Why do neonates receive antiseizure medications?

Abstract

Background

Continuous conventional video-electroencephalography (cVEEG), the gold standard, is not routinely available for monitoring neonatal seizures in Australia. Therefore, seizures are monitored with clinical observation and amplitude-integrated electroencephalography (aEEG), which may result in under- or over-treatment with antiseizure medications (ASMs). We aimed to investigate ASM usage and its relation to the “cVEEG-confirmed seizures” (cVEEG seizures) in the at-risk infants admitted to a tertiary referral neonatal intensive care unit (NICU).

Methods

The study was a part of a diagnostic study comparing cVEEG with aEEG for the detection of neonatal seizures. Thirty-six infants ≥35 weeks gestational age and at risk of seizures and admitted to NICU were recruited after informed parental consent. The infants were monitored and treated with ASMs based on clinical observation and aEEG findings. A simultaneous cVEEG, not available for clinical decision making, was recorded for 24-h and interpreted at a later date. Data regarding ASM usage and seizure burden on cVEEG were collected. Spearman’s Rho coefficient was used to assess the correlation between the number of doses of ASMs administered and seizure burden on cVEEG.

Results

cVEEG recordings of 35 infants were available for analysis. The gestational age of the infants ranged from 36 to 42 weeks, and the most common diagnosis was hypoxic-ischemic encephalopathy. Twelve infants received ASMs during the 24-h study period, of which five (42%) did not have cVEEG seizures. Maximum cVEEG seizure burden was 8.3 h, and maximum number of ASMs used was three. The correlation between the number of doses of ASMs administered in an infant and the seizure burden on cVEEG was low (Spearman’s Rho: 0.44; p = .148).

Conclusion

Treatment of neonatal seizures based on clinical observation and aEEG, without cVEEG, results in unnecessary or inadequate exposure to ASMs for many infants.

Keywords:

• Neonatal seizures
• antiepileptic drugs
• anticonvulsants
• electroencephalography

Acknowledgments

The authors acknowledge Ms. Linda Palumbo and other neuroscience technologists for assistance in cVEEG monitoring, the nurses involved in the care of infants for documentation of clinical seizures in the clinical event charts and all the clinicians involved. The authors also acknowledge patients and their families, who made this study possible.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research was supported by a grant from Channel 7 Telethon Trust.