EEG Monitoring of the Epileptic Newborn

Area of Science:

• Neonatal neurology
• Epileptology
• Clinical neurophysiology

Background:

• Distinguishing neonatal-onset epilepsies from acute symptomatic neonatal seizures is critical for appropriate management.
• Current EEG monitoring guidelines primarily address acute symptomatic seizures, particularly those secondary to hypoxic-ischemic encephalopathy.
• A growing number of rare genetic, metabolic, and structural etiologies contribute to neonatal epilepsy, necessitating updated diagnostic and monitoring strategies.

Purpose of the Study:

• To provide a narrative review of current knowledge on neonatal-onset epilepsies of genetic, metabolic, and structural non-acquired origin.
• To emphasize the specific electroencephalogram (EEG) features and monitoring techniques relevant to these conditions.
• To guide the comprehensive assessment of newborns with epilepsy, considering diverse etiologies.

Main Methods:

• Narrative review of existing literature on neonatal-onset epilepsies.
• Focus on non-acquired etiologies including genetic, metabolic, and structural causes.
• Emphasis on electroencephalogram (EEG) characteristics and monitoring protocols.

Main Results:

• A wide spectrum of rare conditions causing neonatal epilepsy is increasingly identified, reducing the proportion of undiagnosed cases.
• While some epilepsies have identifiable distinguishing features, optimal monitoring for less-described etiologies remains a challenge.
• A comprehensive diagnostic approach integrating clinical, laboratory, EEG, and neuroimaging data is essential.

Conclusions:

• Phenotypic variability in neonatal epilepsies complicates precise recommendations for EEG monitoring.
• A consistent methodological approach, building upon existing guidelines, aids in the accurate assessment of affected newborns.
• Improved diagnostic strategies are crucial for delivering better patient care, particularly with the advent of precision therapies.