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Cerebral oxygenation during subclinical seizures in neonatal hypoxic-ischaemic encephalopathy
Reshma Silas1, Arvind Sehgal, Adrian M Walker
1The Ritchie Centre, Monash University, Level 5, Monash Medical Centre, 246 Clayton Road, Clayton, Melbourne, VIC 3168, Australia.
Insights
Subclinical seizures in newborns with hypoxic-ischemic encephalopathy (HIE) can cause dangerous fluctuations in brain oxygen levels. Monitoring cerebral oxygenation may help guide anticonvulsant treatment for these seizures.
Area of Science:
- Neonatal neurology
- Neurocritical care
- Pediatric epilepsy
Background:
- Subclinical seizures in hypoxic-ischemic encephalopathy (HIE) pose treatment challenges due to potential anticonvulsant toxicity.
- The relationship between subclinical seizures and cerebral oxygenation in HIE is not well understood.
Observation:
- This study observed an infant with HIE experiencing subclinical seizures.
- Cerebral oxygenation levels were monitored during these seizure events.
Findings:
- Longer subclinical seizures associated with autonomic disturbances (e.g., hypertension) correlated with significant fluctuations in cerebral oxygenation.
- Some seizure events led to cerebral hypoxia, indicating a critical impact on brain oxygen supply.
Implications:
- Cerebral oxygenation monitoring may inform treatment decisions for subclinical seizures in HIE.
- Understanding the impact of seizures and anticonvulsants on brain oxygenation is crucial for improving neurodevelopmental outcomes.
Abstract:
Treatment of subclinical seizures in newborn HIE remains a contentious issue, especially in light of potential adverse effects of aggressive use of anticonvulsants. We report on the association of subclinical seizures with changes in cerebral oxygenation in an infant with HIE. Our results show that subclinical seizures of longer durations and with associated autonomic disturbance (increased blood pressure) are more likely to be associated with fluctuation in cerebral oxygenation, with some seizures resulting in cerebral hypoxia. Future studies should aim to delineate the effects of subclinical seizure and anticonvulsant treatment on cerebral oxygenation, and their relationships to developmental outcome. Level of cerebral oxygenation may play a role in refining anti-convulsant treatment and management of subclinical seizures in newborns.
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01:13Seizures: Classification
Seizures are typically classified into two main categories: focal and generalized seizures.
Focal Seizures
Focal seizures originate from specific regions of the brain. These seizures are further sub-classified into two types: