Published online August 1, 2007
PEDIATRICS Vol. 120 No. 2 August 2007, pp. e354-e363 (doi:10.1542/peds.2006-3007)

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ARTICLE

Neurodevelopmental Outcome in Term Infants With Status Epilepticus Detected With Amplitude-Integrated Electroencephalography

Linda G.M. van Rooij, MD^a, Linda S. de Vries, MD, PhD^a, Setyo Handryastuti, MD^a, Dewi Hawani, MD^a, Floris Groenendaal, MD, PhD^a, Alexander C. van Huffelen, MD, PhD^b and Mona C. Toet, MD, PhD^a

^a Departments of Neonatology
^b Clinical Neurophysiology, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, Netherlands

OBJECTIVES. This study evaluated seizure, patient characteristics, and neurodevelopmental outcome of term newborns with amplitude-integrated electroencephalography–detected status epilepticus.

METHODS. Fifty-six term infants with status epilepticus were identified during a 12.5-year period. The time of onset of status epilepticus, background pattern before and after status epilepticus, success of controlling status epilepticus with antiepileptic drugs, and neurodevelopmental outcome were studied.

RESULTS. The incidence of status epilepticus in our population was 18%. Forty-two infants (75%) had a poor outcome and 14 were normal at follow-up. When all infants were studied as a single group, we found that not the duration, but the background pattern was correlated with neurodevelopmental outcome. In 50% of the infants with a poor outcome, the background pattern was abnormal before the status epilepticus and in 71% after the status epilepticus. Among infants with a good outcome, background pattern was normal in 14% before and 7% after the status epilepticus. In a subgroup of 48 infants with hypoxic-ischemic encephalopathy, there was a significant difference in background pattern, as well as in duration of the status epilepticus between infants with a poor outcome, compared with those with a good outcome. In 48% of the infants with a poor outcome, the background pattern was abnormal before, and in 75% after the status epilepticus, compared with 25% and 13%, respectively, for those with a good outcome. In 57% of the infants with a hemorrhage or perinatal arterial stroke, the status epilepticus was not controlled with antiepileptic drugs, compared with 21% in infants with hypoxic-ischemic encephalopathy (not significant).

CONCLUSIONS. The background pattern at the onset of status epilepticus was the main predictor of neurodevelopmental outcome. The duration of the status epilepticus was only of predictive value in the infants with hypoxic-ischemic encephalopathy. No association was found between the ability to control status epilepticus and subsequent neurodevelopmental outcome.

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Key Words: hypoxic-ischemic encephalopathy • term newborn • status epilepticus • aEEG

Abbreviations: aEEG—amplitude-integrated electroencephalogram • HIE—hypoxic-ischemic encephalopathy • PAS—perinatal arterial stroke • BGP—background pattern • PNE—postneonatal epilepsy • SE—status epilepticus • AED—antiepileptic drug • FT—flat tracing • CLV—continuous low voltage • BS—burst suppression • DNV—discontinuous normal voltage • CNV—continuous normal voltage

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Accepted Jan 26, 2007.

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