Melanie A McNally1, Adam L Hartman2. 1. Division of Pediatric Neurology, Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland. 2. Division of Pediatric Neurology, Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland; Division of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland. Electronic address: ahartma2@jhmi.edu.
Abstract
BACKGROUND: Seizures may cause added harm in neonates with hypoxic-ischemic encephalopathy (HIE). Specific recommendations about seizure treatment in this context are lacking. We sought to determine the scope of practice regarding management of non-status epilepticus electrographic-only seizures in this setting. METHODS: A case-based survey was distributed to members of the Child Neurology Society. Providers were asked about their preferred management strategy for sequential clinical scenarios. RESULTS: A total of 177 child neurologists responded to the survey. Seventy-seven percent of providers would treat 20 seconds or less of electrographic seizure activity. In a neonate with mild HIE and an electrographic-only seizure, there was no agreement among providers regarding whether to start maintenance therapy in addition to a one-time anti-seizure drug load. In a neonate with moderate HIE on phenobarbital for early electro-clinical seizures, most providers would escalate treatment for ongoing electrographic-only seizures by increasing phenobarbital dosing. In a neonate with severe HIE complicated by status epilepticus on phenobarbital who subsequently develops recurrent electrographic-only seizures, providers varied substantially in their management preferences. For all three cases, 75% to 85% of providers would not change their management preferences based on the absence of a clinical correlate with the electrographic seizure. CONCLUSIONS: We found marked variability among providers regarding preferred management of non-status epilepticus electrographic-only seizures after HIE. Our results identified specific aspects of electrographic-only seizure management in neonatal HIE where there is limited consensus. These discrepancies may serve as opportunities for future investigation.
BACKGROUND:Seizures may cause added harm in neonates with hypoxic-ischemicencephalopathy (HIE). Specific recommendations about seizure treatment in this context are lacking. We sought to determine the scope of practice regarding management of non-status epilepticus electrographic-only seizures in this setting. METHODS: A case-based survey was distributed to members of the Child Neurology Society. Providers were asked about their preferred management strategy for sequential clinical scenarios. RESULTS: A total of 177 child neurologists responded to the survey. Seventy-seven percent of providers would treat 20 seconds or less of electrographic seizure activity. In a neonate with mild HIE and an electrographic-only seizure, there was no agreement among providers regarding whether to start maintenance therapy in addition to a one-time anti-seizure drug load. In a neonate with moderate HIE on phenobarbital for early electro-clinical seizures, most providers would escalate treatment for ongoing electrographic-only seizures by increasing phenobarbital dosing. In a neonate with severe HIE complicated by status epilepticus on phenobarbital who subsequently develops recurrent electrographic-only seizures, providers varied substantially in their management preferences. For all three cases, 75% to 85% of providers would not change their management preferences based on the absence of a clinical correlate with the electrographic seizure. CONCLUSIONS: We found marked variability among providers regarding preferred management of non-status epilepticus electrographic-only seizures after HIE. Our results identified specific aspects of electrographic-only seizure management in neonatal HIE where there is limited consensus. These discrepancies may serve as opportunities for future investigation.
Authors: Charles R Lechner; Melanie A McNally; Mark St Pierre; Ryan J Felling; Frances J Northington; Carl E Stafstrom; Raul Chavez-Valdez Journal: Neurobiol Dis Date: 2020-12-09 Impact factor: 5.996
Authors: Andreea M Pavel; Janet M Rennie; Linda S de Vries; Mats Blennow; Adrienne Foran; Divyen K Shah; Ronit M Pressler; Olga Kapellou; Eugene M Dempsey; Sean R Mathieson; Elena Pavlidis; Lauren C Weeke; Vicki Livingstone; Deirdre M Murray; William P Marnane; Geraldine B Boylan Journal: J Pediatr Date: 2021-10-07 Impact factor: 6.314