Defining neonatal status epilepticus: A scoping review from the ILAE neonatal task force

Area of Science:

• Neonatal Neurology
• Epileptology
• Clinical Neurophysiology

Background:

• Neonatal seizures, particularly status epilepticus (SE), are a critical neurological emergency.
• Current definitions and assessment of seizure burden in neonates lack standardization.
• Prolonged seizures in adults and older children are linked to adverse outcomes, but this is unclear in neonates.

Purpose of the Study:

• To conduct a scoping review of existing literature on the definitions of neonatal status epilepticus (SE) and/or seizure burden.
• To analyze the methods used for identifying and classifying neonatal seizures.
• To identify variations in definitions and their potential impact on neurological outcomes.

Main Methods:

• A systematic literature review was performed by the International League Against Epilepsy Neonatal Task Force.
• Articles were screened for definitions of neonatal SE and seizure burden.
• Data abstracted included article and cohort characteristics, SE definitions, and methods of seizure identification (EEG, cEEG, aEEG, clinical features).

Main Results:

• 44 articles provided definitions for neonatal SE, primarily in infants with hypoxic-ischemic encephalopathy or at risk for seizures.
• Continuous EEG (cEEG) was the most common method for SE identification.
• Most definitions relied on seizure duration (e.g., ≥50% of an hour, >30 minutes), with 20 studies reporting seizure burden, often as total EEG seizure duration.

Conclusions:

• There is significant heterogeneity in the definitions of neonatal SE across the literature.
• Current definitions, often based on a 30-minute seizure duration, lack sufficient evidence to support their clinical relevance or association with outcomes.
• The Neonatal Task Force aims to develop a standardized framework for defining neonatal SE and assessing seizure burden.