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Positive rolandic sharp waves in preterm infants with periventricular leukomalacia: their relation to background
A Okumura1, F Hayakawa, T Kato
1Department of Pediatrics, Nagoya University School of Medicine, Aichi, Japan.
Insights
Positive rolandic sharp waves (PRS) are associated with severe periventricular leukomalacia (PVL) in preterm infants. These EEG abnormalities may serve as an early indicator of significant white matter injury.
Area of Science:
- Neonatal neurology
- Neurophysiology
- Pediatric neurology
Background:
- Periventricular leukomalacia (PVL) is a common form of brain injury in preterm infants.
- Electroencephalography (EEG) is crucial for assessing neurological function in neonates.
- The diagnostic significance of specific EEG patterns in PVL requires further clarification.
Purpose of the Study:
- To investigate the association between positive rolandic sharp waves (PRS) and periventricular leukomalacia (PVL) in preterm infants.
- To determine if PRS can serve as an early marker for PVL severity and background EEG abnormalities.
Main Methods:
- Retrospective analysis of EEG recordings from 93 preterm infants (31 with PVL, 62 controls).
- PVL diagnosis confirmed via ultrasonography.
- EEG evaluation within 3 weeks of birth, defining PRS and disorganized patterns.
Main Results:
- PRS were detected in 45% of PVL infants, always alongside disorganized EEG patterns; neither was found in controls.
- PRS presence correlated with the severity of diplegia, appearing in 90% of severe cases.
- PRS emerged significantly after the initial detection of periventricular echodensity.
Conclusions:
- Positive rolandic sharp waves (PRS) are linked to severe deep white matter injury in PVL.
- PRS may function as an early electrophysiological marker for severe PVL.
- Combined analysis of PRS and background EEG patterns enhances PVL detection sensitivity in the neonatal period.
Abstract:
The aim of this study was to clarify the significance of positive rolandic sharp waves (PRS) in preterm infants with periventricular leukomalacia (PVL) and their relation to background electroencephalographic (EEG) abnormalities. We retrospectively evaluated EEG findings of 93 preterm infants; 31 infants in the PVL group and 62 in the control group. PVL was diagnosed on the basis of ultrasonographic findings. We evaluated the EEG within 3 weeks of life in this study. PRS were defined as sharp transients of positive polarity appearing in the rolandic regions with an amplitude of more than 100 microV, sharply differentiated from the background activities. The number of PRS per minute was calculated over each record. PRS were defined as present when their frequency was beyond 0.1 per minute. PRS were observed in 14 (45%) and disorganized patterns in 27 (87%) of 31 infants in the PVL group, but both were not recognized in any infants in the control group. PRS were always associated with disorganized patterns. In the first EEG, PRS were absent in 8 of 11 infants with more than two recordings, although at least one of acute or chronic stage EEG abnormalities were already present. PRS were observed in 9 of 10 infants with severe diplegia, in 5 of 11 infants with moderate diplegia and none in 10 infants with mild diplegia. The average age of the first appearance of PRS was 7.6 days. The average age of the first appearance of periventricular echodensity and cyst was 4.2 days and 21.1 days, respectively. In conclusion, PRS are related to severe deep white matter injury and could be an early marker of severe PVL. PRS appeared in combination with disorganized patterns and were considered to be incorporated into chronic-stage EEG abnormalities. Detailed evaluation of background EEG activities can be helpful in detecting PVL with a high sensitivity from the early neonatal period.