title: Phenobarbital reduces EEG amplitude and propagation of neonatal seizures but does not alter performance of automated seizure detection.
abstract: OBJECTIVE
  Phenobarbital increases electroclinical uncoupling and our preliminary observations suggest it may also affect electrographic seizure morphology. This may alter the performance of a novel seizure detection algorithm (SDA) developed by our group. The objectives of this study were to compare the morphology of seizures before and after phenobarbital administration in neonates and to determine the effect of any changes on automated seizure detection rates.
  
  
  METHODS
  The EEGs of 18 term neonates with seizures both pre- and post-phenobarbital (524 seizures) administration were studied. Ten features of seizures were manually quantified and summary measures for each neonate were statistically compared between pre- and post-phenobarbital seizures. SDA seizure detection rates were also compared.
  
  
  RESULTS
  Post-phenobarbital seizures showed significantly lower amplitude (p<0.001) and involved fewer EEG channels at the peak of seizure (p<0.05). No other features or SDA detection rates showed a statistical difference.
  
  
  CONCLUSIONS
  These findings show that phenobarbital reduces both the amplitude and propagation of seizures which may help to explain electroclinical uncoupling of seizures. The seizure detection rate of the algorithm was unaffected by these changes.
  
  
  CONCLUSIONS
  The results suggest that users should not need to adjust the SDA sensitivity threshold after phenobarbital administration.
authors: Academic Research Department of Neonatology, Institute for Women's Health, University College London, London, United Kingdom; Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research and Department of Paediatrics and Child Health, University College Cork, Ireland. Electronic address: sean.mathieson@uclh.nhs.uk.
authors: Sean R
authors: SR
authors: Mathieson
authors: Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research and Department of Paediatrics and Child Health, University College Cork, Ireland.
authors: Vicki
authors: V
authors: Livingstone
authors: Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research and Department of Paediatrics and Child Health, University College Cork, Ireland.
authors: Evonne
authors: E
authors: Low
authors: Department of Clinical Neurophysiology, Great Ormond Street Hospital, London, United Kingdom.
authors: Ronit
authors: R
authors: Pressler
authors: Academic Research Department of Neonatology, Institute for Women's Health, University College London, London, United Kingdom; Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research and Department of Paediatrics and Child Health, University College Cork, Ireland.
authors: Janet M
authors: JM
authors: Rennie
authors: Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research and Department of Paediatrics and Child Health, University College Cork, Ireland.
authors: Geraldine B
authors: GB
authors: Boylan
mesh_terms: D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004569:Electroencephalography; D020936:Epilepsy, Benign Neonatal / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D007231:Infant, Newborn; D010634:Phenobarbital / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000927:Anticonvulsants; D010634:Phenobarbital
keywords: Automated seizure detection; Electroclinical uncoupling; Neonatal seizures