Neonatal seizures: new horizons

Administrator: Hannah Glass, US

Professor Lakshmi Nagarajan
Perth Children’s Hospital
lakshmi.nagarajan@health.wa.gov.au
Introduction: Neonatal Seizures – New Horizons in Neonatal Seizure Management
Over the past decade, there have been tremendous advances in the detection, diagnosis, treatment, and outcome prediction of seizures in neonates. Modern tools including continuous video-electroencephalogram (cEEG) with bedside amplitude-integrated EEG (aEEG) display, magnetic resonance imaging (MRI), and rapid genetic sequencing allow the bedside clinician to accurately detect and adequately treat seizures, as well as diagnose their cause.
This introductory lecture will highlight recent advances in seizure diagnosis and management, with a focus on distinguishing acute provoked neonatal seizures (e.g., caused by brain injury due to hypoxic-ischemic encephalopathy, ischemic stroke, or intracranial hemorrhage) from early onset epilepsy.

Learning objectives:
- Understand the approach to initial seizure management in neonates
- Distinguish acute provoked neonatal seizures from early onset epilepsy

Professor Geraldine Boylan
University College Cork
g.boylan@ucc.ie
Seizure Identification for the 21st Century
Despite the availability of continuous conventional electroencephalography (cEEG), accurate diagnosis of neonatal seizures is challenging in clinical practice. Algorithms that are designed to identify neonatal EEG seizures and alert the bedside clinician are likely to improve seizure detection and management. The Algorithm for Neonatal Seizure Recognition (ANSeR) is an automated seizure detection platform that was developed to trend seizure probability in real time that has been studied in a randomized clinical trial. This lecture will focus on the expanding role of EEG monitoring and machine learning to identify acute provoked seizures and early onset epilepsy and explore potential future uses of this technology

Learning objectives:
- Understand the challenges associated with automated seizure detection in neonates
- Learn the details of the ANSeR study
- Explore future applications of automated seizure detection

Professor Hannah Glass
University of California, San Francisco
Hannah.Glass@ucsf.edu
Treatment Options for Neonatal Seizures – What’s New?
This lecture will detail new evidence for medical management of acute provoked neonatal seizures and epilepsy. Several large multi-center studies provide new evidence for medical seizure management in neonates, including NEOLEV2 (phenobarbital vs levetiracetam for initial seizure treatment), Neonatal Seizure Registry nine center comparative effectiveness trial to guide duration of antiseizure treatment. There is increasing evidence that early identification of neonatal onset epilepsy and treatment that is tailored to the cause of epilepsy can be beneficial. Seizure treatment algorithms to optimize management will be explored.

Learning objectives:
- Know the evidence for phenobarbital as a first line agent to treat acute provoked neonatal seizures
- Understand the evidence for discontinuing antiseizure medications after resolution of acute provoked seizures and prior to discharge home
- Learn the evidence and options for treating neonatal onset epilepsy

Professor Hasan Tekgul
Ege University Medical Faculty
hasan.tekgul@ege.edu.tr
Outcomes after Neonatal Seizures –Risk Predictors and Scoring Systems
Seizures in neonates are most commonly a sign of underlying brain injury with a high risk for a range of adverse neurodevelopmental outcomes. Neurological morbidities in survivors include epilepsy, cerebral palsy, and intellectual disability and they often occur together in the most severely affected children. Risk factors for adverse outcome include prematurity, low Apgar scores, low pH on the first day of life, abnormal neonatal neurological examination, abnormal neonatal electroencephalographic background, prolonged duration of seizures and status epilepticus, and presence and pattern of brain injury (particularly deep gray or brainstem injury)

This lecture will discuss risk factors for adverse outcome after acute provoked neonatal seizures. Outcome predictors and scoring systems for adverse neurodevelopmental outcomes and drug resistant epilepsy will be presented.

Learning objectives:
- Understand the risk factors for cerebral palsy after acute provoked neonatal seizures
- Know the risk factors and risk prediction models for epilepsy and drug resistant post-neonatal epilepsy