[Severe periventricular leukomalacia: characteristic electroencephalographic features]

Area of Science:

• Neonatal Neurology
• Neurophysiology
• Pediatric Neurology

Background:

• Periventricular leukomalacia (PVL) is a severe brain injury in premature neonates.
• Early detection of PVL is critical for management and prognosis.
• Electroencephalogram (EEG) monitoring is essential for high-risk infants.

Purpose of the Study:

• To evaluate the reliability of positive rolandic sharp waves (PRSW) as an early marker of periventricular ischemia in premature neonates.
• To determine the occurrence and characteristics of PRSW in neonates with periventricular leukomalacia.
• To assess the prognostic value of PRSW in this population.

Main Methods:

• Retrospective study of 32 premature neonates with extensive cavitary periventricular leukomalacia.
• Systematic EEG monitoring during the first three weeks of life for infants born before 34 weeks of gestation.
• Analysis of PRSW occurrence, morphology, and frequency, including analysis of electroencephalogram data from Cz, C3, and C4 leads.

Main Results:

• Positive rolandic sharp waves (PRSW) were detected in 84% of premature newborns with periventricular leukomalacia.
• The mean rate of PRSW was 1.54/min, with significant variability.
• Four neonates without PRSW were diagnosed with late periventricular leukomalacia, highlighting the need for extended EEG monitoring in extremely preterm infants (born before 29 weeks).

Conclusions:

• Positive rolandic sharp waves (PRSW) are a reliable early electroencephalogram marker for periventricular ischemia in premature neonates.
• Early EEG monitoring is justified for infants born at less than 34 weeks of amenorrhea.
• Periventricular leukomalacia is associated with a very poor prognosis, including high mortality and significant neurodevelopmental impairments.