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Controlled Clinical Trial
. 2016 Oct;127(10):3343-50.
doi: 10.1016/j.clinph.2016.07.007. Epub 2016 Jul 25.

Phenobarbital reduces EEG amplitude and propagation of neonatal seizures but does not alter performance of automated seizure detection

Sean R Mathieson  1 , Vicki Livingstone  2 , Evonne Low  2 , Ronit Pressler  3 , Janet M Rennie  4 , Geraldine B Boylan  2
Affiliations
Controlled Clinical Trial

Phenobarbital reduces EEG amplitude and propagation of neonatal seizures but does not alter performance of automated seizure detection

Sean R Mathieson et al. Clin Neurophysiol. 2016 Oct.

Abstract

Objective: Phenobarbital increases electroclinical uncoupling and our preliminary observations suggest it may also affect electrographic seizure morphology. This may alter the performance of a novel seizure detection algorithm (SDA) developed by our group. The objectives of this study were to compare the morphology of seizures before and after phenobarbital administration in neonates and to determine the effect of any changes on automated seizure detection rates.

Methods: The EEGs of 18 term neonates with seizures both pre- and post-phenobarbital (524 seizures) administration were studied. Ten features of seizures were manually quantified and summary measures for each neonate were statistically compared between pre- and post-phenobarbital seizures. SDA seizure detection rates were also compared.

Results: Post-phenobarbital seizures showed significantly lower amplitude (p<0.001) and involved fewer EEG channels at the peak of seizure (p<0.05). No other features or SDA detection rates showed a statistical difference.

Conclusion: These findings show that phenobarbital reduces both the amplitude and propagation of seizures which may help to explain electroclinical uncoupling of seizures. The seizure detection rate of the algorithm was unaffected by these changes.

Significance: The results suggest that users should not need to adjust the SDA sensitivity threshold after phenobarbital administration.

Keywords: Automated seizure detection; Electroclinical uncoupling; Neonatal seizures.

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Figures

Fig. 1
Fig. 1
(a) Comparison of median peak seizure amplitudes for pre- and post-Pb seizures in all neonates. Black line represents group median. (b) Change in median peak seizure amplitude for each baby after Pb.
Fig. 2
Fig. 2
(a) Comparison of median number of EEG channels involved at peak of seizure pre- and post-Pb for all neonates. Black line represents group median. (b) Change in median number of EEG channels involved in seizure (peak) after Pb for each baby.
Fig. 3
Fig. 3
Examples of pre- and post-Pb seizures for patient 5. (a) Pre-Pb seizure and (b) post-Pb seizure.
Fig. 4
Fig. 4
Distribution of detection rates for all neonates pre- and post-phenobarbital. Black lines indicate median values.
See this image and copyright information in PMC

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