Electroencephalograms, clinical observations and the monitoring of neonatal seizures.
OBJECTIVE
To identify neonatal seizures and evaluate the efficiency of clinical observations and short duration electroencephalograms (EEG).


METHODS
Sixty-three neonates were investigated using prolonged video/EEG monitoring. Patients with confirmed seizures were treated with sequential doses of phenobarbitone and, if seizures persisted, phenytoin. The likelihood of correct management if short duration EEG and clinical observations had been employed was determined.


RESULTS
Thirty-two patients had confirmed seizures. After administration of anticonvulsants, clinical observations identified seizures in a mean of 66% (s.d. 7.3%) of the cohort. A 60 min EEG after each stage of phenobarbitone therapy would guarantee electrographic seizure capture in a mean of 76% (s.d. 10%) of the cohort. A 60 min EEG after addition of phenytoin would guarantee capture in 50%.


CONCLUSIONS
An EEG would avoid misdiagnoses in most patients with ambiguous clinical signs. After anticonvulsant infusions, EEG add substantial information to that gained by clinical observations.
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Department of Paediatric Neurology, Prince of Wales Children's Hospital, Sydney, New South Wales, Australia.
Flanagan
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D000927:Anticonvulsants / Q000627:therapeutic use; D015331:Cohort Studies; D016903:Drug Monitoring; D004569:Electroencephalography; D006801:Humans; D007231:Infant, Newborn; D008991:Monitoring, Physiologic / Q000379:methods; D015203:Reproducibility of Results; D012640:Seizures / Q000175:diagnosis* / Q000188:drug therapy; D014743:Videotape Recording
D000927:Anticonvulsants