Assessing the Feasibility of Providing a Real-Time Response to Seizures Detected with Continuous Long-Term Neonatal Electroencephalography Monitoring

Cynthia Sharpe, Suzanne L. Davis, Gail E. Reiner, Lilly I. Lee, Jeff J. Gold, Mark Nespeca, Sonya G. Wang, Priscilla Joe, Rachel Kuperman, Marissa Gardner, Jose Honold, Brian Lane, Ellen Knodel, Deborah Rowe, Malcolm R. Battin, Renee Bridge, Jim Goodmar, Ben Castro, Maynard Rasmussen, Kathy ArnellMary Jane Harbert, Richard Haas

Research output: Contribution to journalArticlepeer-review

21 Scopus citations

Abstract

Purpose: Continuous video electroencephalography (cEEG) monitoring is the recommended gold standard of care for at-risk neonates but is not available in many Neonatal Intensive Care Units (NICUs). To conduct a randomized treatment trial of levetiracetam for the first-line treatment of neonatal seizures (the NEOLEV2 trial), we developed a monitoring infrastructure at five NICUs, implementing recent technological advancements to provide continuous video EEG monitoring and real-time response to seizure detection. Here, we report on the feasibility of providing this level of care. Methods: Twenty-five key informant interviews were conducted with study neurologists, neonatologists, coordinators, and EEG technicians from the commercial EEG monitoring company Corticare. A general inductive approach was used to analyze these qualitative data. Results: A robust infrastructure for continuous video EEG monitoring, remote review, and real-time seizure detection was established at all sites. At the time of this survey, 260 babies had been recruited and monitored for 2 to 6 days. The EEG technician review by the commercial EEG monitoring company was reassuring to families and neonatologists and led to earlier detection of seizures but did not reduce work load for neurologists. Neurologists found the automated neonatal seizure detector algorithm provided by the EEG software company Persyst useful, but the accuracy of the algorithm was not such that it could be used without review by human expert. Placement of EEG electrodes to initiate monitoring, especially after hours, remains problematic. Conclusions: Technological advancements have made it possible to provide at-risk neonates with continuous video EEG monitoring, real-time detection of and response to seizures. However, this standard of care remains unfeasible in usual clinical practice. Chief obstacles remain starting a recording and resourcing the real-time specialist review of suspect seizures.

Original languageEnglish (US)
Pages (from-to)9-13
Number of pages5
JournalJournal of Clinical Neurophysiology
Volume36
Issue number1
DOIs
StatePublished - Jan 1 2019

Bibliographical note

Funding Information:
The authors have no funding or conflicts of interest to disclose. The Persyst EEG software company has worked closely with the authors on the NEOLEV2 study and has provided their software to the researchers free of charge but has had no input into this feasibility study or this manuscript. The Corticare commercial EEG monitoring company has worked closely with the authors on the NEOLEV2 study on a commercial basis. This company has had no input into the writing of this manuscript. This manuscript discusses use of the automated neonatal seizure detection algorithm created by the Persyst EEG software company, which is not yet FDA-approved for commercial use. The NEOLEV2 study was funded by the FDA 1 RO1FD004147-01A1. Presented as an abstract at the Pediatric Academic Society Meeting, San Francisco, May 10, 2017. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.clinicalneurophys.com). Address correspondence and reprint requests to Cynthia Sharpe, MBChB, Paediatric Neurology, Starship Children’s Hospital, Park Road, Private Bag 92-024, Auckland 1142, New Zealand; e-mail: cynthias@adhb.govt.nz. Copyright © 2018 by the American Clinical Neurophysiology Society ISSN: 0736-0258/18/3601-0009 DOI 10.1097/WNP.0000000000000525

Publisher Copyright:
Copyright © 2018 by the American Clinical Neurophysiology Society

Keywords

  • Critical care pathway
  • Intensive care unit EEG monitoring
  • Neonatal electroencephalography
  • Neonatal seizures
  • Seizure detection

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