title: Effect of treatment of subclinical neonatal seizures detected with aEEG: randomized, controlled trial.
abstract: The goals were to investigate how many subclinical seizures in full-term neonates with hypoxic-ischemic encephalopathy (HIE) would be missed without continuous amplitude-integrated electroencephalography (aEEG) and whether immediate treatment of both clinical and subclinical seizures would result in a reduction in the total duration of seizures and a decrease in brain injury, as seen on MRI scans.
  
  
  
  In this multicenter, randomized, controlled trial, term infants with moderate to severe HIE and subclinical seizures were assigned randomly to either treatment of both clinical seizures and subclinical seizure patterns (group A) or blinding of the aEEG registration and treatment of clinical seizures only (group B). All recordings were reviewed with respect to the duration of seizure patterns and the use of antiepileptic drugs (AEDs). MRI scans were scored for the severity of brain injury.
  
  
  
  Nineteen infants in group A and 14 infants in group B were available for comparison. The median duration of seizure patterns in group A was 196 minutes, compared with 503 minutes in group B (not statistically significant). No significant differences in the number of AEDs were seen. Five infants in group B received AEDs when no seizure discharges were seen on aEEG traces. Six of 19 infants in group A and 7 of 14 infants in group B died during the neonatal period. A significant correlation between the duration of seizure patterns and the severity of brain injury in the blinded group, as well as in the whole group, was found.
  
  
  
  In this small group of infants with neonatal HIE and seizures, there was a trend for a reduction in seizure duration when clinical and subclinical seizures were treated. The severity of brain injury seen on MRI scans was associated with a longer duration of seizure patterns.
authors.affiliation: Wilhelmina Children's Hospital, Department of Neonatology, KE 04.123.1, PO Box 85090, 3508 AB Utrecht, Netherlands.
authors.forename: Linda G M
authors.initials: LG
authors.lastname: van Rooij
authors.forename: Mona C
authors.initials: MC
authors.lastname: Toet
authors.forename: Alexander C
authors.initials: AC
authors.lastname: van Huffelen
authors.forename: Floris
authors.initials: F
authors.lastname: Groenendaal
authors.forename: Wijnand
authors.initials: W
authors.lastname: Laan
authors.forename: Alexandra
authors.initials: A
authors.lastname: Zecic
authors.forename: Timo R
authors.initials: TR
authors.lastname: de Haan
authors.forename: Irma L M
authors.initials: IL
authors.lastname: van Straaten
authors.forename: Sabine
authors.initials: S
authors.lastname: Vrancken
authors.forename: Gerda
authors.initials: G
authors.lastname: van Wezel
authors.forename: Jaqueline
authors.initials: J
authors.lastname: van der Sluijs
authors.forename: Henk
authors.initials: H
authors.lastname: Ter Horst
authors.forename: Danilo
authors.initials: D
authors.lastname: Gavilanes
authors.forename: Sabrina
authors.initials: S
authors.lastname: Laroche
authors.forename: Gunnar
authors.initials: G
authors.lastname: Naulaers
authors.forename: Linda S
authors.initials: LS
authors.lastname: de Vries
mesh_terms: D004569:Electroencephalography / Q000379:methods*; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000150:complications* / Q000503:physiopathology; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008991:Monitoring, Physiologic; D012640:Seizures / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology