Epileptic high-frequency oscillations occur in neonates with a high risk for seizures
Nicola Kuhnke1, Courtney J Wusthoff2, Eroshini Swarnalingam3
1Department of Pediatric Neurology and Muscular Disease, University Medical Center, Freiburg, Germany.
Insights
Neonatal brains can generate high-frequency oscillations (HFOs), which may serve as an early seizure biomarker. These epileptic brain activity markers were more frequent in neonates with abnormal EEG background activity.
Area of Science:
- Neuroscience
- Neonatal EEG research
Background:
- Scalp high-frequency oscillations (HFOs) are recognized EEG markers of epileptic brain activity.
- The necessary brain maturity for HFO generation remains unclear.
- HFOs have been detected in children and neonates, with some studies linking their reduction to successful epilepsy treatment.
Purpose of the Study:
- To investigate the capability of neonatal brains to generate HFOs.
- To explore HFOs as a potential biomarker for seizures in high-risk neonates.
Main Methods:
- Continuous EEGs from 38 neonates at risk for seizures were analyzed.
- Visual analysis focused on scalp HFOs during 30 minutes of quiet sleep EEG.
- EEGs from 14 patients were of sufficient quality for HFO analysis.
Main Results:
- The average HFO rate was 0.34 ± 0.46/min.
- Approximately 3.2% of HFOs were associated with epileptic spikes.
- HFOs were significantly more frequent in EEGs with abnormal background activity (p = 0.005).
Conclusions:
- Neonatal brains are capable of generating HFOs.
- HFOs show potential as a biomarker for neonates at risk of seizures.
- Preliminary data suggest HFOs are more common in neonates with altered background activity, warranting further investigation into their link with seizure generation and epilepsy development.
Introduction:
Scalp high-frequency oscillations (HFOs, 80-250 Hz) are increasingly recognized as EEG markers of epileptic brain activity. It is, however, unclear what level of brain maturity is necessary to generate these oscillations. Many studies have reported the occurrence of scalp HFOs in children with a correlation between treatment success of epileptic seizures and the reduction of HFOs. More recent studies describe the reliable detection of HFOs on scalp EEG during the neonatal period.
Methods:
In the present study, continuous EEGs of 38 neonates at risk for seizures were analyzed visually for the scalp HFOs using 30 min of quiet sleep EEG. EEGs of 14 patients were of acceptable quality to analyze HFOs.
Results:
The average rate of HFOs was 0.34 ± 0.46/min. About 3.2% of HFOs occurred associated with epileptic spikes. HFOs were significantly more frequent in EEGs with abnormal vs. normal background activities (p = 0.005).
Discussion:
Neonatal brains are capable of generating HFOs. HFO could be a viable biomarker for neonates at risk of developing seizures. Our preliminary data suggest that HFOs mainly occur in those neonates who have altered background activity. Larger data sets are needed to conclude whether HFO occurrence is linked to seizure generation and whether this might predict the development of epilepsy.
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