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Revised: 09/10/2010] [Accepted: 10/26/2010] [Indexed: 01/02/2023]
Abstract
PURPOSE Neonatal seizures are common, especially in prematurity. Phenobarbital (PB) currently represents the antiepileptic drug (AED) of choice, despite being related to increased neuronal apoptosis in animal models and cognitive impairment in human subjects. Levetiracetam (LEV) may have a more favorable profile since it does not cause neuronal apoptosis in infant rodents. METHODS In a prospective feasibility study, LEV was applied as first-line treatment in 38 newborns with EEG-confirmed seizures, after ruling out hypoglycemia, hypocalcaemia, hypomagnesaemia and pyridoxin dependency. Initial intravenous doses of 10 mg/kg LEV were gradually increased to 30 mg/kg over 3 days with a further titration to 45-60 mg/kg at the end of the week. Acute intervention with up to 2 intravenous doses of PB 20 mg/kg was tolerated during LEV titration. LEV was switched to oral as soon as the infants' condition allowed. Based on clinical observation, EEG tracings (aEEG/routine EEGs), and lab data, drug safety and anticonvulsant efficacy were assessed over 12 months. RESULTS In 19 newborns a single PB dose of 20 mg/kg was administered, while 3 newborns received 2 PB doses. 30 infants were seizure free under LEV at the end of the first week and 27 remained seizure free at four weeks, while EEGs markedly improved in 24 patients at 4 weeks. In 19 cases, LEV was discontinued after 2-4 weeks, while 7 infants received LEV up to 3 months. No severe adverse effects were observed. CONCLUSIONS These results illustrate the safety of LEV treatment in neonatal seizures, including prematurity and suggest LEV anticonvulsant efficacy. Additional PB treatment admittedly constitutes a methodological shortcoming due to the prolonged anticonvulsive efficacy of PB. Double blind prospective controlled studies and long-term evaluation of cognitive outcome are called for.
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Affiliation(s)
- Georgia Ramantani
- Department of Pediatric Neurology, University Children's Hospital Dresden, Fetscherstrasse 74, 01307 Dresden, Germany.
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Davis AS, Hintz SR, Van Meurs KP, Li L, Das A, Stoll BJ, Walsh MC, Pappas A, Bell EF, Laptook AR, Higgins RD. Seizures in extremely low birth weight infants are associated with adverse outcome. J Pediatr 2010; 157:720-5.e1-2. [PMID: 20542294 PMCID: PMC2939969 DOI: 10.1016/j.jpeds.2010.04.065] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Revised: 03/30/2010] [Accepted: 04/27/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine risk factors for neonatal clinical seizures and to determine the independent association with death or neurodevelopmental impairment (NDI) in extremely low birth weight (ELBW) infants. STUDY DESIGN A total of 6499 ELBW infants (401-1000 g) surviving to 36 weeks postmenstrual age (PMA) were included in this retrospective study. Unadjusted comparisons were performed between infants with (n = 414) and without (n = 6085) clinical seizures during the initial hospitalization. Using multivariate logistic regression modeling, we examined the independent association of seizures with late death (after 36 weeks PMA) or NDI after controlling for multiple demographic, perinatal, and neonatal variables. RESULTS Infants with clinical seizures had a greater proportion of neonatal morbidities associated with poor outcome, including severe intraventricular hemorrhage, sepsis, meningitis, and cystic periventricular leukomalacia (all P < .01). Survivors were more likely to have NDI or moderate-severe cerebral palsy at 18 to 22 months corrected age (both P < .01). After adjusting for multiple confounders, clinical seizures remained significantly associated with late death or NDI (odds ratio, 3.15; 95% CI, 2.37-4.19). CONCLUSION ELBW infants with clinical seizures are at increased risk for adverse neurodevelopmental outcome, independent of multiple confounding factors.
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Affiliation(s)
- Alexis S. Davis
- Division of Neonatal-Developmental Medicine, Stanford University, Stanford, CA
| | - Susan R. Hintz
- Division of Neonatal-Developmental Medicine, Stanford University, Stanford, CA
| | - Krisa P. Van Meurs
- Division of Neonatal-Developmental Medicine, Stanford University, Stanford, CA
| | - Lei Li
- Statistics and Epidemiology Unit, RTI International, Research Triangle Park, NC
| | - Abhik Das
- Statistics and Epidemiology Unit, RTI International, Rockville, MD
| | - Barbara J. Stoll
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Michele C. Walsh
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH
| | - Athina Pappas
- Department of Pediatrics, Wayne State University, Detroit, MI
| | - Edward F. Bell
- Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA
| | | | - Rosemary D. Higgins
- Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
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33
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Doyle O, Temko A, Marnane W, Lightbody G, Boylan G. Heart rate based automatic seizure detection in the newborn. Med Eng Phys 2010; 32:829-39. [DOI: 10.1016/j.medengphy.2010.05.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Revised: 05/19/2010] [Accepted: 05/23/2010] [Indexed: 11/29/2022]
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34
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Affiliation(s)
- Mehran Mosley
- Lucile Packard Children's Hospital Palo Alto, Calif, USA
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35
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Abstract
Positron emission tomography (PET) is a relatively noninvasive imaging test that is able to detect abnormalities in different organs based on derangements in the chemical functions and/or receptor expression at the cellular level. PET imaging of the brain has been shown to be a powerful diagnostic tool for detecting neurochemical abnormalities associated with various neurologic disorders as well as to study normal brain development. Although its use in detecting neurological abnormalities has been well described in adults and pediatrics, its application in the newborn nursery has not been explored adequately. Early detection of brain injury secondary to intrauterine and perinatal insults using PET imaging can provide new insight in prognosis and in instituting early therapy. In this review, the authors describe applications of PET imaging in the newborn nursery specifically related to the detection of metabolic changes seen in hypoxic ischemic encephalopathy, neonatal seizures, and neuroinflammation in the neonatal period.
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Affiliation(s)
- Sujatha Kannan
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan
| | - Harry T. Chugani
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan,Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan,The PET Center Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan
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36
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Millichap JG. Seizure-Induced Brain Damage in the Neonate. Pediatr Neurol Briefs 2009. [DOI: 10.15844/pedneurbriefs-23-3-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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37
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Affiliation(s)
- Jerome Y Yager
- Section of Pediatric Neurosciences, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
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38
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Eun SH, Eun BL. Treatment and prognosis of neonatal seizures. KOREAN JOURNAL OF PEDIATRICS 2009. [DOI: 10.3345/kjp.2009.52.9.971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- So-Hee Eun
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Baik-Lin Eun
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
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39
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Affiliation(s)
- Eun Sook Suh
- Department of Pediatrics, College of Medicine, Soonchunhyang University, Seoul, Korea
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