[The role of videoelectroencephalography in diagnostics of seizures in neonates and infants].

OBJECTIVE

The clinical characteristic of attack is frequently difficult to unequivocal establishment by observation. It refers especially to seizures in youngest children, due to complicated attack morphology. VideoEEG as a diagnostic tool makes possible more precise establishment of seizures type and derivation.

OBJECTIVE

The aim of this analysis was to establish an importance of videoEEG for the differentiation of epileptic and non-epileptic attacks in neonates and youngest infants.

METHODS

20 children, 10 girls and 10 boys from the Neurological Division, the Neonatal Intensive Care Unit, the Intensive Care Unit, and the Division of Cardiology, admitted for examination between the 2000 and 2004 years in the Lab of Clinical Electrophysiology of the Department of Pediatric Neurology were included. The age of children, including 7 neonates, was at the moment of examination between 3 and 10 weeks. The first attack occurred between the first day of life and 7th week. In 15/20 of children features of encephalopathy were present.

METHODS

The videoEEG recordings were provided in identical conditions, including place and personnel as well, using apparatus PL. 270 video option MedtronicDantec and camera Samsung with movable focus. The visual analysis was provided by two licensed in electrophysiology physicians and results were averaged.

RESULTS

In 15/20 children clinical attacks were registered, including stereotypical seizures in 7 children and polimorphic seizures in 8 children. The most frequent attacks were apneic (11/ 20) and the registered seizures were generalised tonic (6/20) and focal (5/ 20). In 5 children attacks were not registered during examinations. In 2 children of this group the bioelectrical activity was also unchanged, whereas in 3 children the significant pathology was detected. Among 15 children with registered in videoEEG attacks, in 9 children ictal discharges were recorded, in 2 children burst-suppression discharges and in the remaining 4 children ictal changes of bioelectrical activity were not recorded. Interictal activity similar to ictal was detected in 2 children with burst-suppression discharges only, and in other cases it was differentiated. 2 of 4 children without discharges during attacks had also normal interictal activity, whereas in the remaining 2 children the immature low voltage flat activity was recorded. Among 9 children with ictal discharges, in 5 children interictal discharges were detected as well, whereas in 2 children only low-voltage activity with pathological features of sleep was detected, but in 2 children interictal activity was normal. The results of videoEEG and other tests allowed to recognized nn epileptic attacks in 5 children, probably epileptic in 1, epileptic seizures in 8 and epilepsy with genetic and hypoxic-ischaemic disorders in 6 children.

CONCLUSIONS

The videoEEG allowed to register clinical seizures in the majority of youngest children with paroxysmal events, contributing to the diagnosis of tonic and polimorphic seizures and to the correct classification of apnoea. In 25% of children with and without registered clinical attacks, this examination allowed to diagnose non-epileptic attacks. To establish epilepsy, the ictal changes of bioelectrical activity were important and interictal as well.