Electroencephalography and pediatric epilepsy
Warren T. Blume, MD
Epilepsy Unit, University Hospital, London, Ontario, Canada N6A 5A5
Solomon L. Moshé, MD
Barry R. Tharp, MD
ELECTROENCEPHALOGRAPHY (EEG) is useful in the diagnosis and management of pediatric patients with known or suspected seizure disorders; but just as the EEG of children and adolescents differs in some normal and abnormal phenomena from that of adults, neonatal EEG forms still a third distinct discipline.
EEG IN NEONATES
Seizures are a common diagnostic and therapeutic challenge in the newborn nursery and can appear in infants at any gestational age. Nearly any of the several neurologic disorders afflicting such infants can be associated with seizures.1 Clinical manifestations of neonatal seizures differ in several respects from those of older children. The most common forms are focal or multifocal clonic, tonic, and myoclonic attacks. Often such attacks are fragmentary, minimal, and very subtle. Generalized convulsive seizures, particularly tonic-clonic or grand mal, are rare in the newborn, particularly in the premature newborn.
EEG plays a major role in assessing central nervous system (CNS) function in neonates with seizure disorders and in monitoring the effectiveness of any therapy. It is particularly valuable in situations where the attacks are subtle and easily confused with normal or abnormal nonepileptiform motor behavior. For example, Mizrahi and Kellaway2 demonstrated that many types of abnormal motor behavior, particularly in neurologically abnormal neonates, are not accompanied by ictal EEG patterns.
Infants with abnormal pulmonary function or persistent fetal circulation are now being managed with pharmacologic neuromuscular blockade so that ventilatory support can be more effective. Because many of these infants have suffered hypoxic-ischemic events that may be epileptogenic, status epilepticus. . .