title: Early postnatal EEG features of perinatal arterial ischaemic stroke with seizures.
abstract: BACKGROUND
  Stroke is the second most common cause of seizures in term neonates and is associated with abnormal long-term neurodevelopmental outcome in some cases.
  
  
  OBJECTIVE
  To aid diagnosis earlier in the postnatal period, our aim was to describe the characteristic EEG patterns in term neonates with perinatal arterial ischaemic stroke (PAIS) seizures.
  
  
  METHODS
  Retrospective observational study.
  
  
  METHODS
  Neonates >37 weeks born between 2003 and 2011 in two hospitals.
  
  
  METHODS
  Continuous multichannel video-EEG was used to analyze the background patterns and characteristics of seizures. Each EEG was assessed for continuity, symmetry, characteristic features and sleep cycling; morphology of electrographic seizures was also examined. Each seizure was categorized as electrographic-only or electroclinical; the percentage of seizure events for each seizure type was also summarized.
  
  
  RESULTS
  Nine neonates with PAIS seizures and EEG monitoring were identified. While EEG continuity was present in all cases, the background pattern showed suppression over the infarcted side; this was quite marked (>50% amplitude reduction) when the lesion was large. Characteristic unilateral bursts of theta activity with sharp or spike waves intermixed were seen in all cases. Sleep cycling was generally present but was more disturbed over the infarcted side. Seizures demonstrated a characteristic pattern; focal sharp waves/spike-polyspikes were seen at frequency of 1-2 Hz and phase reversal over the central region was common. Electrographic-only seizure events were more frequent compared to electroclinical seizure events (78 vs 22%).
  
  
  CONCLUSIONS
  Focal electrographic and electroclinical seizures with ipsilateral suppression of the background activity and focal sharp waves are strong indicators of PAIS. Approximately 80% of seizure events were the result of clinically unsuspected seizures in neonates with PAIS. Prolonged and continuous multichannel video-EEG monitoring is advocated for adequate seizure surveillance.
authors: Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research, Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.
authors: Evonne
authors: E
authors: Low
authors: Elizabeth Garrett Anderson Institute for Women's Health, University College London Hospital, London, United Kingdom.
authors: Sean R
authors: SR
authors: Mathieson
authors: Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research, Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.
authors: Nathan J
authors: NJ
authors: Stevenson
authors: Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research, Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.
authors: Vicki
authors: V
authors: Livingstone
authors: Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research, Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.
authors: C Anthony
authors: CA
authors: Ryan
authors: Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research, Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.
authors: Conor O
authors: CO
authors: Bogue
authors: Elizabeth Garrett Anderson Institute for Women's Health, University College London Hospital, London, United Kingdom.
authors: Janet M
authors: JM
authors: Rennie
authors: Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research, Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.
authors: Geraldine B
authors: GB
authors: Boylan
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use; D004569:Electroencephalography; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D012640:Seizures / Q000188:drug therapy / Q000503:physiopathology*; D020521:Stroke / Q000188:drug therapy / Q000503:physiopathology*
chemical_list: D000927:Anticonvulsants