title: Neonatal thalamic hemorrhage is strongly associated with electrical status epilepticus in slow wave sleep.
abstract: OBJECTIVE
  Thalamic hemorrhage has been associated with neonatal cerebral sinovenous thrombosis (CSVT), especially when the straight sinus is involved, and often presents with neonatal seizures. Early thalamic injury has previously been shown to predispose to epilepsy and electrical status epilepticus in slow wave sleep (ESES). The objective of this study was to assess the prevalence of sleep-induced epileptic electroencephalography (EEG) abnormalities and postneonatal epilepsy after neonatal thalamic hemorrhage associated with CSVT, in the absence of more widespread cerebral damage.
  
  
  METHODS
  Between 2003 and 2008 15 neonates were diagnosed with a thalamic hemorrhage due to suspected or proven CSVT. Neurodevelopment and the history of seizures were assessed at follow-up in the outpatient clinic in all 14 survivors (age 2-9 years). Whole-night or sleep-deprived EEG recordings were obtained to assess the prevalence of interictal epileptiform activity (EA) and calculate a sleep-induced spike and wave index (SWI).
  
  
  RESULTS
  Three children were diagnosed with classic ESES (SWI >85%). Two children had ESES spectrum disorder (SWI between 50% and 85%), and in two children significant sleep-induced epileptiform activity (SIEA) was noted (SWI between 25% and 50%). Two other children were diagnosed with focal epilepsy, in the absence of sleep-induced epileptiform EEG abnormalities. Five children (age 2-7 years) had normal EEG recordings at follow-up. Deficits in neurodevelopment were seen significantly more often in children with ESES, ESES spectrum, or SIEA.
  
  
  CONCLUSIONS
  Neonates with thalamic hemorrhage associated with straight sinus thrombosis, without evidence of more widespread cerebral damage, are at high risk of developing ESES (spectrum) disorder (35%), SIEA (14%), or focal epilepsy (14%). Electrographic abnormalities may already be present prior to recognition of cognitive deficits. Early diagnosis may guide parents and caregivers, and subsequent treatment may improve neurodevelopmental outcome. Routine annual sleep EEG recordings in children with neonatal thalamic injury following CSVT may improve recognition of ESES.
authors.affiliation: Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Karina J
authors.initials: KJ
authors.lastname: Kersbergen
authors.forename: Linda S
authors.initials: LS
authors.lastname: de Vries
authors.forename: Frans S S
authors.initials: FS
authors.lastname: Leijten
authors.forename: Kees P J
authors.initials: KP
authors.lastname: Braun
authors.forename: Rutger A J
authors.initials: RA
authors.lastname: Nievelstein
authors.forename: Floris
authors.initials: F
authors.lastname: Groenendaal
authors.forename: Manon J N L
authors.initials: MJ
authors.lastname: Benders
authors.forename: Floor E
authors.initials: FE
authors.lastname: Jansen
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D002533:Cerebral Angiography; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007361:Intelligence Tests; D020300:Intracranial Hemorrhages / Q000150:complications* / Q000523:psychology; D020767:Intracranial Thrombosis / Q000150:complications; D008279:Magnetic Resonance Imaging; D008297:Male; D009420:Nervous System / Q000254:growth & development; D009483:Neuropsychological Tests; D012890:Sleep / Q000502:physiology*; D012893:Sleep Wake Disorders / Q000150:complications*; D013226:Status Epilepticus / Q000150:complications* / Q000523:psychology; D013786:Thalamic Diseases / Q000150:complications* / Q000523:psychology; D016896:Treatment Outcome; D014888:Wechsler Scales
chemical_list: D000893:Anti-Inflammatory Agents; D000927:Anticonvulsants