title: Defining the gap between electrographic seizure burden, clinical expression and staff recognition of neonatal seizures.
abstract: BACKGROUND
  Neonatal seizures are often subclinical, making accurate diagnosis difficult.
  
  
  OBJECTIVE
  To describe the clinical manifestations of electrographic seizures recorded on continuous video-EEG, and to compare this description with the recognition of clinical seizures by experienced neonatal staff.
  
  
  METHODS
  Term infants, at risk of seizures, were monitored by continuous 12-channel video-EEG from <6 hours of birth for up to 72 hours. All clinical seizures were recorded by experienced neonatal staff on individual seizure charts. Video-EEG recordings were subsequently analysed. The number, duration and clinical expression of electrographic seizures were calculated (in seconds), and compared with the seizures clinically suspected by the neonatal staff.
  
  
  RESULTS
  Of 51 infants enrolled, nine had electrographic seizures. A further three had clinically suspected seizures, without associated electrographic abnormality. Of the total 526 electrographic seizures, 179 (34%) had clinical manifestations evident on the simultaneous video recording. The clinical seizure activity corresponded to 18.8% of the total electrographic seizure burden. Overdiagnosis also occurred frequently. Of the 177 clinically suspected seizure episodes documented by staff, 48 (27%) had corresponding electrographic evidence of seizure activity Thus, only 9% (48/526) of electrographic seizures were accompanied by clinical manifestations, which were identified and documented by neonatal staff.
  
  
  CONCLUSIONS
  Only one-third of neonatal EEG seizures displays clinical signs on simultaneous video recordings. Moreover, two-thirds of these clinical manifestations are unrecognised, or misinterpreted by experienced neonatal staff. In the recognition and management of neonatal seizures clinical diagnosis alone is not enough.
authors.affiliation: Unified Maternity and Neonatal Services, Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.
authors.forename: D M
authors.initials: DM
authors.lastname: Murray
authors.forename: G B
authors.initials: GB
authors.lastname: Boylan
authors.forename: I
authors.initials: I
authors.lastname: Ali
authors.forename: C A
authors.initials: CA
authors.lastname: Ryan
authors.forename: B P
authors.initials: BP
authors.lastname: Murphy
authors.forename: S
authors.initials: S
authors.lastname: Connolly
mesh_terms: D002983:Clinical Competence; D004569:Electroencephalography / Q000379:methods; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal; D007494:Ireland; D008297:Male; D008505:Medical Staff, Hospital; D008991:Monitoring, Physiologic / Q000379:methods; D009741:Nursing Staff, Hospital; D012189:Retrospective Studies; D012640:Seizures / Q000175:diagnosis*; D014741:Video Recording